The Centers for Disease Control and Prevention (CDC) on Friday warned against the purchase of electronic cigarette cartridges containing marijuana or altered e-cigarette products that the CDC described as counterfeit or “off the street”.
The CDC said these counterfeit products can either be sold in stores or from unauthorized persons/locations. As of Friday, up to 354 possible cases in 29 states and the territories — double the number reported the week before — have been reported. CDC is investigating.
According to the New York Times, patients, mostly otherwise healthy and in their late teens and 20s, are showing up to hospitals with severe shortness of breath, often after suffering for several days with vomiting, fever and fatigue. Some have wound up in the intensive care unit or on a ventilator for weeks. Treatment has been complicated by patients’ lack of knowledge — and sometimes outright denial — about the actual substances they might have used or inhaled.
On lung scans, the illnesses look at first like a serious viral orbacterial pneumonia, but tests show no infection. “We’ve run all these tests looking for bacteria, looking for viruses and coming up negative,” said Dr. Dixie Harris, a critical care pulmonologist in Salt Lake City, who has consulted on four such patients and reviewed case files of nine others in the state.
The V.I. Department of Health said Wednesday that a growing number of cases in the Virgin Islands are also being investigated, and the health department is asking persons who are experiencing symptoms to report to their physician at D.O.H.
There have been reports of individuals’ limbs being amputated because of the mysterious illness.
The Times said the outbreaks have created a crisis for two emerging industries — e-cigarettes and legal cannabis — that have pitched themselves as beneficial to public health. E-cigarette supporters consider the technology a safer alternative to smoking, while cannabis has been sold politically as “medical marijuana” and as a substitute for tobacco growers.
Federal and state officials are urging the millions of Americans who use these products to stop vaping until the cause of the illnesses are identified. The Department of Health also urged Virgin Islanders to stop vaping until the investigation is resolved.
Patients have experienced cough, shortness of breath and chest pain. Some also have had nausea, vomiting or diarrhea, fatigue, fever, weight loss or other issues. The symptoms typically develop over days, but sometimes can manifest over several weeks. The gastrointestinal symptoms sometimes preceded respiratory symptoms. Suspected cases have resulted in serious lung damage, other complications and death.
“Anyone who uses e-cigarette products should not buy these products off the street (e.g., e-cigarette products with THC, other cannabinoids) and should not modify e-cigarette products or add any substances to these products that are not intended by the manufacturer,” the government officials said. E-cigarettes can contain harmful or potentially harmful substances, including nicotine, heavy metals (e.g lead), volatile organic compounds and cancer-causing chemicals. Some e-cigarette products are used to deliver illicit substances and may be acquired from unknown or unauthorized sources.
CDC warned that young people and those in early adulthood should not use e-cigarettes, as well as pregnant women and adults who don’t use tobacco. Those who do should watch for symptoms including cough, shortness of breath or chest pain and seek medical treatment in those cases.
It is suspected that most cases are the result of adulterated or contaminated products involving THC or other cannabinoids from marijuana. The cutting, flavoring, or solvents used in producing these products “off the street”, without regulatory testing, are possible culprits.
The Department of Licensing and Consumer Affairs (DLCA) has received reports of counterfeit Juul cartridges being sold within the territory and Commissioner Designee Richard Evangelista has assigned DLCA enforcement officers to investigate and take whatever action is necessary to remove the dangerous products from the shelves. It is impossible to know what chemicals are being sold in counterfeit and/or “off the street” products, until they are reported and tested, the Dept. of Health said.
Both hospitals in the territory, Schneider Regional Medical Center and Governor Juan F. Luis Hospital and Medical Center are monitoring incoming patients for potential exposure to vaping, D.O.H. said.
Recommendations for the Public
1. While this investigation is ongoing consider refraining from using e-cigarette products.
2. Regardless of the ongoing investigation, anyone who uses e-cigarette products should not buy these products off the street (e.g., e-cigarette products with THC, other cannabinoids) and should not modify e-cigarette products or add any substances to these products that are not intended by the manufacturer.
3. Regardless of the ongoing investigation, e-cigarette products should not be used by youth, young adults, pregnant women, as well as adults who do not currently use tobacco products. If you use e-cigarette products, monitor yourself for symptoms (e.g., cough, shortness of breath, chest pain) and promptly seek medical attention if you have concerns about your health. CDC and FDA will continue to advise and alert the public as more information becomes available.
4. Adult smokers who are attempting to quit should use evidence-based treatments, including counseling and FDA-approved medications. If you who need help quitting tobacco products, including e-cigarettes, contact your doctor.
5. If you are concerned about harmful effects from e-cigarette products, call your local poison control center at: 1-800-222-1222.
6. If you have a medical emergency, please seek immediate medical attention.
7. We encourage the public to submit detailed reports of any unexpected tobacco or e-cigarette-related health or product issues to the FDA via the online Safety Reporting Portal: https://www.safetyreporting.hhs.gov.
8. Any suspect cases can be submitted to Dr. Esther Ellis, Territorial Epidemiologist firstname.lastname@example.org
9. Need to report to DLCA any suspected counterfeit products. Consumers can contact the Office of the Commissioner on St. Croix at 340-713-3522; St. Thomas at 340-714-3522; or on St. John at 340-693-8036; or by email email@example.com