A Research Vault on Vaping-Associated Pulmonary Injury


Compiled by Jason Keehn

Welcome to an open research doc with clustered links, quotes & mild commentary. Not quite a live blog, but will try to keep updating every couple days. Updated 9/28.

  • Highlights
  • Official Pronouncements
  • Industry Responses
  • The Science – What Is Known So Far  
  • Current Case Reports
  • Past Relevant Research
    • Breakdown Products of Common Terpenes and Additives
    • Vitamin E Acetate Formaldehyde
    • Synthetic Cannabinoids
    • Myclobutanil
    • Metals
  • Mass Media Stories (Descending Order of Usefulness)
  • Addendum: Forward Options for Regulators


  • As of 9/27, 13 deaths; closing in on 1000 cases to date, “more expected”; 38 states affected, including dozens in CA, but, so far, seems mostly concentrated in states with no medical or adult use program. Most patients report having purchased illicit product.
  • Trump Wants to Ban Flavored E-cigs
  • House Hearing with CDC on 9/24, Senator Durbin threatens to hold a separate hearing shortly; FDA asks for 3 weeks to design guidance (or by May 2020 – conflicting info);
  • Vape oil additives – cutting agents, thickeners, thinners, preservatives, flavors, colorants – are neither tested for nor banned in any legal state, currently; states don’t set recommendations on dilution ratios; and there is relatively little long term health research on aerosolized terpenes or other additives.
  • Latest State Actions:
    • MI bans flavored e-cigs
    • NY subpoenas 3 vape brands, moves to ban e-cigs as well
    • CA DPH issues harsh warning, and Newsom authorizes $20M education campaign and warning notices to be posted on retail storefronts
    • Mass mandates all ingredients to be listed on labels
    • WA asks retailers to review all product, threatens recalls; sets 21 year age limit for vaping purchases
    • Hawaii goes after… CBD and… gummies?!
    • OR issues guidance, retailers to post warning letter and report any novel / suspicious ingredients
  • First marker identified by Univ of Utah – “lipid-laden macrophages”.
  • Most cases seem to involve both THC and nicotine use; most in NY involve Vitamin E Tocopheral Acetate (synthetic chemical), and it appears implicated in cases in other states as well – but medical authorities are not ruling out other additives, synthetic cannabinoids or interactions.
  • Various sources suggest inverted ratios of THC/DBD to additives may be standard in street carts – from 70 THC extract /30 diluents, to 30/70, for example.Even terpenes at high concentrations could be a problem.
  • California licensed operators ConstanceTherapeuticsand WercShop both issue statements — Constance has a patent on plant-based ALPHA-Tocopherol, and deems it safe for human use in their formulations. WercShop was using a trace amount of Alpha-Tocopheral from a plant source as a stabilizer in its patented, proprietary “Nexus 2.0” formulation, but has now stopped. TrueTerpenes states it does not currently use Tocopheral Acetate, denying anonymous claims and testing results on Reddit. Various licensed prominent brands declare they use only 100% cannabis and terpenes. Honeycut, a LA-based supplier of Vitamin E, has taken its website down.
  • Some scattered research exists on aerosolized Tocopheryl, one study indicates the Alpha version may be beneficial and the acetate version dangerous.
  • Best place to start if you’re not already following all this closely — David R. Downs’ coverage (@davidrdowns):

Official Pronouncements

Industry Responses

The Science – What Is Known So Far

Current Case Reports

Past Research

Formaldehyde (Breakdown Product of Propylene Glycol & Related Additives)

Vitamin E 

Synthetic Cannabinoids

Myclobutanil (& Other Pesticides)



Mass Media Stories  (Descending Order of Usefulness)


Forward Options for Regulators:

  • Move rapidly to mandate additives testing (but standards and methods need to be developed)
  • Require a detailed list of all ingredients and additives (as in Massachussetts)
  • Set limits for some additives/dilutants and even added terpenes, individually or in aggregate
  • Require testing and health data from companies before introducing new cutting agents not on an “approved list”
  • And, possibly, outright bans.
  • FDA/NIH/NIDA will fund research on long-term health effects of aerosolized vape oil ingredients, terpenes, and vape trace metals, as well as testing analytics methods – university researchers, prepare your grant applications now!
  • Will this crisis push FDA to now coordinate and oversee the state-level manufacturing and testing standards for legal cannabis – but can it do so without new federal legislation?

(Stay tuned for our more detailed article forthcoming in the premiere issue of theJournal of Endo-Cannabinoid Medicine)

Correspondence to twist1961 at gmail