WHEN TAINTED LETTUCE causes an outbreak of gastrointestinal disease, the federal government does not issue general warnings about the hazards of eating. Nor does it order a recall of all fresh vegetables. Instead it focuses on the specific products consumed by the people who got sick.
After doctors began to report respiratory illnesses among vapers last summer, by contrast, federal agencies urged the public to avoid all vaping products, including legal e-cigarettes that deliver nicotine, even though it was clear early on that the vast majority of cases involved black-market cannabis extracts. That indiscriminate approach undermined public health in two ways.
First, it did not provide specific guidance to cannabis consumers who might have avoided the products implicated in the lung disease outbreak if they had been adequately informed. Second, it scared smokers away from vaping products that offer potentially lifesaving alternatives to conventional cigarettes. The vague warnings also encouraged a series of panicky state bans that threatened to drive vapers toward illegal products that may pose special hazards.
As of November 5, the U.S. Centers for Disease Control and Prevention (CDC) had counted more than 2,000 lung injuries associated with vaping, including 39 deaths. In cases where the information was available, the CDC reported, just 11 percent of patients with respiratory symptoms said they had vaped only nicotine. As the CDC noted, some of those patients may have been reluctant to admit illegal drug use. Furthermore, it's not clear that any of them had used legal nicotine products, as opposed to black-market e-liquids of unknown provenance and composition.
While legal e-cigarettes have been used by millions of Americans for years, the reports of acute, life-threatening respiratory reactions did not emerge until recently. That suggests the problems are caused by relatively new additives or contaminants in black-market THC cartridges, and perhaps also in counterfeit e-cigarette pods or bootleg nicotine e-liquids.
An analysis of lung tissue samples from 17 patients by researchers at the Mayo Clinic, reported in The New England Journal of Medicine, suggested that many of the lung injuries were caused by exposure to toxic chemicals. Another possible culprit is vitamin E acetate, a cutting agent found in illegal THC vapes that is safe to swallow but may be hazardous when inhaled, leading to a rare form of pneumonia caused by fat particles in...