The study was conducted by doctors from the California Department of Public Health (CADPH) and Centers for Disease Control and Prevention (CDC) with the goal of finding and analyzing the clinical characteristics and vaping exposures of patients hospitalized with EVALI. Data was gathered by the CADPH as it was reported from treating clinicians from August 8, 2019, to November 8, 2019.
The case series covered 160 patients’ medical data along with data collected from a survey completed by 86 (54%) of the patients via a standardized questionnaire. Of those 86 patients, only one patient said they purchased vape products from a legal source.
Of the 160 total patients, 62% were male and the median age was 27 years with an official age range of 14 to 70 years old. Of these cases, 46% of patients were admitted to the intensive care unit, four people died, and 29% required mechanical ventilation. Of those directly interviewed, 83% of patients admitted to vaping THC products, 43% vaped CBD products, and 47% vaped products containing nicotine. These patients were asked to report each brand, type, flavor and active ingredients in each product that was used over the 90-day period prior to hospitalization. Officials also collected the pods, vapes, and cartridges from patients after specifying the exact locations where products were purchased. Between the 86 directly interviewed EVALI patients, 130 products were collected.
Eighty-seven of the collected products were THC-only and 91% of those relied on pre-filled cartridges. There were 25 products that contained only nicotine with just 48% of those coming in the form of a pre-filled cart. 56% of THC cartridges in the study were labeled as using flavoring agents and 76% of nicotine vape products were labeled as flavored.
Patients commonly purchased nicotine products from a dispensary or vape shop, according to study data. EVALI patients who smoked THC-only vape cartridges or pods commonly purchased them from another person (44%). Many reported purchasing vape products from a dispensary (33%) and of these, 25% of those interviewed stated that the dispensary was licensed by the state of California. After further research, however, it was found that only four products (all of which were actually purchased by the same patient) came from a licensed adult-use dispensary. Aside from unlicensed dispensaries and friends, the patients had either purchased the contaminated vape products from pop up shops or couldn’t name their source.
After collecting patient data the study analyzed the products, 49 of which were THC-vapes. Between these, vitamin E or vitamin E acetate was found in 84% of vapes. All products tested under 100 parts per billion for heavy metals except one which tested positive for nickel. Low levels of pesticides were also found in 67% of THC containing vape carts including myclobutanil, bifenthrin, bifenazate, tebuconazole, metalaxyl, propiconazole, imidacloprid-urea, piperonyl butoxide, and trifloxystrobin.
The report highlights the fact that most of these contaminated cartridges and pods came from illegal sources, and the data supports the theory that vitamin E and/or vitamin E acetate is the likely culprit in EVALI cases presented in the last year. Researchers do note, however, that more research must be done to reach more conclusive answers.