On October 9, 2019, the Utah Department of Health (UDOH) announced the state’s first death due to a “vaping-related lung injury.” The reported death, under the age of 30, passed away “at home without being hospitalized prior to their death.” UDOH “determined the individual vaped THC (tetrahydrocannabinol) prior to their death.”

 

In its investigation of adverse health effects related to e-cigarette use, UDOH has “reported 76 cases of vaping-related lung injuries.” UDOH officials note 94 percent of patients “self-reported vaping THC products.” The newly released findings are similar to earlier reports by UDOH. On September 30, UDOH reported “71 cases of vaping-related lung injury.” UDOH gathered data on 36 cases and found 34 patients, or 94 percent, self-reported use of “any THC cartridges.” In Utah, 13 patients, or 36 percent, reported exclusive use of THC vaping devices.

 

Similar to UDOH reports, several other state health departments and the Centers for Disease Control and Prevention (CDC) are consistently linking recent vaping-related hospitalizations to the use of unregulated, illegal vaping devices containing THC.

​

Minnesota, Oregon, Texas, and Wisconsin have all linked recent vaping-related lung illnesses to the use of THC vaping devices. Similarly, on October 3, CDC noted 78 percent of patients “reported using THC-containing products, with or without nicotine-containing products.” Further, 37 percent of patients reported “exclusive use of THC-containing products.”

​

The Utah Public Health Laboratory has tested 39 vaping devices, including 19 THC cartridges, and 20 vaping products containing nicotine. According to its findings, 100 percent of the nicotine-containing devices “contained nicotine and none have shown unexpected compounds.” On the other hand, 90 percent of “the THC cartridges contained Vitamin E acetate.”

​

Numerous health departments are examining the adverse health effects of vaping devices containing vitamin E acetate. The New York Department of Health tested various vaping products, and found “very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed.” Further, vitamin E “is not an approved additive for New York State Medical Marijuana Program-authorized vape products.” Although the specific effects of vaping vitamin E acetate are still unknown, the substance is a lipid, or oil, which is “highly toxic and [has] been associated with lung injury for years.” 

​

Unlike other states—including Massachusetts, Michigan, Montana, New York, Oregon, Rhode Island, and Washington—which have banned, or are in the process of banning, flavored and, in one case, all e-cigarettes and vaping devices, UDOH issued an emergency rule on October 2, restricting the sales of flavored e-cigarette products.

​

Beginning October 7, Utah e-cigarette and tobacco retailers “shall display a mandatory warning sign, warning sign, warning consumers not to use electronic-cigarette products to consume unregulated THC electronic-cigarette substances.” Further, only “retail tobacco specialty businesses with a valid retail tobacco specialty permit” are allowed to sell flavored e-cigarettes and vaping devices. General retailers, including convenience stores, may still sell “non-flavored electronic-cigarette products.” The emergency rule is in place for 120 days.

​

Although UDOH claims its rule is an effort “to protect health, safety and welfare of the Utah youth,” the flavor restriction will likely reduce adult access to tobacco harm reduction products.

​

Despite fearmongering media campaigns insisting that flavors are only in e-cigarettes to attract youth, flavors are an important component in helping adult smokers quit (and abstain from returning to) combustible cigarettes. Indeed, a 2018 survey of nearly 70,000 American adults who use e-cigarettes and vaping devices found 83.2 and 72.3 percent reported vaping fruit and dessert flavors, respectively. Moreover, only 20 percent of respondents reported using tobacco flavors at the point of e-cigarette initiation.

​

Although UDOH has been proactive in attempting to identify the specific vaping devices behind adverse health conditions, many health groups, including UDOH, are linking recent hospitalizations to black-market THC brands.

A September 6 report in The New England Journal of Medicine examined vaping-related hospitalizations in Illinois and Wisconsin. In these cases, 21 of 41 patients reported “using a THC product … marketed under the ‘Dank Vape’ label.” Further, 38 percent of self-reporting patients in Utah used Dank Vapes prior to their lung illnesses. This is particularly frightening because Dank Vapes is an illegal, unlicensed product. Dank Vapes is a shady packaging company, not a legitimate company.

​

Although Utah’s recent emergency ruling is not as encroaching as all-out bans on flavored e-cigarettes, it is still disingenuous that policymakers would restrict access to tobacco harm reduction products while dedicating very little in tobacco revenue (from taxes and legal settlements) to help smokers quit, or prevent youth tobacco use. For example, Utah first sued tobacco companies in 1996 and was one of the states that settled in 1998, resulting in the Master Settlement Agreement (MSA). From 1999 and 2019, Utah has received an estimated $710.2 million in MSA payments. Despite receiving an estimated $141.9 million in MSA payments and taxes in 2019, Utah dedicated only $7.0 million, or 0.04 percent, of state funds toward tobacco control programs including education and prevention.

 

Utah’s restriction on tobacco harm reduction products is a disservice to public health. Moreover, UDOH has identified the use of THC-laden cartridges, which are illegal and unregulated, to be the primary cause of the state’s recent vaping-related hospitalizations. If Utah lawmakers actually want to address youth vaping, policymakers should dedicate more than 0.04 percent of the state’s vast tobacco moneys to anti-smoking programs.

​

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute or Tobacco Harm Reduction 101.