Vaping: FDA to ban sale of flavored cartridge-based products

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https://www.cnet.com/news/a-timeline-of-recent-juul-and-vaping-health-controversies-death-update/

In recent months, more than 2,500 people have ended up in the hospital due to severe lung illnesses and other health problems after vaping -- and at least 64 people have died. It's clear we're just starting to understand the dangers of vaping.

E-cigarettes hit the US market about a decade ago, touted as a safer alternative to traditional tobacco cigarettes. However, they didn't really gain traction until 2015, when Juul Labs (then part of Pax Labs) debuted its discreet USB-size vaporizer and quickly became the industry leader.

The result was a spike in vaping, especially among teens and young adults, a segment of the population that, until then, had been using fewer tobacco products, according to the US Centers for Disease Control and Prevention. In 2016, the Food and Drug Administration finalized a rule extending its authority to regulate all tobacco products, including e-cigarettes, the repercussions of which are still playing out today.

At the same time, marijuana vaping rapidly gained in popularity -- in both legal and illegal forms.

Below, we go through what's happened over the past year as health officials and the vaping industry try to adapt within this quickly changing regulatory landscape.

Feb. 19, 2020 -- Death toll passes 60

The CDC says there have been 64 deaths across 28 states and the District of Columbia as of Feb. 4, and 2,758 total cases of hospitalizations. However, emergency department visits have declined since they peaked in September.

Jan. 24, 2020 -- 10 California school districts sue Juul

The latest unified school districts to sue vaping giant Juul are from all across California, including Los Angeles, Anaheim, San Diego, Glendale, Compton, Davis, Chico, King City, Campbell and Ceres.

"It's inspiring to see school districts across California stand shoulder-to-shoulder to take on Juul, the schoolyard bully that preys on our kids and puts the health and academic success of all students at risk," the school districts' attorneys said in a press release.

Vaping-related deaths are up to 60 as of Jan. 14.

Dec. 31, 2019 -- FDA will reportedly ban flavored products, but only for cartridge-based vapes

The US Food and Drug Administration will ban the sale of flavored cartridge-based vaping products, but not tank vaping systems, according to a Tuesday report by Dow Jones citing unnamed sources. This compromise is to balance the increase in teen vaping with the "impact on small businesses and the possible political fallout for President Trump," the report said. The White House didn't immediately respond to a request for comment.

Dec. 20, 2019 -- CDC "confident" vitamin E acetate linked to lung illness

The CDC said that the number of people visiting emergency rooms for lung injuries is declining, according to a report from the Chicago Tribune. Health officials say they're "confident" that vitamin E acetate in black-market marijuana products is strongly linked to the illnesses.

Dec. 19, 2019 -- Death toll hits 54

The CDC has updated its vaping-related injury and death statistics, announcing that the death toll has climbed to 54 people as of Dec. 17. Deaths have been recorded in the District of Columbia and in 27 states.

There have now been 2,506 cases of hospitalized vaping-related lung damage. The CDC has a map showing where these cases are occurring in the states.

Dec. 18, 2019 -- Facebook, Instagram ban influencers from promoting vaping

Social media sites Instagram and Facebook have restricted influencers from promoting certain branded content. It's a limitation on a practice in which brands in turn promote influencer posts, widening the reach of those posts beyond an influencer's follower list. Restricted brand content now includes vaping, tobacco products and weapons.

Dec. 17, 2019 -- Five San Francisco Bay Area school districts sue Juul

Five Bay Area school districts -- San Francisco Unified School District, San Mateo-Foster City School District, Livermore Valley Joint Unified School District, Jefferson County Public Schools and Cabrillo Unified School District -- all filed complaints against Juul in the District Court, Northern District of California, on Dec. 17.

The San Francisco Unified complaint alleges Juul and its part owner, Marlboro cigarette maker Altria, have joint interests in "creating a new generation of addicts." Juul's sleek design and fruity flavors were meant to appeal to children, it alleges. "The mint-flavored e-cigarette pods are the most popular flavor for high school users," the complaint says. It's filed under the Racketeer Influenced and Corrupt Organizations, or RICO, category.

A Juul spokesperson said in an emailed statement that the company is "focused on resetting the vapor category in the US," adding it has ceased selling its mint-flavored pods. "Our customer base is the world's 1 billion adult smokers, and we do not intend to attract underage users," the spokesperson said. "To the extent these cases allege otherwise, they are without merit."

Another singular person from San Francisco County also filed a lawsuit on the same day, suing for personal injury. "Countless lives have been horribly and irreparably impacted by nicotine use and addiction," that complaint, Lovaasen v Juul Labs, says. "And if you could addict a 14-year-old to smoking, you gained a customer for decades, if they lived that long ... taking a page from big tobacco's playbook, Juul, in concert with its advertising agencies and others, developed a product and marketing strategy that sought to portray its e-cigarette products as trend-setting, stylish and used by the type of people teenagers look up to."

Dec. 12, 2019 -- Illinois AG sues Juul as vaping death toll hits 52

Illinois Attorney General Kwame Raoul announced a lawsuit against Juul Labs on Thursday, alleging the company intentionally marketed its products to minors. The lawsuit also said Juul "misrepresented the potency of nicotine in its products and misrepresented Juul's products as smoking cessation devices."

"This lawsuit is part of a comprehensive approach to addressing a public health epidemic, particularly one impacting young people," Raoul said.

The CDC on Thursday also updated its vaping-related injury and death stats, announcing the death toll has climbed to 52 people as of Dec. 10. Deaths have been recorded across 26 states. There have been 2,409 cases of hospitalized vaping-related lung damage.

Dec. 5, 2019 -- Death toll climbs to 48

After a two-week break for Thanksgiving, the CDC on Thursday announced the vaping-related death toll has reached 48 people as of Dec. 4. Deaths have been recorded across 25 states and in the District of Columbia.

The CDC also reported that there have been 2,291 cases of vaping-related lung damage -- but it noted it has removed non-hospitalized cases from its previous numbers. These EVALI (e-cigarette or vaping product use associated lung injury) cases are now across all 50 states, as well as the District of Columbia and two US territories, Puerto Rico and the US Virgin Islands.

Dec. 4, 2019 -- Minnesota attorney general sues Juul

Minnesota Attorney General Keith Ellison is the latest state AG to announce a lawsuit against Juul Labs, claiming the vaping giant for harming minors. "My job as AG is to protect Minnesotans from fraudulent & deceptive practices and to protect their health," he tweeted on Dec. 4. "I'm announcing today with all these folks that the State is suing Juul for creating a public nuisance, violating consumer-laws, and harming youth with deceptive marketing."

Nov. 22, 2019 -- Trump holds vaping roundtable at the White House as death toll reaches 47

President Donald Trump on Friday hosted a roundtable at the White House on vaping, with the discussion focused on whether menthol should be banned along with other flavors.

It comes as another five deaths were reported in the last week. As of Nov. 20, the CDC says 47 deaths have now been confirmed in 25 states and the District of Columbia. The CDC also reported that there have been 2,290 cases of vaping-related lung damage. These EVALI cases have occurred in every state except Alaska. Cases have also been reported in the District of Columbia and two US territories, Puerto Rico and the US Virgin Islands.

Nov. 19, 2019 -- NY attorney general sues Juul Labs

New York Attorney General Letitia James filed a lawsuit against Juul Labs on Nov. 19, accusing the company of using deceptive marketing practices that targeted minors and misleading consumers about the safety of its products. James said the e-cigarette maker has put countless New Yorkers at risk by glamorizing vaping and that its "aggressive advertising has significantly contributed to the public health crisis."

Juul spokesman Austin Finan said the company hasn't yet reviewed the complaint, but added that Juul remains committed to working with attorneys general, regulators and public health officials to combat underage vaping and convert adult smokers from traditional cigarettes.

"As part of that process, we recently stopped accepting orders for our Mint JUULpods in the US, suspended all broadcast, print, and digital product advertising in the US and are investing in scientific research to ensure the quality of our FDA Premarket Tobacco Product Application and expanding our commitment to develop new technology to reduce youth use," Finan said in an emailed statement. "Our customer base is the world's 1 billion adult smokers and we do not intend to attract underage users."

Nov. 18, 2019 -- Vaping death toll rises to 42; Trump reportedly backs down on flavored vapes ban; White House says it's "an ongoing rulemaking process"

The US Centers for Disease Control and Prevention says 42 deaths have now been confirmed in 24 states and the District of Columbia as of Nov. 13. The CDC also reported that there have been 2,172 cases of vaping-related lung damage, or EVALI.

Trump has reportedly backed down from a ban on flavored vaping products. According to The New York Times, Trump "resisted moving forward" with the ban due to "potential pushback from his supporters."

"President Trump and this administration are committed to responsibly protecting the health of children," Judd Deere, a spokesperson for the White House, told CNET in an emailed statement. "At this time, we are in an ongoing rulemaking process, and I will not speculate on the final outcome."

Nov. 13, 2019 -- Teen with lung injury gets double-lung transplant

A 17-year-old boy received a double-lung transplant last month after damage caused by vaping left his lungs scarred, stiffened and pocked with dead spots, according to a report from The New York Times. Dr. Hassan Nemeh, the lead surgeon on the team at Henry Ford Hospital in Detroit, told the Times that the young man would've faced certain death without the surgery. The Times' report said that the CT scans of the patient's lungs looked like his chest was empty prior to the transplant. Normal lungs appear dark on CT imaging because they're full of air. The scan reportedly didn't pick up an image because there was no air in the lungs.

Nov. 8, 2019 -- CDC says vitamin E acetate could be the cause of lung illnesses; Washington DOH calls on processors to stop adding vitamin E acetate to vaping products

Federal health officials reported that tests conducted on the lung fluid of 29 sick patients revealed the presence of vitamin E acetate. Vitamin E acetate is an additive in some THC-containing products. The announcement doesn't officially rule out that other possible ingredients may be causing the lung injuries, but a report from the Centers for Disease Control and Prevention said no other potential toxins were detected in its tests. The CDC says it continues to recommend that people not use e-cigarettes, or vaping, products that contain THC.

Washington state's Department of Health and its Liquor and Cannabis Board called on all cannabis processing companies to "immediately stop adding vitamin E acetate to vapor products and distributing any vapor products containing vitamin E acetate."

"DOH and LCB are also asking cannabis retailers to immediately stop selling cannabis-containing vapor products known to contain vitamin E acetate," they added. "All products available for retail sale are required to have documentation available that lists ingredients."

Nov. 7, 2019 -- Deaths reach 39; Juul stops selling mint-flavored vapes; biometric lawsuit reportedly leveled at Juul

The CDC says 39 deaths have now been confirmed in 24 states and the District of Columbia as of Nov. 5, and 2,051 cases of EVALI. Three deaths each have occurred in the states of California, Georgia, Illinois, Indiana and Minnesota; two each in Kansas, Massachusetts, Oregon and Tennessee; and one death in Alabama, Connecticut, Delaware, Florida, Michigan, Mississippi, Missouri, Montana, Nebraska, New Jersey, New York, Pennsylvania, Texas, Utah and Virginia, as well as the District of Columbia.

Juul has also halted sales of its mint-flavored vaping products in response to results from the 2019 National Youth Tobacco Survey and Monitoring the Future survey. "These results are unacceptable and that is why we must reset the vapor category in the US and ... combat underage use," Juul Labs CEO K.C. Crosthwaite said Thursday. "We will support the upcoming FDA flavor policy and will follow the PMTA process."

The mint products had accounted for around 70% of all sales, according to a report by CNBC. In the US, the flavors Juul now sells are Virginia Tobacco, Classic Tobacco and Menthol.

Juul is also reportedly facing a Biometric Information Privacy Act lawsuit alleging it used face-matching technology without consent by comparing real-time photos of its users to government IDs before allowing them to purchase products online.

"When a customer uploads a photograph and ID, he or she is enrolled in Juul's facial recognition database(s) using the provided photo, from which Juul uses third-party facial recognition software to create a scan of his or her facial geometry to match the provided ID," the reported complaint alleges.

The lawsuit alleges Juul does not properly inform customers of the collection, storage and use of their facial data; has not publicly published its guidelines for permanently destroying the data; doesn't have consent from users to disclose their facial geometry to third parties; and does not have a written release from customers.

Nov. 1, 2019 -- China bans the online sale of e-cigarettes; Trump administration reportedly considers ban on flavored vapes

China has reportedly banned the online sale of e-cigarettes amid the growing number of deaths attributed to a mysterious lung disease linked to vaping. A statement by China's State Tobacco Monopoly Administration and State Administration for Market Regulation, spotted by Bloomberg, said all websites and apps selling e-cigarettes should be shut down. In addition, all online marketing campaigns must halt.

Trump's administration is also reportedly considering a ban of flavored vaping products. Only tobacco and menthol flavors would be spared because they are less appealing to minors, according to an Axios report Friday, which said Trump was briefed Thursday by senior health officials.

Trump could make an announcement next week, Axios said, citing unnamed sources. It added that the FDA is also expected to issue guidance next week. The White House didn't immediately respond to a request for comment, while the FDA said it had nothing more to add.

Oct. 31, 2019 -- Death toll rises to 37; the youngest deceased patient was 17, CDC says

In the span of a week, another three people have died of vaping-related illnesses, the CDC has said. As of Oct. 29, the deaths are across 24 states. The median age of deceased patients is 53, but the youngest was 17 years old, the CDC said. More deaths are also under investigation.

There have been 1,888 cases of EVALI, the CDC said. The median age of patients is 24, but the youngest is just 13, and 70% of patients are male.

Ulf Wittrock/Getty Images
Oct. 29, 2019 -- Lawsuit alleges Juul shipped at least a million contaminated e-cigarette pods

Juul is reportedly facing a lawsuit from a former employee who alleges the company shipped at least 1 million contaminated e-cigarette pods earlier this year, but declined to tell customers or issue a recall.

Juul denies the allegations. In an emailed statement on Oct. 30, a Juul Labs spokesperson said that the safety issues raised in the lawsuit are "meritless" and that the company has "already investigated the underlying manufacturing issue and determined the product met all applicable specifications."

Oct. 28, 2019 -- Juul reportedly laying off 500 as vaping deaths rise to 34

Juul will be cutting 500 jobs by the end of the year, according to a report from The Wall Street Journal, citing sources. The news comes as the CDC says there have been 34 deaths and 1,604 lung injury cases as of Oct. 22.

Oct. 17, 2019 -- Deaths reach 33, THC blamed for majority of cases

The CDC announced on Oct. 17 that as of Oct. 15, there have been 33 deaths across 24 states in the US. There have been 1,479 lung injury cases, involving every state except Alaska, as well as in the District of Columbia and one US territory.

The majority of the illnesses have been linked to vaping products containing THC, especially those bought off the street or from illicit dealers.

Speaking to a House Appropriations subcommittee on Oct. 16, a CDC official said the illness is "fatal or potentially fatal, with half the cases requiring intensive care," CNBC reported. EVALI is also getting worse as flu season hits, the report quoted CDC Principal Deputy Director Anne Schuchat as saying.

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Oct. 9, 2019 -- Washington state reportedly bans sale of flavored vapes

The Washington state Board of Health has reportedly voted to temporarily ban the sale of nicotine- and THC-flavored vaping products two weeks after Gov. Jay Inslee asked for the emergency rule in an executive order. The board voted unanimously, Q13Fox reported, and the ban will go into effect this week and last four months.

The Washington Department of Health didn't immediately respond to a request for comment.

Oct. 7, 2019 -- Massachusetts reports its first vaping related death; nationwide deaths reach 18

Massachusetts health officials reported that a 60-year-old woman who vaped nicotine has died. This is the first vaping related death in the state, according to The Boston Globe. The Department of Public Health is still investigating what products she used and where they came from. The woman's identity wasn't disclosed to the public.

As of Oct. 1, the CDC is reporting 18 deaths across 15 states.

Sept. 27, 2019 -- San Joaquin County DA launches investigation into Juul; FDA commissioner tweets about vaping investigation

Tori Verber Salazar, district attorney of San Joaquin County near the San Francisco Bay Area, told CNET her office has launched an investigation into vaping giant Juul because "too many minors are using" the company's products. One in four high school students are now vaping, she said, mentioning one minor who's in a coma with "the lungs of a 70-year-old man."

Juul marketed to youths through its colorful ads and fun flavors like bubble gum, Verber Salazar said. The company was "built on the heart and lungs and brain and damage" it's caused to the youth population with its highly addictive narcotic products, she added. Calling Juul's actions "organized criminal behavior," she said the DA's office is going to look into both civil and criminal actions against the company, including a potential class action lawsuit.

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Juul shares Verber Salazar's "concerns about youth vaping," a company spokesperson said in an emailed statement Friday afternoon. "We welcome the opportunity to cooperate and share information about our commitment to eliminate combustible cigarettes and our aggressive, industry leading actions to combat youth usage," the spokesperson added, pointing to Juul's shutdown of its social media accounts and cease-sale on flavored pods.

Also speaking Friday, Commissioner Ned Sharpless of the US Food and Drug Administration tweeted that the vaping investigation "is top priority" for the FDA, the Centers for Disease Control and Prevention and state and local health organizations. "We're working to identify what's making people ill & follow the supply chain to the source," Sharpless tweeted. "FDA's prepared to use the full extent of our authorities based on what facts emerge."

According to the CDC's latest update on its investigation into vaping lung injuries, "THC products play a role in the outbreak." The CDC's national report found that of 514 patients surveyed, 77% had used products that contained THC, 36% had used exclusively THC vapes, and 16% had used nicotine-only vapes.

Sept. 26, 2019 -- Vaping lung cases reach 805 with at least 12 known deaths, CDC says

According to the latest information from the US Centers for Disease Control and Prevention, the number of cases of the mysterious lung illness attributed to vaping has soared 52% over the last week, bringing the total number of cases to 805, CNBC reported. To date, 12 people have died and patients have been found in 46 states.

The deaths include two in California, two in Kansas and one each in Georgia, Florida, Illinois, Indiana, Minnesota, Missouri, Mississippi and Oregon. The median age of patients is 23 years old, and two thirds of patients are male.

Sept. 25, 2019 -- Juul CEO steps down as vaping company ceases all US advertising

Kevin Burns, who co-founded Juul, will be replaced by K.C. Crosthwaite, an executive for tobacco company Altria. Juul also said it would suspend all broadcast, print and digital advertising in the US and promised to "refraining from lobbying" the Trump administration on its proposal to ban flavored e-cigarettes.

Sept. 24, 2019 -- California warns of "sudden lung damage"

The California Department of Public Health released a health advisory that warns citizens of the "imminent public health risks posed by vaping any product." It said it's received reports of 90 people in California with a history of vaping being hospitalized "for severe breathing problems and lung damage" since June.

Two people have died in California, the state's public health department said. The advisory added that everyone should stop vaping "no matter the substance or source." If people continue vaping, they should never modify a vaping product, or buy one off the street, it said.

Vaping appears to be causing "sudden lung damage," the health department said. Symptoms that could be linked to vaping include coughing, chest pain, difficulty getting your breath, nausea, vomiting, diarrhea, abdominal pain, fatigue, fever and weight loss.

Teens and young adults make up almost half of those hospitalized with breathing problems from vaping, according to the health department. And 30% of the people hospitalized in California had to be treated with a mechanical ventilator -- in other words, they were put on life support -- in the intensive care unit.

Sept. 20, 2019 -- Walmart discontinues the sale of e-cigarettes

Citing "regulatory complexity" and "uncertainty" around e-cigarettes, Walmart said it'll stop selling the products, according to a new report from CNBC. Earlier this year, the company raised the required age to buy tobacco products to 21 and discontinued the sale of fruit and dessert nicotine flavors.

The University of California, San Francisco, was ahead of the curve. It's been a smoke- and tobacco-free campus since Aug. 1, 2017.

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Sept. 19, 2019 -- Vaping criminal probe announced by FDA as illnesses rise to 530

Health officials from the Centers for Disease Control said that the number of cases of vaping-related lung illnesses has risen to 530 across 38 states. As reported by The Washington Post, the Food and Drug Administration revealed a criminal investigation into the outbreak. Seven people have died from the illness so far. The FDA has collected more than 150 samples from patients across the country and are now analyzing them for the presence of cutting agents and other substances.

Sept. 16, 2019 -- Three confirmed cases of severe lung disease related to vaping in Washington

The Washington State Department of Health confirmed two new cases of severe pulmonary disease related to vaping, bringing the total number of confirmed cases statewide to three. Of the two new cases, one patient is in their teens, and the other is in their 20s. All three confirmed cases reported vaping prior to the onset of their illness, but the department has not yet identified a common product, device or additive among the three, though investigations are ongoing.

"The symptoms of these patients match what the Centers for Disease Control and Prevention have asked all state and local health jurisdictions to be on the lookout for in regards to the nationwide investigation into this matter," Washington State Health Officer Kathy Lofy said in a press release. "This is now a state-wide outbreak."

Sept. 12, 2019 -- Photos emerge revealing severe lung damage, Juul continues ads despite FDA warning

A collection of photos obtained by Business Insider from doctors and researchers illustrate what are believed to be the severe effects of vaping-related lung damage. The images include those of a California teen who underwent surgery to remove a blister that collapsed his lung after he used a cannabis vape he bought at a concert. Other photos illustrate patterns noted by researchers, including inflammation, damage to the alveoli (or the lungs' air sacs), and particles of fat in lung tissues. The surgeons quoted in the article said they couldn't confirm that the injuries and illnesses were definitely caused by vaping.

Despite a warning letter from the US Food and Drug Administration last week, a Juul spokesman told CNBC the company will continue to run its "Make the Switch" ad campaign, which positions vaping as a safer alternative to cigarettes. The company is required to obtain FDA approval before asserting that a product is safer than cigarettes but hasn't submitted an application for such approval, CNBC said.

Sept. 9, 2019 -- FDA calls out Juul for claiming vaping is safer than other tobacco products

The FDA has raised more concerns about Juul over some questionable marketing that suggested that Juul's vaporizer is safer than other tobacco products. What's worse, high school students testified before Congress claiming that a company rep told them that Juul is "totally safe."

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Sept. 6, 2019 -- Two more deaths and CDC warning

Health officials in Minnesota confirmed that a 65-year-old person died in August after a long hospitalization from severe lung injury. The person had a history of underlying lung disease, but the lung injury was associated with vaping illicit THC products. (THC is the component in marijuana that gets people high.) The lung injury progressed to other conditions, ABC 5 reported on Friday. The Minnesota Department of Health told the station that the state has had 17 patients to date who've been classified as confirmed or possible cases. An additional 15 cases are under investigation.

The first death in Los Angeles county related to vaping was also reported the same day by ABC 7. The county has reported 12 cases "of vaping-associated pulmonary injury" to date, according to its Department of Public Health.

The CDC also released a statement about its investigations and said no single product is linked to all cases of lung disease. Many of the patients reported recent use of products containing THC while some reported using products with both THC and nicotine. A smaller group said they used nicotine only.

Illinois Sen. Dick Durbin tweeted a letter to Ned Sharpless, acting commissioner for the US Food and Drug Administration, demanding action. Durbin said the FDA should send letters to all schools in America warning them of health consequences related to vaping. He also called on the agency to ban e-cigarette flavors other than tobacco and ban e-cigarette devices that haven't been approved by the FDA.

"If Dr. Sharpless doesn't take action in the next 10 days, I plan to call for his resignation. Enough is enough," Durbin tweeted.

Sept. 5, 2019 -- Indiana reports vaping-related death

A third life was claimed by severe lung injury related to vaping, The Wall Street Journal confirmed. After news of the individual's death, federal health authorities urged people to stop using e-cigarette products while they investigate about 450 cases of the mysterious illness in 33 states.

Sept. 4, 2019 -- A second vaping-related death

Severe lung disease linked to vaping took another life, according to The New York Times. The unidentified person was hospitalized after vaping THC using a product bought at an Oregon recreational marijuana shop, the Times said. The patient was "otherwise healthy and quickly became very ill," a public health physician and lead investigator in the case told the paper.

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Aug. 30, 2019 -- CDC: Don't buy vaping products off the street, and don't modify them

The Centers for Disease Control and Prevention "took the unusual step" of issuing recommendations regarding vaping and e-cigarette products, The New York Times reported. The CDC's vaping recommendations cover the general public, clinicians and public health officials. Among the advice for the public: "Anyone who uses e-cigarette products should not buy these products off the street (e.g., e-cigarette products with THC, other cannabinoids) and should not modify e-cigarette products or add any substances to these products that are not intended by the manufacturer." The CDC also said, as it had done previously, that "e-cigarette products should not be used by youth, young adults, pregnant women, as well as adults who do not currently use tobacco products."

Aug. 29, 2019 -- FTC launches an investigation into Juul's marketing practices

The Federal Trade Commission has launched an investigation into whether Juul practiced deceptive marketing, including targeting minors and may seek monetary damages, according to a report from The Wall Street Journal.

Aug. 28, 2019 -- Juul CEO says respiratory illness cases are 'worrisome'

Juul CEO Kevin Burns calls the recent string of lung illnesses potentially linked to vaping "worrisome" and urges nonsmokers to avoid using Juul. "If there was any indication that there was an adverse health condition related to our product, I think we'd take very swift action," Burns said in a CBS This Morning interview.

Aug. 23, 2019 -- Illinois reports a patient dying after vaping

The Illinois Department of Public Health said a person who had "recently vaped and was hospitalized with severe respiratory illness" had died. The death may be the first tied to vaping in the US, according to the Associated Press.

Juul Labs was founded by former smokers with the goal of eliminating cigarettes, according to the company's mission statement.

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Aug. 20, 2019 -- Juul Labs leaves Vapor Technology Association

Six days after the VTA issued a lawsuit against the FDA, Juul Labs announces that it won't renew its membership to the industry group, citing differences on "critical policy issues."

Aug. 19, 2019 -- Health officials report more than 150 people have been hospitalized

State and federal health officials report that 153 people -- many of them young adults -- across 16 states have been treated for respiratory issues that occurred after vaping.

Aug. 19, 2019 -- Juul Labs sued over marketing practices

A 19-year-old Juul user sues the company for targeting minors and using deceptive marketing practices, saying the practices led to his nicotine addiction. The lawsuit also names tobacco giant Philip Morris and its parent company Altria, a Juul investor.

Aug. 17, 2019 -- CDC opens probe into vaping-related lung disease

State and federal health officials team up to explore whether e-cigarettes caused severe pulmonary issues in 153 people (and counting).

The CDC says "e-cigarette products should not be used by youth, young adults, pregnant women, as well as adults who do not currently use tobacco products."

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Aug. 16, 2019 -- Investors still bullish on Juul Labs

Juul Labs raised another $325 million from investors, despite growing health and legal concerns, according to regulatory filings.

Aug. 14, 2019 -- Vaping industry group sues FDA

The Vapor Technology Association, which represents hundreds of vaping companies, files suit against the FDA to delay regulators' review of the e-cigarettes currently on the market.

Aug. 7, 2019 -- FDA says it's received 127 reports of vaping-related seizures

FDA releases a statement saying it's now received a total of 127 reports of seizure or other neurological symptoms, such as fainting or tremors, that occurred after vaping between 2010 and 2019.

July 26, 2019 -- WHO issues global tobacco epidemic report

In a report, the World Health Organization calls for more research and regulation of e-cigarettes and specifically names Juul as one of the new industry players that "continue to subvert tobacco control."

In early September, the CDC released a statement about its investigations and said no single product is linked to all cases of lung disease.

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July 24, 2019 -- Facebook, Instagram restrict e-cigarette content

Facebook issues a new policy that will restrict sales of and limit content related to alcohol and tobacco products, including e-cigarettes, across Facebook and Instagram.

July 23, 2019 -- FDA launches anti-vaping ads to combat teen vaping

The FDA launches new anti-vaping commercials as part of The Real Cost, the agency's nearly $60 million smoking prevention campaign. In the TV ads, a street magician uses tricks to educate teens on the risks of using e-cigarettes.

July 12, 2019 -- E-cigarette marketing application submission deadline set

A US District Court judge in Maryland gave e-cigarette companies until May 12, 2020, to submit premarket tobacco applications to the FDA for approval.

June 25, 2019 -- San Francisco bans e-cigarettes

San Francisco, home to Juul's headquarters, becomes the first city in the US to ban the sale of e-cigarettes.

April 3, 2019 -- FDA announces investigation into potential link between seizures and vaping

The FDA notifies the public that it has received reports of people experiencing a seizure following the use of e-cigarettes.

March 27, 2019 -- Health experts sue FDA over delay of e-cigarette review

Seven public health and medical groups and several pediatricians file suit against the FDA for not following proper requirements when the agency gave e-cigarette companies more time to submit their products for review.

March 13, 2019 -- FDA restricts sale of flavored tobacco products

FDA issues new guidelines restricting the sale of most flavored tobacco products, including e-cigarettes, at convenience stores, gas stations and pharmacies. The FDA also asks that all e-cigarette manufacturers submit applications showing their products meet current regulations by Aug. 8, 2021.

Nov. 18, 2018 -- Juul Labs shuts down social media accounts

After the FDA expresses concern that Juul is luring in underage users, the company shuts down Facebook and Instagram accounts, and limits its Twitter presence to "non-promotional communications only."

Sept. 31, 2018 -- FDA inspectors seize documents from Juul Labs HQ

The FDA conducted an unannounced inspection of Juul Labs' San Francisco headquarters, seeking more information about the company's sales and marketing practices. Inspectors collected "over a thousand pages of documents," according to the agency.

Sept. 12, 2018 -- FDA calls teen vaping an "epidemic"

Dr. Scott Gottlieb, the FDA commissioner at the time, issues a statement calling teen vaping an "epidemic" and urges the e-cigarette industry to address the problem or risk having their flavored products pulled from the market.

 

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Journey of a tainted vape cartridge: from China’s labs to your lungs


Jon Doneson started feeling ill on a Friday morning in June, after he arrived home in New York on a red-eye flight from the West Coast. He’d traveled to China, then to California, as part of his job managing the back office of his wife Susan’s apparel company. He hoped to re-acclimate to Eastern time, so rather than resting he went to the gym. But he became ill after his workout, vomiting violently and sweating heavily.

Doneson, 52, wrote it off to fatigue. In subsequent weeks Susan pointed out that he had a strange cough. But to Doneson it wasn’t particularly bothersome.

Susan and Jon Doneson fought Jon’s strange lung illness for weeks. They didn’t suspect a THC vape pen until a pulmonologist noticed that he’d mentioned it on an intake form. (Courtesy of Jon Doneson)

Then, on August 12, he woke up around 5:30 a.m. feeling something different.

“The cough was actually very painful,” he says. He experienced night sweats. He had a fever and pain. His doctor diagnosed bronchitis, but the prescribed meds failed to dent the symptoms. At a follow-up visit, a chest X-ray indicated that Doneson had double pneumonia. This time his doctor prescribed doxycycline for the infection.

About ten days later, though, Doneson felt so awful that he asked his wife to take him to the doctor, who told him to go straight to the emergency room. When doctors at Manhasset’s North Shore University Hospital learned he’d recently visited China, they quarantined him and tested him for various ailments. All came back negative.

Next came a battery of nearly a dozen infectious disease specialists and Centers for Disease Control officials. They clustered around Doneson, who even in his feverish state knew how surreal the scene looked—bed-ridden in a pressurized room with a red quarantine sticker on the door. As he recalls it, “I was totally in disbelief.”

Sickened lungs show up as cloudy on the left x-ray, and clear after treatment of one suspected VAPI patient in Utah. (Courtesy University of Utah)

Doneson, a Queens native who now lives in Roslyn Heights, considers himself a healthy person. He runs and works out, doesn’t smoke, rarely drinks. He never dreamed he’d be the patient in a scene out of a Hollywood contagion movie.

As his situation worsened, doctors asked Susan Doneson to fill out a ‘Do Not Resuscitate’ form. She was emotionally devastated. Jon tried to calm her. “Listen,” he told her, “I had a rock star of 52 years of a life.” But he wanted to stay alive for their 10-year-old son.

He might have died had a pulmonologist not noted a small detail while obtaining his medical history: Doneson said that a few months earlier, he’d started using a THC vape pen.

North America’s illicit THC vape market

Illicit market THC carts containing high levels of vitamin E oil, confiscated in New York. (Courtesy New York State Department of Health)

As the world now knows, a multi-billion dollar marketplace exists for illicit THC vaping devices and cartridges. Millions of street consumers use them, and unlike vape carts purchased in state-licensed medical marijuana dispensaries and cannabis stores, illicit products lack regulation and mandatory testing for potency or purity. Recent reports have estimated that America’s legal, regulated cannabis industry accounts for only 22% of the nation’s $52 billion in cannabis purchases. The other 78% of the THC market remains untested and out of control.

Until this year, the health effects of street-purchased vape cartridges went largely unnoticed. It’s not clear whether that’s because doctors didn’t spot earlier vape-related lung irregularities, or if something dramatically changed in the vaped oil itself in the past few months. What we know is this: Near the end of 2018, a new additive entered the street THC vape cart supply. And hundreds of serious pulmonary injuries, and possibly as many as nine deaths, followed.

Public health officials and labs have discovered the new additive—a form of vitamin E oil used as a cutting agent—tainting a large amount of the devices that sick people reported using. At Leafly, we wanted to know how that additive entered the market, and why.

Our team of reporters and editors investigated the origin of the various components of a street-market THC vape cartridge. Ultimately, we were able to identify a contaminated supply chain that begins in the manufacturing centers of China, runs through the wholesale markets of downtown Los Angeles, disperses to regional pen-filling operations, and finally ends up in the hands of unsuspecting consumers like Jon Doneson.

It’s important to note that this supply chain is not coordinated or controlled by powerful drug cartels. Companies small and large operate independently at every link in the chain.

Along its journey each vape cartridge—also known as a cart—may pick up lead (the toxic heavy metal), pesticides, unsafe additives like vitamin E oil, and the residual solvent butane. Each of these ingredients can cause lung injury. As many as 50 million of these tainted carts may currently be circulating in the United States. Since the federal Centers for Disease Control (CDC) began tracking VAPI (vaping-associated lung injury) in July 2019, the agency has documented 530 confirmed or probable cases of injury. The CDC expects that number to climb.

Most VAPI victims used THC carts purchased in the illicit street market. Many used THC and nicotine carts, and some claim to have used nicotine only. All three products can be manufactured with the same hardware. The same supply chain that produces tainted THC vapes also yields dirty, counterfeit JUUL pods for the nicotine market, and tainted CBD carts for the CBD market.

Peter Hackett is the owner of Air Vapor Systems, a Concord, California-based company that imports vaporizer cartridges. He says it takes less effort to get into the fake JUUL or cheap CBD cart game than it does to get into the tainted THC cart game.

“It’s ten times easier,” he says. “You can buy nicotine on Amazon. Same for CBD. Every constituent up till the THC oil is exactly the same.”

Public health officials have raised the alarm about illicit THC vape cartridges for more than two months now. In early September, Leafly identified the suspected toxic substance—tocopheryl-acetate (vitamin E oil)—and the brand names of the vape cart additives containing it. Although some companies have stopped selling them, tocopheryl-acetate cutting agents remain largely available for purchase and in the illicit THC vape cart market still today.

Step 1: cheap hardware from Chinese factories
Type in “empty” and “cartridge” into the e-commerce site Alibaba, and dozens of Chinese manufacturers pop up, offering to make them to order. The cheapest run about 59 cents per cart, if you order 10,000 or more. For a few pennies extra you can have a customized logo engraved on each tank. The same manufacturer will create packaging, too. Just say the word and send the money.

More than 95% of North America’s illicit vape pen hardware is manufactured in the Bao’An District of Shenzhen, China, says Peter Hackett, the industry expert who regularly does business there.

“If you’re vaping something, it was made in Bao’An in Shenzhen,” he says. “There’s over 1,000 factories and hundreds more [getting in the game] every day.”

Many factories are “little more than a collection of people trying not to starve,” added Hackett. “They’ll make you anything.”

Last year those factories were making fidget spinners. This year they’re turning out empty vape cartridges, fake JUUL pods, and counterfeit packaging.

Workers bundle those cartridges and packages, then shrink-wrap, pallet, and load them onto a cargo container ship. Twenty days later they arrive at the Port of Los Angeles and Long Beach, CA, the busiest container port in the United States. From there, they go either to the direct-mail customer or to brokers in the Toy District in Los Angeles.

Step 2: the Los Angeles wholesale market

Cheap imported vaping hardware can be had at wholesale volumes and prices in downtown Los Angeles. (David Downs/Leafly)

The center of North America’s illicit vape cart industry is a 12-block region near LA’s Skid Row. It’s known as the Toy District, because years ago it served as the center of America’s cheap wholesale toy industry. Today it remains the place to buy low-quality imported goods in large lots: toys, restaurant equipment, party supplies, votive candles.

Between East 3rd and Boyd, it’s all vapes, vapes, and more vapes. It only takes a wad of cash and an hour of haggling to buy everything you need to begin harming consumers with an illicit market THC vape cart, a fake JUUL pod, or something advertised as CBD.

Why bother to purchase at a brick-and-mortar store when Alibaba can ship it direct? Because Alibaba requires a credit card and leaves a digital footprint. LA’s wholesale market deals in cash.

“If you sell $300,000 in [illicit vape] carts, you can’t walk into a bank with that. You have no stated business,” Hackett explains. “Third Street is an easy place to go in with dirty cash, and come out with more supplies.”

On Friday, Sept. 13, a Leafly investigative team wandered through this neighborhood spotting empty vape carts and counterfeit empty Juul pods. LA’s Toy District is not a high-rent neighborhood. Just blocks from ritzy new downtown condos, addicts openly inject drugs on the sidewalk. A homeless guy wanders in and out of street traffic without pants or underwear. You breath shallow in the thick car exhaust.

Each storefront is dingy, poorly lit, and stocked with disheveled, half-open cardboard boxes and sales racks. Big metal fans blow the hot air around, while radios buzz loud scratchy music. Every item you’d find in a head shop or vape shop, you’ll find here wholesale—like some loud, chaotic vape bazaar.

Vape hardware: cheap, cheaper, cheapest
Every type of vape cart, for wholesale in downtown LA. (David Downs/Leafly)

Walking in and out of the rows of wholesale vape supply stores, we posed as aspiring vape pen makers, “just doing some pricing for our boss.”

In each store, a salesperson quickly walked up and peppered us with questions. “What you looking for? … What size? … Ceramic? … You need packaging? … Minimum order is 100. … Yeah, prices go down after 1,000 units. What brand you with?”

There is no difference between an empty vape cart destined to hold THC, versus one for nicotine, or CBD. It’s all for sale, from the same people, to anyone with cash.

It’s an open question whether the carts sold here would pass California’s tough adult-use cannabis testing standards. Since testing started on Jan. 1, 2019, labs have quarantined many vapes for too much lead—either because of the lead in the metal itself, or because factories wash the finished product in diesel fuel, which leaches lead into the carts.

Unsafe additive available, too

Honey Cut advertised for sale alongside empty carts in downtown LA. (David Downs/Leafly)

In addition to the low quality hardware, LA’s Toy District vape wholesalers sell the dangerous additives not approved for human inhalation— including dubiously sourced terpene flavorings and hazardous diluent thickeners like vitamin E oil. You can also purchase more traditional diluents like propylene glycol, polyethylene glycol, and vegetable glycerin.

These chemicals also get made in China. Many come in packaging labeled as “FDA-approved” and “generally recognized as safe” (GRAS). But a previous Leafly investigation found that those designations, with regard to vitamin E oil, apply only in cases of oral ingestion (eating) or application to the skin, not for vaporization and inhalation. They comprise a tame part of the global cosmetics and supplements industries. Street markets divert the drums, pails, and gallon jugs of these chemicals into the vape channel.

Among all the additives, there’s one that makes every vendor in the Toy District tense up and start shaking their head: “Honey Cut.”

After asking around, our local guide ‘Marcus’ reported that “you won’t find anyone down here selling it.” He said news reports have frightened it off the shelves. “They’re scared to sell it.”

Honey Cut swept through the Toy District in late 2018. The groundbreaking product, produced by a mysterious company in Los Angeles, offered manufacturers the ability to cut THC oil concentrations by 50% to 70% without consumers noticing—because instead of thinning the viscosity of the vape oil, it actually thickened it. (Consumers use oil thickness as a proxy for purity.) Honey Cut is odorless, tasteless, and didn’t make consumers cough, so they could inhale it deep into their lungs. And it was cheap, too.

Why would manufacturers want to cut THC oil? The same reason they’d cut any street drug: to make more money. Thanks to the math of cutting, a vape cart maker could spend $50 to produce $4,800 in revenue. How? Hackett explains:

Take a liter of bulk THC oil—it’s pricey at $6,000. Now increase its volume by 30% with vitamin E oil (300 ml for $50). As long as no one notices, you now have 1,300 mls of THC oil worth $7,800, having spent just $50.

Furthermore, retail markup magnifies the profits of cutting. Each 1-gram street cart retails for $16. (A licensed, regulated, and tested cannabis oil vape cart in a legal adult-use state like California or Washington typically retails for $40 to $60.) So $16,000 in uncut oil becomes $20,800 in cut oil. You just made almost $5,000 extra dollars by adding $50 worth of invisible poison to the mix.

Honey Cut inspired copycats
Leafly has learned that as many as 40 brands—some legal, some not—quickly copied Honey Cut. They paid lab technicians to specify the chemical formula, and started selling their own versions. Some major, legitimate additive brands followed suit. Some initial sellers misread the research and FDA signal on the safety of vitamin E oil. Others didn’t care and just followed the fad to bank the profits.

Floraplex released Uber Thick— which two lab tests confirmed is vitamin E oil. Mass Terpenes put out Pure Diluent—also vitamin E oil, New York authorities said. And Mr Extractor of Oregon released Clear Cut—same thing. Vitamin E oil use peaked this summer, right as the VAPI poisonings ramped up. Vitamin E oil might be in 60-70% of street carts, insiders say.

We went to the The Terpene Lab at 330 E. 3rd St—the same place where Mr Extractor founder Drew Jones filmed a YouTube video advertising Clear Cut for use in heavy amounts, nationwide. The product name “Clear Cut” still sits on printed menus at the bar. But when we ask the salesperson for thickener, she asks a manager who quickly barks back, “No! We don’t have any! No!”

The makers of Honey Cut called every vendor in the Toy District after Leafly’s Sept. 7 article, which named Honey Cut as a potential cause of the injuries. The company told them to stop selling it: ‘It’s recalled. It’s not safe.’ Honey Cut’s website and ordering page disappeared.

Other manufacturers have since suspended sales of their thickeners. Floraplex and Mr Extractor no longer offer Uber Thick and Clear Cut, respectively.

Still, in the Toy District, one vendor offered to sell us thickener under the table, outside of the store.

At a store called Cali Kulture, we bought some of the last diluent thickener overtly for sale in the Toy District. It’s called Peak Terpenes Thicc Stretch and it’s priced at $90 for 30 milliliters. The label says it’s a secret mix of fruit, nuts, and other plant oils, and there’s a nut allergy warning. It’s clear, innocuous smelling, and viscous like honey.

Leafly had SC Labs, an independent cannabis testing company with laboratories in California and Oregon, analyze the substance. The report found that it’s almost all vitamin E oil. Peak Terpenes has since pulled the product from its online catalog.

“These products are great if you want to make beard oil,” says Arnaud Dumas de Rauly, a vape hardware expert at The Blinc Group. “The vitamin E oil acts as a preservative. It’s good for your skin. It’s not great for your lungs.”

Furthermore, that nut allergy warning won’t get passed down by the person who fills an illicit pen and sells it, De Rauly said. Just imagine what inhaling peanut oil would do to someone with a nut allergy. It could kill them.

Right after we bought Thicc Stretch, Cali Kulture staff got spooked and pulled the last of the red bottles off the shelf.

Fake packaging available, too
To illicit vape cart manufacturers, fake and counterfeit packaging is just as important as cheap hardware and thickeners. Street consumers also shop by brand, so Toy District stores compete to offer the most diverse array of counterfeit or popular street designs around. That includes the popular black market brands Dank Vapes and Chronic Carts, brand names with no actual company behind them. Wholesalers also offer counterfeits of packaging from legal licensed brands like Cookies, STIIZY, and Brass Knuckles.

At one wholesaler, a saleswoman asked a Leafly editor about the Connected Cannabis Co. T-shirt he wore. Connected is a popular state-licensed cultivator and retailer in California.

“Hey, where did you get that shirt? Do you work for them? No? Good, because if you did, I would have to throw you out.”

“Why?” the editor asked.

“We sell [counterfeits of] their bags,” she said, and smiled.

At a store called Cart Cartel, we were told they had sold out of Dank Vapes boxes. Their next shipment was due in the following Tuesday. “Call us first,” a salesman told us. “We always get the packages first around here.”

Counterfeit packaging for sale in downtown Los Angeles. Supreme and Cookies are both popular state-licensed brands, and illicit manufacturers copy their design changes as soon as they’re made. (David Downs/Leafly)

We returned to one of the biggest, most prominent stores—Cali Kulture, at 306 Wall St.—where we haggled and agreed to buy Dank Vapes packaging, a minimum order of 1,000 packages, for $120.

At a smaller shop near Cali Kulture, we bought the exact Chronic Carts Runtz strain packaging found on a VAPI victim in New York. The dealer sold us 20 units for $2. His next-door neighbor took one of our team member’s mobile phone number and now sends regular texts advertising new products.

At the end of the day, here’s what we walked away with: five sample vape carts; 1,000 units of fake-brand packaging with professional-looking designs and names like DANK and Chronic Vape—the same bogus brand packages that public health officials have seized from VAPI patients injured in New York and California; and perhaps most disturbingly, we bought 30 milliliters of chemical cutting agent—known as thickener—weeks after Leafly identified them as a leading suspect in the lung injuries. These cutting agents were never approved for inhalation, and can cause an allergic or toxic lung reaction.

All of this hardware, chemicals, and packaging is technically legal until you put an illegal drug into it. We spent a total of $210. We kept the receipts.

Step 3: regional pen factories
Los Angeles hosts the national hub for illicit cartridge parts and THC oil additives, but the cannabis oil that goes into those carts is manufactured in regional facilities around the country. This is often a house or condominium rented as a residential space, but secretly used as a butane hash oil manufacturing lab.

Contaminants coming from this process include concentrated pesticides like myclobutanil—which turns into toxic hydrogen cyanide when burned—as well as residual solvents like butane, propane, pentane, and hexane. All are known lung irritants.

These THC oil labs then wholesale bulk distillate via online sites, or through their own networks to “pen factories”—places that bring all these inputs together.

Law enforcement officials allege this pen factory in Wisconsin stocked tens of thousands of fake-brand packages for illicit vape cartridges. (Courtesy of Kenosha County Sheriff’s Department)

Each pen factory might employ as many as a dozen workers at $10 to $20 an hour.

The setup at a house allegedly rented by the Huffhines brothers in Bristol, Wisconsin, seems typical. Bristol is a Kenosha County village about 40 miles south of Milwaukee. It’s a short commute east of the town of Paddock Lake, where Tyler Huffhines, age 20, and his older brother Jacob, 23, live with their parents.

Though barely out of his teens, Tyler already had a reputation as something of a business prodigy. The Kenosha News wrote a story about him in 2018 when the Central High School student ran his own online shoe company. The headline was, “Who Wants To Be a Millionaire?”

After graduation, law enforcement officials allege that Tyler pivoted from sneakers to illegal THC vape cartridges. According to the Kenosha County Sheriff’s Office, the Huffhines brothers rented a condominium in Bristol and invested in tens of thousands of empty vape cartridges and product packaging.

Law enforcement officials contend that the Huffhines brothers purchased illicit-market cannabis oil from unlicensed producers in California, then combined it with other ingredients in the Bristol condo. Court documents state that deputies discovered 57 glass Mason jars filled with the oil when they searched the residence.

In locations like the Huffhines brothers’ Wisconsin condo, the cannabis oil can come in a variety of containers. Tocopheryl-acetate (vitamin E oil) is sold in volumes ranging from ounces to full metal drums. Workers cut the THC oil with vitamin E oil or other unsafe thickeners, add in some flavoring also not approved for inhalation, and syringe one milliliter of the mix into each 1-gram vape cartridge.

The filled cartridges get placed into pre-printed packaging material purchased from the Los Angeles wholesale markets. At the Huffhines condo in Wisconsin, thousands of filled vape carts were allegedly sealed into packages with the Dank Vapes and Chronic brands—exactly the kinds of boxes purchased by Leafly in LA’s Toy District. A law enforcement raid earlier this month at a similar illegal vape cart factory in Phoenix also yielded an oversized duffel bag holding hundreds of similar Dank Vapes boxes. Just yesterday, law enforcement officials seized 75,000 illegal vape carts at an alleged pen factory in Anoka County, Minnesota. They, too, were sealed in Dank Vapes packaging.

Chronic Carts, the same fake-brand packaging sold in the Los Angeles wholesale markets, turned up in the Wisconsin pen factory. (Courtesy of Kenosha County Sheriff’s Department)

Fake brands become ‘real’ through repetition
Dank Vapes is not an actual brand or company. It’s a creation of packaging wholesalers. But when illegal vape cart makers in Wisconsin, Arizona, Minnesota, and other regional hubs buy them by the tens of thousands from LA wholesalers, they combine to form a bizarre sort of national brand presence. You might see Dank Vapes THC vape carts for sale in Michigan, Georgia, or Nebraska—but each contains a cart made by an independent street-market manufacturer. Dank Vapes itself does not exist.

The Huffhines brothers’ operation in Briston, Wisconsin, allegedly moved a lot of units. The Kenosha County Sheriff estimates that they filled 5,000 cartridges a day. Investigators found 31,200 filled cartridges ready for shipping, along with 98,000 empty carts.

Carts from their operation may have sent consumers to the hospital. In late July, a man in his mid-20s checked in to Aurora Memorial Hospital in Burlington, Wisconsin—about 17 miles from Bristol. The man reported trouble breathing. Within 24 hours, doctors put him into a medically induced coma.

The man’s brother turned over a suspect vape cart and package to the authorities. It was a Dank Vapes cartridge. That same week, Children’s Hospital in Milwaukee reported treating eight patients with severe lung damage in the previous four weeks. The common thread: vaping street-market THC cartridges.

t took law enforcement officials seven weeks to trace a local supply of Dank Vapes cartridges back to their alleged source: The Huffhines brothers’ condo in Bristol. (Law enforcement officials have not directly linked the alleged Huffhines operation to the hospitalized man’s condition.) The brothers were arrested on Sept. 11 and now face multiple drug charges.

Step 4: local street sellers
Regional pen factories move their product to retailers and consumers in a number of ways. THC pen factories retail directly to locals, or strangers online via social media and the dark web. They also wholesale to broker/distributors who move the vape carts to retail markets.

Illicit THC vape cart retailers operate coast to coast—from the more than 2,800 unlicensed stores in California, to the fleets of drug couriers pedaling the streets of New York City, and plenty of local high school dealers in between.

In New York City, the illicit vape cart market flourishes in part because licensed, legal products from medical dispensaries are limited and extraordinarily expensive. A lab-tested medical marijuana vape cartridge that typically costs $40-$60 in California can run up to $165 in a New York City dispensary. That’s ten times the price of an illicit vape cart.

That price gap has created a thriving illegal industry selling carts through NYC’s clandestine delivery services, at pop-up cannabis markets, and in some corner bodegas.

Oleg MaryAces, director of education and marketing at Lock & Key Remedies, a New York-area CBD product maker, told Leafly that the Northeast saw a flood of cheap cannabis vape pens in early 2019.

“When California implemented its testing law, they had hundreds of thousands of vapes in warehouses that they could no longer sell because of pesticide regulations, he says. “So they dumped them in the Northeast. Prices dropped a lot, and it fueled the market here.”

Since the VAPI outbreak, New York’s illicit cannabis delivery services have used the health scare to assure their customers that their own products are clean. “They’re tested,” one delivery specialist told Leafly. (We agreed to not publish his name, for obvious legal reasons.) “There’s no vitamin E acetate.”

True? False? Nobody knows. His customers would have to take his word for it, as there is no testing documentation nor any regulations requiring same. “Some of my friends would buy oils from delis and stuff,” he added. “They were really cheap. I knew those would be bad quality. Why the **** would you buy weed from your deli dude?”

Step 5: consumption and hospitalization
Once it made its way into New York City’s sprawling illicit vape cart market, a single tainted cartridge—or maybe several—made its way into Jon Doneson’s personal supply.

Doneson, the middle-aged Long Island marketing expert, started experimenting with vaping a few months before his trip to China last summer.

A stranger introduced him to vape pens early in 2019 like many Americans have over the past year—at a party, randomly, when someone pulled one out and offered it to him. As a naturally high-octane guy who had recently plunged headlong into a start-up enterprise with his wife, he liked the idea of having access to something that relaxed him.

A few months later, he found his own supply.

Doneson declines to detail how he came to possess the vape pen and THC cartridge that caused his illness, but it wasn’t through the state’s licensed medical marijuana system. “I’m not going to name places,” he says. “I’m not going to name people, but they’re more available than one might think, okay? You know, it’s easier to get that for a 15-, 16-year-old than a six-pack of beer at the grocery store.”

He says he purchased vaping supplies on multiple occasions and never had any reason to suspect anything amiss about the product. He doesn’t recall the brand he used, but the vape pen that caused his illness came packaged in a “fancy box” that looked legitimate—“like buying a carton of milk… There’s no reason to second-guess or question anything.”

It worked for him. Doneson typically took a pull six or eight times a day. The THC vapor took the edge off in a way that left him fully functional and without the smell of cannabis on his breath. “I liked it,” he says. “It really did do the things they said it’d do.

Until, of course, it almost killed him. Vitamin E oil is thought to block the fluid lining of your lungs, like saran-wrapping them shut. The toxin kicks off an aggressive immune response to clear the contaminant, and if that response fails, runaway inflammation, fluid build-up, and cell damage increases until the lungs fail.

The pulmonologist who correctly diagnosed Doneson treated what the hospital later termed “a devastating lung illness” with a cocktail of antibiotics and steroids.

Doneson says that once he received the correct meds, his improved quickly. Early the next morning, he woke up in a dark room.

“I laid there literally for 10 minutes, trying to figure out, ‘Am I alive, dead? Am I in hell, heaven? Where the hell am I?’ Then I realized, I started laughing, I realized, ‘Wait a minute, not only am I alive, but I think I feel better.’”

The hospital discharged him the following day.

When Doneson’s vape pen cartridge was tested, the results came back positive for formaldehyde, pesticides, vitamin E, and THC.

Nine people have died in this country from vape devices in the past few months. Doneson came “very, very, very close to being number [ten],” he says. North Shore’s Annamaria Iakovou, a pulmonary and critical care physician, notes that over the past three months, her hospital has seen more than a dozen cases involving patients with similar symptoms.

Lessons learned
At a certain point in this story, Leafly’s investigative team came to a dark realization: Now that we have nationwide surveillance and reporting in place, the CDC’s numbers of the sick and dead aren’t going to stop climbing until everyone in the United States who wants a clean THC vape cart can purchase one in a legal, licensed, and regulated store.

Alcohol prohibition’s end solved bathtub gin poisonings. But we’re still a ways away from the end of cannabis prohibition in the US. In a best case scenario, this VAPI outbreak could spur progress, and not retreat, because the facts are clear:

• Legal adult access to tested cannabis in the US is already cleaning up the supply chain. Adult-use states have proven far more immune to this outbreak than prohibition states. Of the 530 confirmed and suspected cases, one is potentially linked to a licensed store, in Oregon, and five in Washington.
• Most state cannabis regulators have recalled problematic products in the past. Over the last 18 months, California has quarantined more than 5,639 licensed cannabis batches for issues including labeling problems (2,379 batches), pesticides (1,585), residual solvents (339), and heavy metals (393). After VAPI news broke, regulators immediately moved to tighten ingredients disclosure requirements in Massachusetts. Oregon regulators told stores to pull suspicious products. Those measures are possible because regulation exists. The street market can’t do that, and won’t.

Meanwhile, the federal era of malignant neglect of the US cannabis supply chain must come to an end.

“Regulation, not prohibition, is the answer here,” University of Denver law professor Sam Kamin wrote in response to the VAPI health crisis. “Black market, unregulated nicotine and cannabis products are the worst threat here.”

Jonathan Caulkins, a drug policy researcher at RAND, added: “If vapes are going to be allowed, then stronger testing, oversight, and regulations are needed, which presumably includes being tougher on violators, either with government action and/or with product liability lawsuits.”

President Obama and President Trump have both allowed states to legalize, one by one. Most 2020 presidential candidates support some form of legalization. Julian Castro recently became the first to directly connect a coherent federal policy to consumer safety. He tweeted on Sept. 11: “We need to legalize cannabis nationwide and properly regulate products in order to keep folks safe.”

For legal, state-licensed companies, the VAPI health crisis has acted as a wakeup call. They must beef up their anti-counterfeiting technology and education programs. They’re distancing themselves from additives and thickeners—which must disappear from all legal products, immediately.

Finally, consumers have begun making healthy choices. Online message board Reddit’s page “fakecartridges” is full of consumers across the nation tossing their tainted carts in the trash.

In the legal markets, vape sales were down 15% in early September off the three-month average. Oregon in particular saw a staggering 65% drop in pen sales.

To Jon Doneson, now recovering at home on Long Island, the lesson of all this is clear: Until the United States begins to regulate the market for these products, avoid using them. He worries that even legitimate dispensaries might sell cartridges cut with toxic substances, either unknowingly or as a way of pumping up profits.

“Get rid of all your THC pens,” he says. “That’s it. You don’t know. It’s Russian roulette. You don’t know if it’s a good one or a bad one. So, why take the risk?”

“I’m sure the Chinese are putting a lot of product into American hands. A lot of bootlegs are coming in from out of the country. Wherever there’s money to be made, people are going to do what they can.”

 

[fallstuff]

Vaping lung issues has been officially associated with Vaping THC liquid fused with vitamin E.

 

[Menthol]

Mint and flavored cigarettes are also dangerous.