There’s strong new evidence connecting vitamin E acetate to the mysterious and sometimes deadly outbreak of vaping-related lung illness.
Federal health authorities said Friday they found the oil, a cutting agent long suspected in the outbreak, in 29 out of 29 lung fluid samples taken from patients in 10 states. They called the findings a "breakthrough" in the investigation.
"This is the first time that we have detected a potential chemical of concern in biologic samples from patients with these lung injuries," the Centers for Disease Control and Prevention said.
As of Tuesday, the outbreak — officially called "e-cigarette, or vaping, product use associated lung injury," or EVALI — had stricken 2,051 people nationwide, causing 39 deaths. In Oregon, the numbers stood at 17 cases, with two deaths.
The CDC said Friday that "the trend in cases appears to be downward." Although cases date back to March, the outbreak gathered force in the second half of the summer, peaking in mid-September with around 200 new weekly patient admissions. But in the latest weekly report, new admissions were down to 13.
Health officials are advising against vaping, and several states have moved to ban at least some vaping products. In Oregon, a lawsuit brought by vaping shops has limited a ban on flavored vapes to those regulated in the Oregon Liquor Control Commission's recreational marijuana program.
Products sold in those OLCC-regulated shops are required to list additives, and no labels have ever been approved with vitamin E.
But amid suspicions and uncertainties, state regulators in September asked retailers to "review your vaping products ... for those containing additives that may be of public concern (and) consider acquiring more detailed information about the included additives from the product manufacturer."
That led many retailers to move away from vape products that contained anything beyond cannabis extract, even before rules banning flavored vapes went into effect one month ago. Meanwhile, cannabis vape sales plunged.
Through the course of the outbreak, most patients have been found to have vaped cannabis products, but some vaped nicotine products and some both. In the latest research, THC was identified in 82 percent of the samples and nicotine in 62 percent of the samples. The CDC recommends against using any THc vaping products, and any other vapes "obtained from informal sources."
CDC said it tested for various other possible additives — including MCT oil and terpenes — and none were detected in the lung fluids.
The new Oregon rules include a prohibition on terpenes derived from plants other than cannabis. That's been criticized by companies that use plant-derived terpenes to flavor their vapes; they note that isolated terpenes are the same in chemical makeup whether they come from cannabis or other plants.
But the OLCC said those terpenes have no proven safety record for inhalation, come from outside the OLCC system, frequently contain unknown ingredients and are added at a point in the process that misses pesticide and solvent testing.
As for Vitamin E acetate, it's generally considered safe when consumed as a supplement or used as a skin cream, but has been suspected of causing lung problems. In early September, New York health authorities said Vitamin E had been found in 13 samples from devices used by eight of 34 patients it tested.
The CDC said the fact that the new information comes from patients in 10 different states adds to its power.
"These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs," the CDC said.
Still, the CDC said more work was necessary. And it's worth noting that in early October, the Mayo Clinic in Scottsdale, Arizona, said it didn't find evidence of oils in the lungs, and instead likened the injuries to a "chemical burn."