1) vaping things that really should not be vaped, resulting in oil droplets getting in your lungs. e.g. "cannabidiol oil, which is not designed for vaping but has been used that way." Apparently some vaping fluids are much worse than others, thus the recommendation to "stop buying bootleg and street cannabis and e-cigarette products, and to stop modifying devices to vape adulterated substances."
2) people not seeking timely medical attention and lying about the causes, as marijuana possession is still a crime where they live.
From the article:
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> The patient’s older brother, a police officer, was suspicious. He rummaged through the youth’s room and found hidden vials of marijuana for vaping.
> Health investigators are now trying to determine ... whether the risk stems from a broader behavior, like heavy e-cigarette use, vaping marijuana or a combination
> Many vaping ingredients are not listed on the products. Vitamin E oil appears to have been a common substance associated with the severe and sudden respiratory problems in some of the New York cases, according to state health officials. It is not known how it was used. Vitamin E is sometimes advertised as a supplement in cannabidiol oil, which is not designed for vaping but has been used that way.
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Nicotine is typically in a base of propylene glycol or vegetable glycerine (I think I got those right). I believe both are cheaper than the "adulterants" such as vitamin e oil being used to cut the THC oils, so it is unlikely that people vaping exclusively nicotine products are being affected.
There's been some concern around certain flavorings being much riskier than others (i.e. popcorn lung) though I suspect it'll be some years yet before the effects from those start playing out.
I ask because my hemp mentor will never touch concentrates. He argues that even the tiniest bit of pesticides or inorganic fertilizers will also be more concentrated and he’s not willing to gamble on it. There’s just too many unknowns when it comes to that.
However, the highest number I've seen reported was just shy of 1 ppm myclobutanil. Not great, but that's still pretty low.
https://www.thestranger.com/slog/2018/12/20/37272899/no-one-...
People have been consuming large quantities of cannabis oil that were saturated in pesticides for over a decade without this kind of crisis.
I run a cannabis copacking company and one of my clients was the first to go pesticide free back in 2016. It was near impossible to source material for them. Prior to 2018 about 95% of material was sprayed with pesticides. Because black market distillate is typically made from mixed batches of oil there was higher contamination rates than that.
I think it's questionable to consume cannabis in general and especially concentrates. The safest method is likely oral consumption. I have seen contaminants in concentrates, such as fire retardant, that pass all screening tests. Neem oil, for example, is an approved pesticide for CA but is really nasty stuff to be smoking.
This. People have been vaping THC e-cig cartridges for years. Same for using other concentrated products like wax. Yet it seems only very recently that this has become some kind of 'epidemic'.
I'm not saying that it's safe, but it seems very sudden that all these cases show up. Or maybe they were happening before, but because it seemed so hard to diagnose, people weren't connecting the cases?
My worst episodes of CHS I've had from smoking synthetic cannabinoids, I'm not aware of neem oil having any relevance in the production of those.
Imho a large factor could simply be an overabundance of product leading to people overconsuming because "Cannabis has no negative effects", so nobody cares about basics like tolerance breaks anymore [0], instead people just keep upping their THC doses to get past their tolerance threshold.
[0] https://psychonautwiki.org/wiki/THC#Dependence_and_abuse_pot...
Speculation should not be presented as fact.
We don't know what is causing these cases but you have presented a reasonable hypothesis.
Common cutting agents in the licensed market are PEG200, PEG300, and MCT oil. None are those are proven safe from what I know.
In the black market the initial cutting agent was PEG600. Then TrueTerpenes came out with Viscosity ( https://trueterpenes.com/products/diluent/viscosity-extract-... ). Initially they said it was all terpenes (simple alcohols found in cannabis responsible for some effects and flavor) to sell it. It later came out that it was "mineral oil" but the reality is no one knows exactly what it is but it's a petroleum-based product of some kind. There was backlash against TrueTerpenes for this but selling mineral oil at $1500/liter (price point for cutting agents) is profitable. Some reports have described the symptoms as consistent with lipid pneumonia.
Next FloraPlex released their thickening agent. Then HoneyCutt. I started hearing stories of people selling 0% THC epoxies to unsuspecting buyers as distillate starting a few months ago.
Now there are people making their own thickening agents.
Is it a theory? Yes. I'm normally scientifically conservative but I'd place a friendly wager on this one.
In my research, one finding that stuck out [2] was that natural oils (triglycerides, saturated or unsaturated) are more pro-inflammatory than straight-chain mineral oils. MCT oil would absolutely cause acute inflammation and in severe cases, collapse of alveoli.
However, the long chains, longer than C14, have half-lives measured in months to years. The effects of these is harder to know, but excessive exposure causes essentially COPD.
Edit: oh look, here's an article specifically pointing out lipoid pneumonia [2]. I actually disagree with their thesis, that vegetable glycerine is causing the inflammation. I would bet it's more likely to be one of these thickeners, or a carrier agent for a flavor, causing the inflammation. I know people who go through over an ounce per day of VG solution that aren't getting chemical pneumonitis, but inhalation of sub-milliliter amounts of oils has sent friends of mine to the hospital.
Basically, if it's not air, it doesn't belong in your lungs. However, the degree and character of the damage done depends on the chemical composition.
Shorter molecules, molecules with more hydrophilic nature (alcohols, polyols, ketones, acids), biologically active molecules, are more acutely inflammatory, but usually the body can deal with them. Longer molecules, biologically inert ones, are less acutely reactive to the immune system, but can cause disruption of membranes and long term toxicity. Unsaturated fatty acids are especially bad because they can be oxidized directly into inflammatory signal chemicals. [4]
[1] https://en.wikipedia.org/wiki/Chemical_pneumonitis
[2] pdf - https://www.ajronline.org/doi/pdf/10.2214/AJR.09.3040
"Mineral oil (a mixture of inert, long-chain, saturated hydrocarbons obtained from petroleum) and vegetable-based oils tend to cause minimal to mild inflammatory reactions (Fig. 3). The intraalveolar oils can coalesce in the alveoli and become encapsulated by fibrous tissue, resulting in a nodule or mass (paraffinoma) (Fig. 4). Conversely, animal fats are hydrolyzed by lung lipases into free fatty acids that trigger a severe inflammatory reaction that manifests as focal edema and intraalveolar hemorrhage [5]. "
[3] html - https://casereports.bmj.com/content/2018/bcr-2018-224350
[4] https://www.frontiersin.org/articles/10.3389/fimmu.2014.0048...
"unsaturated fatty acids can be oxidized in a tightly regulated and specific manner to generate either potent pro-inflammatory or pro-resolving lipid mediators. "
I wonder if you have any words on "MCT" being too broad a term. I made my carts with Bulletproof's Brain Octain, which claims to be 100% caprylic acid (C8).
I'm not naive enough to ask "Is it safe?" But I'm curious if you think an 8-chain MCT would treat your lungs significantly different than a 12-chain MCT?
I could easily imagine someone learning that you can make carts with MCT, and finding something cheap, only to be unknowingly using 100% C12. Cue the lipid pneumonia.
C8 is really fascinating because, I reckon, it's too short to set off the inflammation cascade directly, so it would be up to macrophages to alert the body "hey this doesn't belong". However you still have the usual risk from hydrophobic product in the lung.
Personally, I would use vegetable glycerine and nothing else if you can at all avoid it. PG is a bit more irritating than VG, but any short polyol is going to be diffused away into the mucous much more easily than hydrophobic products.
For marijuana/hemp you can make a water-based tincture using VG as the solvent just using dried plant matter. A magical butter machine can do it, putting it in a bottle and shaking it up every day for a few months, there are likely other methods. It's similar to making a CBD/THC oil but instead using VG as the carrier.
Making your own tincture from decent-quality dried plant matter is the most economical and surefire way to know that it unadulterated and limited in contaminants.
[1] https://www.frontiersin.org/articles/10.3389/fimmu.2014.0048...
Theatrical fog causes "irritation of mucous membranes such as the eyes and the respiratory tract associated with extended peak exposure to theatrical fog. " Another study "also found long-term exposure to smoke and fog was associated with both short-term and long-term respiratory problems such as chest tightness and wheezing".
Cigarettes are terrible, but vaping ain't vitamins.
https://en.wikipedia.org/wiki/Fog_machine#Adverse_health_eff...
Not all theatrical fog is the same as vaping as far as I am aware. If you have any articles specifically dealing with the components used for vaping I would be interested to read them. Vaping does not use oil.
My issue was only that you followed a bunch of informative facts with an untested theory that was not differentiated from the facts that preceded it.
Biomass ("trim") was very easy to source leading up to CA recreational legalization in 2018. For those of you who don't know the majority of cannabis nationally comes from CA and OR. Legalization brought with it enforcement against unlicensed NorCal farms that drastically reduced supply. This was amplified by the massive overproduction of the 2017 market that had many farmers leave the market due to extremely low prices. This is evidenced by the shutdown of soil/grow supply warehouses throughout NorCal.
By February 2019 the last of the October 2018 harvest had been processed to distillate. Many operators started reprocessing waste material. At the same time, distillate started to make it's way over from Mexico. There is a drought of product in the black market but wholesale buyers were reluctant to pay higher prices after becoming accustomed to the low prices of 2018. In the beginning unscrupulous sellers started diluting their product by 60%. Buyers eventually caught on to the charade and started paying attention to the reduced viscosity of the oil as an indicator of cutting agents. Sellers countered this by adding thickening agents.
Now you have an illicit market with high demand, not enough supply, and customers that represent established black markets across the country that don't want to pay a risk premium for oil.
The cutting agents themselves are expensive so people have started making their own. Now people are getting sick from the cutting agents.