Over the last few weeks, health officials across the U.S. have been reporting cases of respiratory illness.
People have had trouble breathing, chest pain, stomach complaints in a few cases, and many have been hospitalized.
Two deaths have been reported so far.
The CDC suggests that the culprit might be vaping. A Washington Post story published Thursday said state and federal health officials have found that those who’ve fallen ill had used cannabis products containing a chemical derived from vitamin E. Yet a federal official also told the paper that despite finding this “common element,” it’s still too early to conclude it caused the illnesses.
Although no cases of this kind of illness have appeared in Canada so far, Health Canada is warning people who vape to watch out for signs of respiratory problems.
Here’s what we know, and a lot we don’t, about what’s going on.
How many cases are there?
As of Sept. 6, 2019, the CDC reported 215 cases of possible vaping-related illness in 25 states, with additional cases being evaluated.
According to Health Canada, as of Sept. 4, there haven’t been any cases reported in Canada.
Why do health authorities think the illness is related to vaping?
All patients have reported using vaping products, according to the CDC. No patients showed any evidence of infectious diseases making chemical exposure the likely culprit, said a recent CDC update. Unfortunately, there aren’t that many other common elements so far.
Some people were using vaping liquid containing THC or CBD — chemicals found in cannabis. Some weren’t. Patients also responded differently to different tests and treatments, with inconsistent symptoms.
“To date, no single substance or e-cigarette product has been consistently associated with illness,” said a recent CDC update.
Howard Zucker, New York state’s health commissioner, said Thursday that a state lab found high levels of vitamin E acetate in nearly all cannabis-containing samples it analyzed. “As a result, vitamin E acetate is now a key focus of the Department’s investigation of potential causes of vaping-associated pulmonary illnesses,” Dr. Zucker said.
Investigators are looking for more clues or common details between the cases, in the interim the CDC said:
“While this investigation is ongoing, people should consider not using e-cigarette products.”
WATCH: American dies after respiratory illness linked to vaping
“There’s two questions,” said David Hammond, a professor of public health at the University of Waterloo. “Is this a general effect of vaping? Or is this something different?”
Andrew Hyland, chair of the department of health behaviour at Roswell Park Comprehensive Cancer Center in Buffalo, notes that it’s not even certain that vaping is the cause.
“It says that vaping is a common element in many of these, but they’re still not sure,” he said. “My read of the advisories and the data that I’ve seen is that it may be more likely to be related to tainted THC oil that people are vaping.”
Hammond also thinks that these cases might be related more to a bad product than to vaping more generally.
“It’s probably due to a contaminant or a faulty set of devices for the reason that people have been vaping for a decade. We just haven’t seen this sort of case before and it’s a bit odd that it would suddenly appear.”
Canada and the U.K. haven’t seen any cases despite lots of people vaping in those countries, he said, which suggests that it’s a local U.S. issue.
Dr. Andrew Pipe, of the University of Ottawa Heart Institute, told the Global News podcast Wait, There’s More that he expects the number of U.S. cases to rise and that he thinks we will also eventually see cases in Canada.
“There are probably far more cases than have already been reported.”
He thinks we might be seeing these cases now partly because of the recent upsurge in vaping’s popularity.
Does this mean vaping is unsafe?
“There’s a consensus that vaping is less harmful than smoking,” Hammond said.
This isn’t an endorsement though: “It’s not that surprising because there’s no consumer product as bad as smoking.”
Vaping is much less harmful than smoking but still more harmful than just breathing clean air, Hyland said.
WATCH: Growing number of Canadian youth vaping
If you’re not a current smoker, Health Canada recommends staying away from vaping.
“Vaping is not without risk, and the potential long-term effects of vaping remain unknown. Non-smokers, people who are pregnant and young people should not vape,” the department said in a recent statement.
Much of the current research on vaping has been to compare it to smoking, Hammond said, and it compares favourably. But recent research has found that the vapour can contain ultrafine particles, which could cause an inflammatory response that might be a precursor to heart disease, he said.
“The things that people are concerned about are cardiovascular disease, respiratory issues, there’s issues with nicotine dependence and addiction which is an important health outcome in its own right,” he said.
It took decades though for medical evidence of the harmful effects of smoking to pile up, Hyland said. So it’s still very early to know much about the health effects of vaping. “Long term health impacts: we don’t know.”
One key question: whether health effects are linked to the vape itself, or the liquid or other substance that people are vaping.
This remains to be seen, Hammond says. “The idea that this is like a benign or totally safe thing to do is I would say incorrect and simplistic because it is a drug delivery device. It depends on what you’re delivering.”
Pipe thinks it could be both. “There’s kind of a witches’ brew of substances out there that are being inhaled and causing this lung damage and that lung damage might also be initiated due to some of the trace metal elements and other products that come from the devices themselves.”
How do you vape more safely?
First of all, as noted above, experts say you really shouldn’t vape at all. “It’s a good thing in that you’re not getting thousands of chemicals from combustion but there’s a risk that people’s attitudes sort of go too far the other way and they think that this is a clean, healthy thing to do,” Hammond said.
Both the CDC and Health Canada recommend you don’t vape, and they’re especially concerned about people like teenagers who have never smoked before using these devices.
However, if you do vape, Health Canada says to make sure you buy your products from licensed sources and not modify your devices or products in any way.
If you’re vaping cannabis, Hammond suggests it’s lower-risk to vape a dried herb rather than a prepared concentrate or vaping liquid, since if you’re buying legal cannabis, it’s subject to quality controls. Cannabis concentrates for vape pens aren’t currently legal in Canada, he said, though they will be eventually.