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Whether you’re unfamiliar with vaping entirely or a regular user of cannabis vapes, you may have heard about worrying news and headlines since the last year - first about a spate of cases of lung injuries and illness in the USA linked to THC vaping products, that in the following months became a full-on outbreak across the country. You may also have seen news calling out the “dangerous chemicals” being snuck into vapes, with the spotlight laser-focused onto a substance called vitamin E acetate.
The nexus of this issue spins around THC vape products, but if you’re a user of CBD vapes or were looking to get into them, you may also be worried about how all this will affect you, or what information you can rely on. Here’s everything you need to know about vape oils, vitamin E acetate, how they tie into THC and CBD vaping, and how you can protect yourself.
CBD, THC, and Vaping: a quick primer
First, let’s elaborate on what CBD and THC mean. These abbreviations refer to cannabidiol (CBD) and tetrahydrocannabinol (THC), two compounds naturally produced by glands in the cannabis plant (Cannabis sativa) and thus classified as cannabinoids. Over 120 cannabinoids exist, but these two are the most abundant and significant in cannabis plants, and many of the plant’s pharmacological effects can be attributed to them.
THC, for example, is responsible for cannabis’s psychoactive effects - by binding to certain receptors in the brain, it induces the euphoria, sensory perception and pleasurable state of mind that a person experiences when using cannabis. People often take it recreationally for this effect, and it also is purported to have a host of other benefits that include pain relief, helping with insomnia, calming anxiety and easing muscle spasticity.
CBD, meanwhile, is non-toxic and non-neurotropic in nature - so when ingested or consumed, it doesn’t cause that same “high” state. It’s increasingly been in the spotlight for its ability to support health, and it’s been used to offer aid to people dealing with conditions like anxiety, chronic pain, epilepsy, skin conditions, cancer, and many others. People have used CBD to improve mood, ease pain, provide stress relief and energy boosts, help people manage their sleep and appetite and more. Studies also suggest that CBD is non-addictive, and long-term usage is less likely to cause people to build up a tolerance to it, making it a much safer and appealing option for people seeking to manage chronic, long-term conditions. It’s also thought to be able to help deal with withdrawal symptoms from nicotine addiction.
THC and CBD vaping comes as a very natural step forward in cannabis consumption. Vaping was first marketed as the safer alternative to smoking, and its ease of use, functionality, potency, and the sleek and discreet appearances of the devices used greatly contributed to its rise in popularity. For cannabis, which is often smoked in order to use it, a transition to vaping follows a lateral line of progression, and from there the concept of vaping cannabis-derived products like THC and CBD is just another extension of that.
Before we dive further, we’ll do a quick rundown of how vaping works. Every time you use a vape device, vapour is produced by the same basic process. First, you have a vape cartridgeor tank that holds vape oil. The vapour created by vape devices doesn’t just come from nowhere - it’s an aerosol that is created from this specially-formulated liquid.
An atomizer, fuelled by a power source like a battery, heats up the vape oil to turn it into an aromatic vapour. This then travels through an airway or mouthpiece to enter the mouth of the user, where it is inhaled into the lungs smoothly. It’s an easy-to-understand mechanism that relies on every part functioning properly to get the desired experience.
There are a great many nuances to these other components, but our focus is specifically on vape oil. Vape oil, or e-liquid or vape juice, is used in essentially all vape devices and consists of a mixture of ingredients, which can include nicotine and flavouring agents, or alternative compounds like CBD.
What’s in a vape oil?
A vape oil usually comprises mostly of a carrier liquid, in which the other ingredients are dissolved. Propylene glycol (PG) and vegetable glycerin (VG) are extremely common choices for carrier liquids in vape oils and are often used together - so much so that many vape oils can be classified based upon the ratio of VG to PG content in a given liquid. Most conventional vape oils will consist of around 95% PG and VG content, with the other 5% made up of flavourings, nicotine and other additives. Other alternative carrier liquids are medium-chain triglyceride oil (MCT), which is a refined form of coconut oil, or triethyl citrate, which is an emulsifier made from citric acid.
CBD vapes differ from this as nicotine is completely excluded, and instead, the cannabinoid forms the main ingredient. It should be noted that generic CBD oil, while safe for oral ingestion, should not be vaped. These oils are made with different ingredients than vape oils - the former usually contains coconut or olive oil, which while edible is very unsafe when inhaled and should not be smoked. CBD vape oil, manufactured specifically for vaping, should not contain these oils and thus be safe for use.
In CBD vapes, the respective cannabinoid oils are packed into the vape cartridges in quantities of about a gram or half-gram, depending on the manufacturer. These vape cartridges still rely on a carrier liquid to hold the ingredients - in this case, MCT oil is more commonly used as a carrier liquid as it’s clear, odourless and tasteless, vaporizes at a low temperature and is rapidly broken down by the human body. Cannabinoids like CBD dissolve readily in MCT oil, allowing for producers to make highly concentrated solutions with MCT oil as a carrier liquid.
Terpenes are also an increasingly common ingredient in cannabis vape cartridges. These are all-natural compounds also produced by cannabis plants that are responsible for the plant’s aroma and flavour and can impart those flavours to the vape oil itself. They are also used in vape oils to alter viscosity so manufacturers don’t have to add other potentially harmful thinning or thickening agents like PG and VG. Terpenes are also thought to contribute to the entourage effect, helping to mitigate adverse effects and boost beneficial ones of the other cannabinoids in cannabis.
Manufacturers also use several different methods to produce cannabinoid-containing vape oil for use in their vape devices. One of the most refined and effective techniques is carbon dioxide supercritical fluid extraction, which allows for the plant’s chemical components to be effectively separated, and when properly made the oils produced can even retain small amounts of terpenes, removing the need for additional additives for flavouring or thickening agents. In many other cases, though, CBD distillates are made in ways that necessitates the addition of chemicals to alter viscosity and oil consistency.
This is where additives come in - used as supplemental thinning or thickening agents, these compounds are included to bulk up an otherwise high-potency but small amount of CBD vape distillate and fill up the cartridge. Many of these substances, however, have become increasingly controversial and new findings have revealed them as dangerous to our health. One of these substances is vitamin E acetate, the most recent cause of alarm for researchers and the vape community worldwide.
What is Vitamin E Acetate?
α-Tocopheryl acetate, known more commonly as vitamin E acetate, is an artificially-produced form of vitamin E - specifically, it’s the ester of acetic acid and α-tocopherol, one of the forms of vitamin E. At room temperature, it’s a fat-soluble liquid that doesn’t degrade in air, visible light, or UV radiation, and can be hydrolyzed back into α-tocopherol and acetic acid when placed under suitable conditions, or when ingested by people, which makes it one method of obtaining vitamin E.
Vitamin E acetate is often used as an ingredient in dermatological products like skin creams since it’s safe, not oxidized when in air and has the desirable ability to penetrate through the outer layers of skin to reach the living cells underneath. It’s used instead of vitamin E because in its acetate form it is less acidic and has a longer shelf life. Research indicates that the acetate is slowly hydrolyzed after it’s absorbed into the skin, which allows for vitamin E to be regenerated and thus provides ultraviolet light protection. It’s also thought to have beneficial antioxidant effects.
Its actual efficacy as a topical medication is questionable, however. While anecdotes and claims of improved wound healing and scar tissue reduction abound, scientific reviews have found on multiple occasions that the evidence is insufficient to support the belief that vitamin E acetate actually has beneficial effects when applied topically. There are also some reports of allergic contact dermatitis - irritation of the skin caused by an allergic reaction to a material - resulting from people using vitamin E derivatives like vitamin E acetate in skincare products.
Currently, vitamin E acetate is coming under fire in particular for its role in an outbreak of vaping-related illness. The U.S. Centers for Disease Control and Prevention (CDC) singled out this acetate as a strong candidate for the causative agent behind a huge spate of vaping-associated pulmonary injury (VAP) and illness cases in the USA in 2019. Though the evidence at the moment still does not rule out the contributions of other chemicals, the inclusion of vitamin E acetate in vape cartridges is thought to be a major factor behind over 2,000 cases across the USA alone.
Unwanted reactions: vaping-related illness
In April 2019, a cluster of cases from Illinois and Wisconsin came to the attention and alarm of scientists. 98 patients were reported with severe respiratory illness, 95% of which were hospitalized and 2 of which died. The vast majority of these patients (89%) stated that they had used THC vaping products prior to the onset of their symptoms, across a wide variety of products and devices. All these patients had presented with similar clinical characteristics, though the exact causes were still unclear, and scientists rang a warning bell about this cluster representing an emerging clinical syndrome.
Today, over a year later, this cluster has since expanded into a full-on outbreak and one that is still ongoing, although it is contained almost exclusively to the USA and Canada. As of January 2020, there have been 2,711 cases of vaping-associated lung illness resulting in patients being hospitalized, and 60 ensuing deaths as confirmed by the CDC. 79% of patients are young adults under 35 years old, with cases as young as age 13 being reported. The actual number of cases is probably far greater than what the CDC has on record, as many cases are likely under-reported and only severe cases are brought to the CDC’s attention.
These cases of severe lung illness have been strongly linked to the usage of vaping products, and more specifically cannabis vaping products - around 86% of patients studied by the CDC stated that they had used THC. Direct exposure to chemicals within these products has been identified as the cause behind the outbreak, among them nicotine, and vitamin E acetate. Findings by the CDC, based on fluid samples from the lungs of 29 patients suffering vaping-associated lung injuries, found that there was evidence that vitamin E acetate was present at the main site of injury in all the samples tested.
Vitamin E Acetate: a toxic component
Vitamin E acetate is of particularly strong concern for cases of lung illness where patients used THC-based vaping products. A large part of this has to do with how vaping and cannabis products are regulated in the USA. Nicotine-containing products are regulated by the Food and Drug Administration, whereas THC products are allowed and regulated by some states but illegal under federal law. This means that sellers operate under the radar, unregulated as long as they evade detection.
Vitamin E acetate is used as a thickening agent by illicit THC vape cartridge manufacturers, mixed in to attain an appropriate viscosity for vaping without proper testing, as well as to make up for the limited availability of cannabis and high demand. Leading up to the outbreak, illegal sellers used around 50% or more of diluent thickeners to bulk up their vape cartridges, with vitamin E acetate commonly used because of its similarity to THC oil.
Even legal manufacturers are prone to using this compound, as many do not regularly check for chemicals that have emerged as a health threat. The health regulations on recreational cannabis and cannabis derivative products are patchwork, and, while products are tested for “potency, moisture, foreign matter, microbiological, mycotoxins (fungi) and residual solvents”, the list doesn’t encompass pesticides, heavy metals, or chemicals of growing concern like vitamin E acetate. Manufacturers also often don’t think to carry out additional safety tests, and many of the ingredients used in vape oils aren’t fully understood.
While some jurisdictions have taken action since the beginning of the outbreak to more strictly control the sale of products with vitamin E acetate and other chemicals, it doesn’t change the underlying issue in states where THC products are illegal and are therefore produced illegally.
The use of vitamin E acetate in vape oils is particularly harmful, as vitamin E acetate is essentially oil. Its molecular structure gives it a boiling point of 183.9 °C, well above the boiling point of water. Once heated up enough to vaporize, vitamin E acetate can also potentially decompose into toxic byproducts, and when it’s cooled down inside the lungs it returns to its original liquid state and essentially coats the lining of the lungs with grease.
A more recent study found that when vaporized, vitamin E acetate ends up producing not only carcinogenic alkenes and benzene but exceptionally toxic ketene gas. The inhalation of this toxic byproduct is suggested to be a large contributing factor to the lung injuries seen in the victims. Patients also consistently present with foam cells in the lungs - macrophages laden with lipids, which have impaired immune functions and actively worsen inflammation. This is associated with lipoid pneumonia, an illness that occurs when lipids enter the lungs.
While this outbreak of cases is largely an American-centric problem at the moment, it’s a source of alarm and worry for vape users and the industry worldwide, because vitamin E acetate use is something that is used by illicit and legal manufacturers everywhere. European governments also need to call for better legislation and oversight of vape and cannabis products to keep consumers safe. In the meantime, consumers have to be even more alert and aware of where they’re getting their vapes, and what’s in them. In the UK, stricter measures will be enforced in March 2021 where any non-compliant brands will be pulled off shelves. At Amphora, we’re committed to building a foundation of trust with our customers from the start, even before regulations come into force. That is why we carry out third-party lab testing of all our products, to ensure they are safe and of the highest quality.
Vaping mindfully, staying safe
CBD is known to be great for supporting your health and wellbeing, and there are CBD vape products out there that will let you take full advantage of all of CBDs benefits. You need to be careful, though, to make sure you get the right products and keep an eye out for those that could be tainted with harmful additives. Your vaping experience should be enjoyable, and to do that we want you to consume your CBD in a way that doesn’t put your own health and wellbeing at risk in any way.
First and foremost, you should always consult with a doctor before using CBD vape products of any sort, particularly if you have a serious health condition or intend to use cannabinoid vaping for therapeutic purposes. Youths and people who are pregnant or lactating especially shouldn’t be using these products. CBD can also interfere with other prescription medications or dietary supplements by interfering with drug metabolism or the liver’s ability to break down toxins, which is something to keep in mind if you use medication.
Next, before you go purchasing any cannabis vape products, you should check how your region classifies cannabis-derived products and their regulations on THC content. Generally speaking, most places that have legalised cannabis products will have restrictions on the amount of THC that is allowed in a given product - 0.2% THC is the threshold for the UK, for example, and if a product contains less than that, it can be safely and legally obtained from local dispensaries, or online retailers. If an area has legalised cannabis products, it means that those products will likely be better regulated and controlled and it’s easier for you to acquire quality products with a guarantee of accredited lab-testing.
It’s crucial you get your vape products from manufacturers that have a good reputation and make high-quality products, so make sure you read the ingredients list and fine print and you should always check for a label to confirm that the vape has been tested by a third-party laboratory to ensure quality control. Products that lack this may not be legitimate and be laced or cut with potentially dangerous compounds like vitamin E acetate, which could put your health at direct risk. As the cases in the USA have demonstrated, it’s vital that you know just what goes into your vapes. This also means you should refrain from using CBD vape products that you’ve acquired informally, like from a friend or acquaintance, where you don’t have an assurance or certification.
Dosage also differs from person to person and is something that depends very much on the individual in question. Factors like body weight, metabolism, frequency of usage, and more can change the optimal CBD dosage a person needs over time, so a person should always track and observe their own dosage and the effects on their body.
Any products that are ingested or absorbed into the body can come with certain adverse side effects, and CBD is no different. Be aware that CBD use of any kind can come with fatigue, diarrhoea, and changes in weight and appetite. Vaping CBD may also trigger other symptoms, like nausea, dizziness or chest pain - if you experience any of these you should immediately stop using the product and seek medical attention.
Knowing all of the warnings and information now, and even with advice and guidance on how best to navigate the market safely, it can seem daunting to try and procure CBD vapes that will be best for your health and won’t put you at risk. If you worry about your health and the quality of products, Infused Amphora can save you some stress and proudly offer our organically-made, all-natural CBD vape products.
Our products are completely free of vitamin E acetate, as well as PG or VG and other harmful ingredients. They’re sourced from organically-grown hemp plants and manufactured by way of supercritical carbon dioxide extraction technology to give a clean and safe distillate for the final product. Infused Amphora vape oils contain natural, organic CBD distillate and terpenes for flavour and wellness, and completely exclude THC or artificial additives or components. All our products undergo stringent third-party testing to ensure they’re held up to a medical-grade standard of quality,
By purchasing any one of our holistic selection of CBD vape cartridges, you can breathe easy knowing that your vape experience and wellness is in good hands.
Written by | Infused Amphora Team
The Infused Amphora Team is dedicated to creating resources to educate and engage consumers on the growing evidence of CBD benefits and the extensive health and wellness properties of CBD oil.
Contributors | Angus Taylor + Dr Gaylord Wardell
IPI is a pharmaceutical ingredient company that cultivates cannabis strains curated to extract specific cannabinoids, terpenes, and flavonoids for the formulation of effects-based health and wellness products. Angus is an experienced public speaker, engaging stakeholders, governments and media. Angus was the co-founder of NewLeaf Cannabis, Canada’s most successful retail brand to date, and has been established as a well-known and recognized expert in the field.
Dr Wardell is a practising physician with over 40 years of clinical and educational experience in pain management, medical practices and education. Dr Wardell is past President of the Pain Society of Alberta, and current President of the Alberta Medical Association, section of Pain. He is a popular public speaker, an active blogger on medical and pain-related issues, and proponent for scientific validation for patients experiencing pain.
Infused Amphora “Learn” is intended for informational purposes only and is NOT a substitute for professional medical advice, diagnosis or treatment.