By Harry Kazakian
The mounting toll of deaths and severe injuries from vaping are certain to be followed by criminal prosecutions and personal injury lawsuits. Prosecutors and plaintiffs will both be intent on identifying the individuals and entities accountable for this currently puzzling public health scourge.
As of this writing there have been 29 deaths and 1,300 illnesses across the country linked to vaping. It’s a cruel irony that as more people are afflicted, more identifiable patterns are starting to emerge.
First among those is that a majority of injuries are being reported among people who use THC or THC-infused vaping liquids. By some reports, such as this one in the Motley Fool, as many as 77 percent of cases involved people who used a mix of nicotine and THC in their vaping devices within 30 days of the onset of their symptoms.
Even so, scientists and medical professionals are scrambling to discover the cause and save others from severe injuries or death.
The FDA’s proposed regulations on e-cigarettes and vaping fluids are currently entangled in lawsuits and politics. To protect the public, the FDA on Oct. 4 issued a public warning against using any vaping products containing THC and any capsules of any kind obtained off the street. The warning included capsules users themselves might modify with THC or flavored oils.
What we know
This isn’t the first time injuries caused by vaping have made the news. When the devices first gained popularity, I investigated several cases where devices exploded or caught fire, resulting in serious injuries to the users. These accidents continue, including just this past summer to a Utah teen who lost teeth, a portion of his gums, and shattered his jaw.
Determining the cause entailed deconstructing these early devices to see where the ignition happened. The results were revealing: there were two places that were weaknesses in design and especially prone to failures that left people burned and disfigured.
The first place to inspect was the device’s lithium ion battery. Vaping pens did not previously separate the battery from the ignition source. This one was clear: Lithium ion batteries are not intended to get wet or be used in moist environments. The vaping liquid itself was a cause.
Inexpensive replacement batteries, ordered from the web, are prone to leaks and overheating due to unregulated manufacturing practices of Chinese factories, where safety and quality often aren’t part of the equation, especially if items are for export. China floods the market with knockoffs; internet sellers or vape store owners buy these for pennies and make good profit off them.
Adding to this was that vapers, especially young people, are sometimes reluctant to spend the money it takes to replace a vaping device’s filter or coil, which can be pricey, especially if following the manufacturer’s recommendation. Filters run $6 to $10 and need to be replaced after five to eight uses; coils run about $35 and last from one to four weeks, depending on the users habit.
So to get around this add-on expense, users neglect changing the filters as often as they should — producing a build-up of impenetrable gunk, a caramelized blob containing additives placed in the vaping liquid, such as glycerin, Vitamin E, and sweeteners.
And while some turn to YouTube to learn how to make their own filters and coils, or just figure some cotton will do the trick, despite it being highly flammable and not good for filtering out impurities. Others seek out after-market products, most of which come from, and often are no better at doing the job.
This leads us to where, as an investigator and former paramedic, new investigations will likely lead.
What’s in that gunk again?
Let’s reflect for a minute on what pathologists know about warm, moist environments. They’re a breeding ground for bacteria. And what’s a vaping device other than a kind of nebulizer, which doctors use to deliver some medicines with warm, moist air into patients’ lungs.
E-cigarette devices aren’t medical devices. And the walls of an unsterile vaping device is a Garden of Eden for microorganisms. More often than not, they harbor bacteria such as staph and strep; molds and yeasts; and fungal bacteria which causes all types of respiratory problems and death.
A study from the Harvard T.H. Chan School of Public Health released in April found that about 80 percent of e-cigarette devices tested contained bacterial and fungal contamination, “which cause acute and chronic respiratory effects.”
“In addition to inhaling harmful chemicals, e-cig users could also be exposed to biological contaminants like endotoxin and glucan,” said Mi-Sun Lee, research fellow and lead author of the paper. “These new findings should be considered when developing regulatory policies for e-cigarettes.”
Then there’s the vaping liquids themselves. Again, China is a source for capsules and the liquids within them, which may not be pasteurized or otherwise manufactured in sterile conditions. Additives especially in fruit flavored liquids popular with teenagers and young people often include propylene glycol, which not only can injure the lungs if inhaled at high temperature, but can transform into formaldehyde.
THC vape liquids are especially suspect. Often they contain vitamin E acetate, which inhaled can coat the lungs’ lining and kill the cells that allow you to breathe. And a CBS News investigation revealed high levels of pesticides in Chinese THC capsules, noting that among the five pesticides identified, one was myclobutanil – which turns into hydrogen cyanide when heated. Hydrogen cyanide is the systemic chemical asphyxiant employed in Nazi death camps.
And we haven’t even touched on the dangers of nicotine addiction, which have been well known and documented for decades.
The solution lies in quickly developing laws and regulations to protect consumers. Class action lawsuits are already being prepared, and maybe the next step will come from state attorney generals, whose aggressive prosecution of cigarette makers in part opened the door for vaping to be marketed – falsely – as a safer alternative.
If you are an attorney representing a matter involving a severe injury or a wrongful death case arising out of a vaping devise, remember, autopsy reports are public records, I recommend retrieving autopsy reports from all other death cases to compare and see if there are any similarities with your case.
*This article was first published in Forbes magazine and is reprinted here with permission.