Small percentage of cases reporting non-THC product use needs further study
CDC recently released two reports on e-cigarette, or vaping, product use–associated lung injury (EVALI), confirming that most EVALI patients report using tetrahydrocannabinol (THC)-containing products and that new EVALI cases have continued to decline with time.
The two reports appear in CDC’s Morbidity & Mortality Weekly Report (MMWR).
The first MMWR report updates EVALI patient demographic and self-reported substance use characteristics. As of January 14, 82% of EVALI patients nationwide with available data reported using any THC-containing e-cigarette, or vaping, products, and 57% reported using any nicotine-containing products; 33% reported exclusive THC-containing product use, and 14% reported exclusive nicotine-containing product use.
The report also analyzed updated data on newly reported cases to CDC, as well as emergency department visits over time related to e-cigarette, or vaping, products. These data show that the EVALI outbreak began in June 2019 and peaked in September 2019. The number of cases has since continued to decline, but new cases and deaths continue to be reported.
“These reports build on the continued scientific progress CDC and our partners have made to reduce the number of EVALI cases,” said CDC Director Robert R. Redfield, M.D. “It is also critically important that we continue to do all we can do to protect Americans – particularly young people – from this serious health threat.”
The second MMWR report summarizes characteristics of EVALI patients in Illinois by substances used in e-cigarette, or vaping, products. The study found that while most Illinois EVALI patients reported use of THC-containing products, a small percentage had no evidence of any use of THC-containing e-cigarette, or vaping, products.
Of 121 interviewed EVALI patients in Illinois, nine reported using only nicotine-containing products and had no indication of any THC use. These patients were more likely to be older and female than patients who reported using THC-containing products. These findings support earlier data suggesting that while THC containing e-cigarette, or vaping, products and vitamin E acetate play a major role in the outbreak, evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC or non-THC products, in some of the reported EVALI cases.
A third CDC publication, a commentaryexternal icon, released today in New England Journal of Medicine, discusses key aspects of the EVALI outbreak and notes that it is distinct from the ongoing epidemic of e-cigarette, or vaping, product use among U.S. youth. This commentary also underscores that both the EVALI outbreak and youth-vaping epidemic warrant immediate, decisive, and science driven action to protect public health, and that the focus of these actions must target the underlying drivers.
The EVALI outbreak primarily affects young adults, is driven by the use of THC-containing products from informal sources and is strongly linked to vitamin E acetate. In contrast, the youth e-cigarette, or vaping, product use epidemic primarily affects adolescents, is driven by use of nicotine-containing products obtained mostly from formal sources, and has been caused by multiple factors, including advertising, attractive flavors – particularly in cartridge-based products, and the availability of easily concealable devices that deliver high levels of nicotine.
Current Recommendations from CDC and FDA
- CDC and FDA recommend that people not use THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, or family, or in-person or online dealers.
- Vitamin E acetate should not be added to any e-cigarette, or vaping, products. Additionally, people should not add any other substances not intended by the manufacturer to products, including products purchased through retail establishments.
- Adults using nicotine-containing e-cigarette or vaping products as an alternative to cigarettes should not go back to smoking; they should weigh all available information and consider using FDA-approved smoking cessation medications. They should contact their healthcare professional if they need help quitting tobacco products, including e-cigarettes, as well as if they have concerns about EVALI.
- E-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant. Adults who do not currently use tobacco products should not start using e-cigarette, or vaping, products.
- THC use has been associated with a wide range of health effects, particularly with prolonged frequent use. The best way to avoid potentially harmful effects is to not use THC-containing e-cigarette, or vaping, products.
- Persons engaging in ongoing cannabis use that leads to significant impairment or distress should seek evidence-based treatment by a health care professional.