Understanding vitamin E acetate
This week, you’ve likely run across numerous headlines about vaping and e-cigarettes linked to recent lung illness and deaths across the US. The alarming nature of this news likely put you on pause, and you might be looking at that vape pen with critical eyes.
So, let’s discuss what’s happened and how you can protect your health.
What Is Vape-Related Lung Disease?
It’s certainly not news that use of vape pens and e-cigarettes has increased exponentially over the past few years. Reasons for this trend include ease of use, discretion (especially for cannabis users), and mitigating health risks associated with traditional smoking methods. However, vaping poses its own types of risks.
Studies have shown that e-cigarettes can contain harmful chemicals like formaldehyde.  The potential harm from these chemicals varies and appears dependent upon device power and aerosol particle size. [1,2] A study published in August, however, found that even nicotine-free e-cigarettes can cause short-term changes in blood flow and oxygenation rates. 
For these reasons and more, the FDA recently sent a warning to JUUL, a company that manufactures and markets e-cigarettes, for their health claims. Younger people, who are increasingly using e-cigarettes, are especially vulnerable to the addictive properties and potential harms of these products.
And this summer, cases of vape-related lung disease and associated deaths began emerging. In fact, a study published in early September in The New England Journal of Medicine described 53 cases of lung illness; the vast majority of patients had used vape products with tetrahydrocannabinol (THC) within 90 days prior to experiencing symptoms. 
What Is Vitamin E Acetate?
After analyzing the devices associated with some of these cases, New York health officials identified vitamin E acetate, an additive used in some cannabis vape cartridges, as the likely cause of the lung illness and associated deaths.
Vitamin E acetate, or tocopheryl acetate, is a form of oil that is commonly used in cosmetics. When inhaled, like other lipids, the oil can stick to the lungs, gumming up essential tissue. This prevents the body from receiving enough oxygen, which leads to pneumonia-like symptoms. [4,5] These symptoms can be serious and can lead to death.
Vitamin E acetate is found in many “illicit” vape cartridges, meaning that they were not purchased from legal medical or recreational dispensaries. These are the cartridges implicated in the recent illnesses and deaths.
This additive is used because it is cheap and easy to come by—but is NOT safe for inhalation. Therefore, the CDC has issued a warning to consumers advising them not to use any vape pens or cartridges purchased from the illicit market.
What Can You Do To Protect Your Health?
This issue has brought to light the importance of standardized testing and regulation across markets—something that is currently lacking and poses danger to consumers. Even products sold in medical or recreational dispensaries may not undergo comprehensive, rigorous testing.
Government authorities in many states are now taking steps to ensure that manufacturers of vape pens and cartridges do not use vitamin E acetate and other potentially harmful additives and chemicals.
If you are concerned about your health, you are certainly not alone. As described, there are many reasons why people may choose to vape cannabis; however, another important consideration is dose control. For patients using cannabis to control symptoms like acute pain, quick onset can provide needed relief. So, what should you do?
There are many different ways to consume cannabis, such as smoking/vaporizing flower, or using oils, tinctures, edibles, and other formulations. While this story will likely continue to evolve, for now, consider guidance from authorities on staying away from illicit vape pens and cartridges. And check products purchased in legal dispensaries to make sure they do not contain vitamin E acetate.
- Jensen, R.P., et al. “Hidden Formaldehyde in E-cigarette Aerosols.” NEJM, vol.372, no.4, 2015, pp. 392-394. (impact factor: 70.67; cited by: 364)
- Floyd, E.L., et al. “Electronic Cigarette Power Affects Count Concentration and Particle Size Distribution of Vaping Aerosol.” PLoS One, vol.13, no.12, 2018, pp. 1-15. (impact factor: 2.776; cited by: 4)
- Caporale, A., et al. “Acute Effects of Electronic Cigarette Aerosol Inhalation on Vascular Function Detected at Quantitative MRI.” Radiology, 2019, in press. (impact factor: 7.608; cited by: 1)
- Layden, J.E., et al. “Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin – Preliminary Report.” NEJM, 2019, doi: 10.1056/NEJMoa1911614. (impact factor: 70.67; cited by: 3)
- Vethanayagam, D., et al. “Exogenous Lipid Pneumonia Related to Smoking Weed Oil Following Cadaveric Renal Transplantation.” Can Respir J. vol.7, no.4, 2000, pp. 338-342. (impact factor: 1.803; cited by: 22)