Vitamin E Acetate Products Investigated in THC Oil Deaths

There was big news on the lung injury outbreak yesterday, and it came—again—from the cannabis press. Leafly reported that multiple companies have been making and selling cutting agents for hash oil used in vape cartridges that contain the substance known as vitamin E acetate. The dangerous product may be in more than half of all the carts sold in the U.S.

As we reported last week, vitamin E acetate has gained popularity as a diluting agent for black market cannabis oil produced in California and sold in cartridges across the country. While it’s sometimes called vitamin E oil, the substance is not a true oil, although it is oil soluble. Its chemical name is tocopherol acetate (or tocopheryl acetate for the synthetic version), and before it was used to dilute cannabis oil to stretch the batch to fill more carts, it was primary employed in the manufacture of cosmetics and soaps.

Companies sell it to cannabis processors under many brand names including Honey Cut, Uber Thick, and Pure Diluent. It is not intended for inhalation.

The manufacturers of those three products have been sent subpoenas by New York State, after testing by the Department of Health showed the products were almost pure vitamin E acetate. Most of the black market THC oil carts supplied by lung injury victims and tested by the state showed high levels of vitamin E acetate, according to TV station WABC.

New York Gov. Andrew Cuomo ordered the subpoenas. Cuomo also said he intends to ban flavored e-liquid and force vape shops to post warning signs. Like many politicians and public health officials, Cuomo can’t seem to separate the black market THC problem from nicotine vaping—even when his own health department has showed him the test results.

E-liquid for nicotine (or non-nicotine) vaping doesn’t contain thick cutting agents, which are as dense as cannabis oil itself and would be useless in liquid-based vape juice. But that hasn’t prevented public officials from trying to conflate the two products as the death toll climbed to five in the nationwide outbreak.

The CDC continued last Friday to warn consumers away from all forms of vaping, despite having found no evidence that nicotine vaping products are responsible for any of the 450 suspected cases in 33 states. The agency held a phone briefing for news media, along with the FDA and state health officials.

Dr. Dana Meaney-Delman of the CDC told the reporters that “while the investigation is ongoing, CDC has advised that individuals consider not using e-cigarettes because as of now, this is the primary means of preventing this type of severe lung disease.”

Oddly, the FDA focused squarely on the cannabis oil vapes in its update, noting that “many of the samples tested by the states or by the FDA as part of this ongoing investigation have been identified as vaping products containing [THC] and further, most of those samples with THC tested also contained significant amounts of Vitamin E acetate. Vitamin E acetate is a substance present in topical consumer products or dietary supplements, but data are limited about its effects after inhalation.

“While the FDA does not have enough data presently to conclude that Vitamin E acetate is the cause of the lung injury in these cases, the agency believes it is prudent to avoid inhaling this substance.”

CNBC reporter Angelica LaVito noticed the discord between the agencies and asked about it. “You’re saying that a lot of these cases have THC and nicotine,” she said. “Some, one or the other. But you’re telling people not to use e-cigarettes. Would you use recommend using vaping more broadly or how could we communicate this more accurately?” The CDC’s response was to use “e-cigarettes.”

Former FDA commissioner Scott Gottlieb responded to LaVito on Twitter to explain that the FDA supports harm reduction for people who smoke, and that the CDC “was always more skeptical.” The reporter may have exposed the differences, he said.

Two other manufacturers told Leafly they have also been selling vitamin E acetate to the cannabis industry: Constance Therapeutics of California and Mr. Extractor of Oregon, which made a product called Clear Cut. (The Constance Therapeutics CEO recently wrote a defense of her vitamin E-based CBD product on LinkedIn, to which cardiologist Konstantinos Farsalinos commented.)

Honey Cut has advertised its ability to dilute cannabis oil up to 75 percent, according to Downs. The company’s website—which listed no contact address or phone number—has been down since last week.

“We don’t sell [Uber Thick] for vaporization, but that’s what some customers use it for,” Floraplex’s Jared McKinney told Leafly’s David Downs in August. “Whether it would be bad or good, we can’t say either way.” The company no longer shows Uber Thick on its website. Downs said the Floraplex CEO estimated that there are 50 million carts containing vitamin E oil on the black market.

Drew Jones of Mr. Extractor told Leafly that he believes 60 to 70 percent of the cannabis vape carts in the country contain vitamin E acetate. He said that the Oregon Liquor Control Commission (OLCC) knew about and allowed him to use the diluent. The agency denies that, telling Leafly that Jones is not a license-holder in the state and that vitamin E acetate was not knowingly allowed into cannabis products. But the substance isn’t banned for use in oil vapes in Oregon—or anywhere else on the west coast.