The past two years, vaping has become the poster child for chill. But the portable devices are looking a lot less cool these days: Federal health officials announced last week that hundreds of people across the country have been hospitalized this summer with a mysterious and very serious lung infection linked to vaping, and now five people have died.
We don’t know what the illness is exactly—docs say the scans look like a bacterial or viral pneumonia that’s attacked the lungs, but their tests show no infection. But we do know it’s affecting folks (namely teens and young 20-somethings) who’ve used either e-cigarettes or cannabis oil vape pens.
Now, the FDA and New York State Department of Health are pointing to a new culprit within cannabis pens: After testing the cartridges used by people who have vaped THC oil and suffered lung damage, lab results show almost all contain high levels of vitamin E acetate.
“We know Vitamin E is a common allergen. It used to be in most skincare products, but people were getting rashes enough that manufacturers stopped putting it in things,” explains Harvard physician and cannabis medicine specialist Jordan Tisher, M.D. “If you inhale it, you’re getting the equivalent of a rash on your lungs, which could be deadly.”
But the reality is, while this additive certainly isn’t helping anyone’s health, it’s really just one piece of the problem of vaping any liquid, including cannabis oil, he says.
The Real Risks of Cannabis Vape Pens
We know e-cigarettes wreak havoc on your health. But we don’t know much about the safety—or risk—of cannabis oil vape pens, says Kent Hutchison, Ph.D., founder of the Center for Research and Education Addressing Cannabis and Health at the University of Colorado Boulder.
But in all likelihood, outside of nicotine and tobacco, cannabis oil vape pens actually pose much of the same risks as their federally legal counterparts. Propylene glycol and vegetable glycerin—both in the liquid within e-cigarettes and cannabis vape pens—have been linked to chest tightness and wheezing; the flavorings are potentially carcinogenic when heated; and vaping even nicotine-free substances prevents your blood vessels from dilating, which isn’t good for heart health or athletic performance, and raises inflammation levels.
“The real problem with vape pens is you have no control over the temperature,” Tishler says. Part of what makes cigarettes more harmful than e-cigarettes, or joints more harmful than vaping cannabis flower, is that combustion changes the chemical structure of what’s being burned. “Vaporizing may be healthier, but these devices heat to the point of combustion, and that degrades whatever the material is—vegetable oil, cannabis terpenes, basically any added oil—into a carcinogen,” Tishler explains.
Are Legal Devices Safe?
The silver lining most are holding on to as this health epidemic grows is that health officials are mostly pointing to black market vape pens as the real problem—that is, people are getting sick from cannabis oil and vaporization devices that have been purchased outside a dispensary and are therefore made of questionable quality.
But even cartridges from dispensaries aren’t necessarily safe. “Every state has its own rules on what it’ll test for in cannabis products and what’s allowed in the manufacturing process,” Tishler points out.
And that’s the real message of this growing epidemic, says Ryan Vandrey, Ph.D., who studies behavioral pharmacology of cannabis, nicotine, and tobacco at Johns Hopkins University: These are poorly regulated industries. The standards of quality are different from state to state, and we don’t even know if legalized states have the resources available to them (e.g., manpower and money) to establish and follow regulations.
Quick clarification: There are two kinds of cannabis vape pens—one for oil and one for flower. These risks are exclusive to vaping cannabis oil.
But that’s also what vast majority of recreational smokers reach for: “There are so many factors that make these pens attractive,” says Vandrey. “Handheld oil vaporizers are terribly convenient, small, discreet, odorless, deliver multiple doses, and don’t look like a joint. Plus there’s the perception of decreased health risk: The rollout of e-cigarettes framed the devices as a safer approach to smoking, and that gets generalized to all kinds of smoking.”
So What’s There to Do?
The FDA and CDC are warning people to stay away from any kind of oil vaping device, whether it’s an e-cigarette or cannabis pen, at the very least until they can nail down what’s hurting and killing people.
Tishler would argue that everyone stay away from them always. “Oil vape pens are bad devices and I’ve been saying this for years. I recommend all my patients stay away from them,” he says.
The cleanest of all routes is tinctures or edibles, since inhaling anything is going to irritate your lungs somewhat, Hutchinson says. But both take longer to kick in and are harder to control the dose of.
The healthiest method of ingestion for immediate effect: Vape dry cannabis flower. It seems like a close cousin, but it’s actually a completely different beast—and a much healthier one, Tishler says.
For starters, you avoid the issue of questionable additives in oils (though you do want to buy flower that’s been tested for mold and pesticides). But the real key is temperature: “Quality flower vapes come with a heat regulator and as long as you stay under 350°F, you’re actually vaporizing and not hitting combustion, so you’re minimizing the risk of carcinogens,” he explains.