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Ongoing FDA investigations and a spate of hospitalizations show that “safer than cigarettes” does not mean safe.

the question of vaping’s relative danger has recently taken on a much more desperate tone. While vaping is still so new that broad, long-term data on inhaling the often mysterious chemicals found in both nicotine and cannabis “vape juice” won’t be available for years, Americans are beginning to see the effects that heavy or extended use of the vaping market’s vast array of products might have.

The early evidence is alarming. A report today from the Centers for Disease Control and Prevention found 450 cases in 33 states of a mysterious “vaping illness” that affects the lungs of otherwise healthy people, most of them under the age of 30. So far, three people have died, and the CDC is investigating a fourth.

Now government agencies such as the FDA and the CDC have to play catch-up. The most immediate concern is the illness that has landed hundreds of people in the hospital this summer. Its laundry list of potential symptoms includes fatigue, nausea, dizziness, and extreme shortness of breath. Vape juice can contain dozens of different chemicals, so reverse-engineering what hundreds of sick people across the country have in common is tricky. Some of the problematic substances might be long gone by now, or they could be part of black-market cannabis products that patients are reticent to turn over to federal authorities.

The FDA has emphasized that it is too early to know for sure what’s causing the worst health problems, but testing so far points to cannabis products as the likeliest source of the most dire symptoms. Most patients have reported using vape products with tetrahydrocannabinol, the psychoactive ingredient in cannabis. No common chemical has been found yet across all the samples the FDA has tested, but public health authorities in New York have suggested vitamin E acetate is a possible culprit. Vitamin E acetate is sometimes found in the oil base for vape juice and can be harmful when inhaled in high concentrations.

In much of the country, cannabis’s cultural acceptance far outpaces its legal availability, which means that its users rely on products with unknown origins and ingredients, manufactured with no regulatory oversight. Marijuana is still illegal at the federal level, so even states that have legalized it are left on their own when regulating its manufacture and sale. One of the deaths has been linked to a cannabis vape purchased from an Oregon dispensary.

Advocates for the nicotine-vaping industry have been quick to point to black-market cannabis products as the real source of health problems, which they claim are being used misleadingly by anti-tobacco advocates to fuel their own crusades. But that argument belies the fundamental lack of information available when evaluating nicotine vaping’s impacts on health and its potential interactions with other drugs. Many of the people who are known to have fallen sick this summer use nicotine vapes in addition to cannabis, and it’s possible that lung irritation caused by frequent use of nicotine e-cigarettes could hasten or worsen the impacts of chemicals found in black-market cannabis products.

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