What We Currently Know About Vaping Illness
As of September 25th, there are 805 reports of this illness in 46 states. There have been 12 confirmed deaths in 10 different states. So far, none of the deaths have occurred in New York.
The one thing that all of the victims seem to have in common is that they’ve vaped in the past 90 days. From there, there are many variations. Some report only smoking e-cigarettes and some have smoked counterfeit cannabis cartridges, and some have smoked both.
The length of time between exposure and the illness developing has been varied as well. The illness, now called VAPI–vaping associated pulmonary illness–tends to develop over the course of a few days, but can take weeks.
What Are The Symptoms Of VAPI?
The main symptoms of VAPI are coughing and shortness of breath sometimes accompanied by nausea and vomiting, diarrhea, fever, fatigue and weight loss. Most victims are hospitalized, with some requiring intensive care or even respirators. Most cases resemble lipoid pneumonia.
It’s vital to note here that regardless of the speculations, the FDA hasn’t actually found a common thread between the different illnesses. Mitch Zeller, director of the Food and Drug Administration’s Center for Tobacco Products says that it looks like many cases involve THC, but not all. Some cases involve oils and some involve CBDs. A few reportedly involve nicotine only, but Zeller is eyeing those cases dubiously.
The latest death was a Georgia man who reported heavy nicotine vape use, but reported no THC use. Zeller is doubting the veracity of these reports though, as investigators are relying on self-reported data in states where THC products are highly illegal. Patients would obviously be reluctant to report THC use. Possession of one ounce or less in Georgia can result in a year in prison, and possession of more than an ounce is a felony charge carrying up to 10 years.
So it’s easy to understand that high criminal penalties are hampering investigations into the source of the problem. This means it will probably take a little longer to get to the bottom of this puzzle–especially if it involves black market or counterfeit vape pens.
Alternatives To Vaping Cannabis
For those who currently vape and wish to use other methods until the source of the illness is clear, there are several alternatives available.
The non-vape oil products currently allowed in New York are:
- Solid and semisolid preparations like capsules, tablets and lozenges,
- Ground, non-smokable plant preparations,
- Ground, vaporizable plant preparations, and
- Topical applications and patches.
The Difference Between Oral and Inhaled Cannabis
Oral cannabis and inhaled cannabis are very different. They even involve different psychoactive compounds. When cannabis is smoked, delta-9-THC is absorbed into the lungs. When cannabis is ingested, much of the THC is converted to 11-hydroxy-THC in the liver.
11-hydroxy-THC crosses the blood-brain barrier much more easily because it’s more water-soluble. So, even though it takes longer for the high to hit from eating–up to 90 minutes or more–it lasts longer and is much more potent.
This is one of the main reasons many people prefer inhaled cannabis. It’s easier to titrate the dose. Inexperienced patients tend to take too much oral cannabis because of the delayed onset. If they take too much because they mistakenly believe it’s not working, they will get an unpleasant surprise when it all kicks in at once and it will last for hours.
With inhaled cannabis, the effects are felt much more rapidly–usually within about ten minutes. This makes it much easier to find the best dose. It also mitigates the discomfort if they take more than they’re comfortable with because the effects usually peak in about 15 to 45 minutes and wear off in a couple hours.
Inhaled cannabis’ fast onset also makes it the preferred method of administration for pain patients, who are the vast majority of medical cannabis users in New York.
This is why the recommendation to avoid vaping will have a powerful impact on New York cannabis patients. Those who need to switch to oral cannabis will need to take their time adjusting their dose for the best comfort and symptom relief.
A Closer Look At Vaping Alternatives
Tinctures are sometimes called cannabis oral solutions. Whatever the name, they’re a liquid solution that’s held under the tongue. This helps your system to absorb the THC faster through the network of large blood vessels there.
Just like with vape pens, you’ll find tinctures from low to high CBD to THC ratios designed to treat different conditions.
Like all oral cannabis, it’s easy for patients to assume a tincture isn’t working if the effects take longer than they expect. It’s very important to wait at least 90 minutes, if not longer before attempting to adjust the dose. Don’t take more than your doctor recommends.
Oral sprays work like tinctures do, but they make microdosing easier. This makes it simpler for first-time users to start with small doses and experiment until they find the right amount.
You might see ads that say oral sprays mimic smoking. That’s not to say that you should inhale them. That will hurt your lungs. Oral sprays are meant to be sprayed on the mucous membranes inside your mouth and held there for about 30 to 60 seconds without swallowing. They work much the same as tinctures in this way, and should be dosed in the same way with the same waiting period before trying more.
Capsules may be a more comfortable dosing method for patients who are used to taking pills. They come in a wide variety of dosing options and THC to CDB ratios. The downside is that it’s harder to adjust the dose if you find that your capsules are more potent than needed.
Also, make sure you let your pharmacists know if you have any allergies, such as to gluten or wheat. They may need to check the inactive ingredients to ensure you can take them safely.
Tablets work in basically the same way as capsules. Their advantage is that it’s easier to split your dose if you find that the option you purchased is too potent for your needs. Again, make sure to check the inactive ingredients for any possible allergens that can affect you.
Ground Flower Pods
This is a very new option that’s only recently become available with Curaleaf–although other retailers are sure to follow soon. Ground flower pods are simply cannabis buds that have been pre-ground for easy vaping. The flower is inserted into a specially designed vaporizer that heats the herb to just under the combustion level. This releases the cannabinoids for inhalation without creating smoke and tar.
So far, ground flower pods are only available in a 20:1 THC to CBD ratio.
Health authorities have not weighed in yet on whether vaping dry herbs may be a safe option to vaping oil during the investigation, so it’s best to ask a doctor if this method is advisable.
If your doctor decides this is a good option, you’ll need a special device called a dry herb vaporizer to use the flower pods. These devices come in desktop or handheld units and can run on household electricity or batteries. Your dispensary and doctor can recommend the best make and model to suit your needs and show you how to use it.
What If A Dose Is Too Strong?
Those who’ve never taken oral cannabis might experience some anxiety if they take a strong dose. If you haven’t found your sweet spot yet, you might want to be with a comfortable friend or family member till you find it.
Some people experience palpitations, paranoia and panic attacks instead of the usual calming and pain-relief they experience with inhaled cannabis. If this happens to you, remember that no one has ever died from a cannabis overdose. Simply remain calm and call your doctor to have your dosage adjusted. Your doctor might want to consider a higher CBD to THC ratio as well.
Until you feel better, drink plenty of fluids and eat a snack if you feel hungry (which you most likely will). This can help to occupy your mind. Try to find something fun to do as well, like playing a game with friends, reading a good book or watching a favorite show or movie. It may seem like forever till it wears off, but it eventually will–usually within about 6-8 hours.
And of course, if you start to experience any very unusual symptoms like excessive vomiting, call your doctor.
How To Change Your Cannabis Administration Method In New York
Unlike most other states, New York requires that a doctor recommends the specific amount of cannabis a patient needs, the ratio of CBD to THC, and how to administer it. In other words, New York recommendations work a lot like medication prescriptions. Some doctors recommend a wide variety of options, and some are very specific.
If you received your recommendation from a NuggMD doctor, chances are you already have access to other forms of cannabis besides vaping. Their doctors recommend many types and strengths to allow room for trial and error. Other doctors may have recommended only one specific method and strength.
If you have one of those recommendations that only allow vaporization oil, you will need to see a doctor to get this changed. NuggMD doctors are available from 8AM to 10PM daily via NuggMD’s state-of-the-art telemedicine platform. You can see a new cannabis doctor with them from the comfort of your own home today.
As stated above, it could take months to discover the cause of the recent illnesses. Meanwhile, patients and recreational cannabis users will need to weigh the risks versus benefits of their particular form of cannabis use.
There will likely be unintended consequences of the bans and precautions as well. Some states are considering banning all vape products, not just flavored liquids. Most notably, the governor of Massachusetts declared an emergency ban of all vape products for 4 months. This is leading to speculations that more problems will occur as vapers turn to black market products instead. Others are questioning why e-cigarettes are banned after 12 deaths when legally-sold regular cigarettes kill nearly half a million people a year.
Regardless of whether the current illnesses are simply media hype or something more serious, those who choose to use inhaled forms of cannabis should monitor their lung health carefully and report any new breathing problems to their physician.
Deb Tharp is a cannabis activist, consultant, and writer. She began her cannabis activism at the age of 18, helping local candidates campaign door-to-door in the Midwest. Little did she know that the plant would save her husband's life a decade later. After watching him recover 60 pounds to his skeletal frame in a matter of months, she was convinced that the war on weed must end. She ran for State Assembly in 2010 while completing her bachelor's degree at University of California, Irvine. During her campaign, she managed to bring cannabis legalization to the forefront of the debate. Little more than a year later, she was publicly arrested while gathering signatures for a cannabis ballot initiative in Orange County. She fired back at the county by qualifying Measure CC in Santa Ana under Kandice Hawes' of OC Norml’s expert leadership. In the following years, she authored, qualified and helped to qualify over a dozen local legalization ballot initiatives across the state while teaching other activists how to do the same. She currently writes for Nugg, the nation's largest online cannabis marketplace, while pursuing her law degree at Taft Law School and will graduate in 2021.