Sketchy THC vape products. Sneaky teens. How patchwork regulations on e-cigarettes led to health cri

Article from USA Today
Vaping illnesses: Crisis mixes teens, black market THC, no regulation

Ricky D'Ambrosio bought his last cannabis oil cartridge last month at a California marijuana dispensary that "felt legitimate, but wasn't in the best part of town."

About a week after he finished it, the 21-year-old began vomiting so much his mother rushed him to the hospital. He spent 10 days there, four of them in a medically induced coma. A college student who loves to water ski and wakeboard, D'Ambrosio could barely walk down the driveway when he got home Sept. 10.

D'Ambrosio is one of at least 530 people — most of them young men — the CDC says are confirmed and probable cases of vaping-related lung illness. Eight people have died in six states with the first confirmed death in April. Federal and state investigators are focusing on vape cartridges that likely contained contaminated tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana. But they are also looking at all substances used in electronic cigarettes, including those with nicotine.


Ricky D'Ambrosio, 21, poses for a portrait at Folsom Lake in Granite Bay, Calif. near his home. D'Ambrosio used to waterski and wakeboard in the lake but had trouble walking to the end of his driveway after his release September 10th from the hospital where he was in a medically induced coma due to acute respiratory failure from vaping (Photo: Max Whittaker, for USA TODAY)

The Centers for Disease Control and Prevention and the Food and Drug Administration has warned consumers not to buy THC oil from street dealers. Both agencies also recommend against all vaping.

So why is this all happening right now?

The conditions were ripe for a crisis: Teen use of electronic nicotine cigarettes have soared as marijuana has become increasingly legal and accepted. Vaping became an increasingly popular, more discreet way to consume cannabis, especially by those already-primed young people. A black market has boomed in a regulatory void. That was thanks in part to the 2018 farm bill – signed by President Donald Trump in December – which allowed growing and sales of cannabis-based hemp in many states and created a mass market for THC-containing cannabidiol (CBD).

"If you ask what happened, there was a surge in popularity of CBD vapes by national brands this summer," says former FDA commissioner Dr. Scott Gottlieb.

David Kurzfeld, whose California company removes contaminants from marijuana, says vaping has gone mainstream: "Kids don’t want to roll joints anymore."



An expanding black market
Arizona's Maricopa County sheriff provided more evidence last week when he announced the arrest of two men with more than $380,000 worth of illegal THC vape cartridges, including the Dank brand linked to most of the 53 vaping-related lung illnesses studied in Illinois and Wisconsin, along with guns and cash.

Even in California, where marijuana is legal for recreational and medical use, a black market thrives. Mendocino County Sheriff's office seized $5 million worth of contaminated counterfeit THC oil bearing the brand CaliPiffs in March. It had 7,000 times the allowable level of a pesticide that turns into the poison cyanide when heated. The men arrested in July told agents half of their product was sold on the black market and the other half went to "legitimate dispensaries," Christopher Davidson, a special agent with the Mendocino County major crimes task force said last week.

Recent testing by the Associated Press found synthetic marijuana – which is linked to deaths and effects including psychosis and violence in users – in 10 of 30 brands of CBD sold commercially and on the black market. Some also had no CBD.

"People want the product so bad in other states, it's hard to keep people honest," said Kurzfeld, who owns Modular Processing Systems in Willits, California, which tested the cannabis seized in Mendocino County. "They're spraying all kinds of crazy substances on their plants, it’s going downstream and we're seeing all the effects all over the country."

'Easier to hide from our parents'
D'Ambrosio started vaping at the end of his sophomore year in high school. By his senior year in 2017, he estimates about half his class vaped. He and his friends tried cigarettes, but D'Ambrosio said, "this was easier to hide from our parents."

D'Ambrosio made his own devices with coils they would "drip vape juice on" before he moved onto brands and devices including Juul and Nova he would get online or at any "fairly reputable" vape shop.

rates this year are double that of 2017, the National Institute on Drug Abuse reported last week, and a study out last month found this more than triples the likelihood they will use marijuana. NIDA said 12% of high school seniors reported vaping nicotine daily and 20% of 10th graders used e-cigarettes in the last month, up from 16% last year.

D'Ambrosio could finally make legal purchases on his 21st birthday which was June 28. He and his friends bought a joint from a dispensary in Sacramento to celebrate that day. He bought his last cartridge of THC in August from a different dispensary in the county.

He spent the week of Aug. 18 helping a friend move despite the start of flu-like symptoms. By Tuesday, Aug. 27, he had trouble catching his breath, began throwing up, sweating and developed a fever. When he couldn't stop throwing up that Saturday night, his mother took him to the emergency room, as they feared it was a risk for his blood sugar. He also has Type 1 diabetes.

A chest X-ray initially came back clear, but by early Monday morning, it was cloudy. "He went downhill and downhill very fast," said his mother, Christy D'Ambrosio.

"There's no protocol for his care," said his mother. Doctors "can’t tell us what the future holds because he's the only one they've seen with anything like this."

Buying on the street
Every state requires consumers to be at least 18 to purchase vape supplies. So many teens buy the vape devices and cartridges illegally. Millions of students already had the devices so slipping in street-bought THC cartridges required little effort and eliminated the sticky, smelly task of preparing weed to smoke.

Dr. Sean Jorgensen Callahan is a pulmonologist and University of Utah professor who treated two of the six patients with vaping-induced lung illness whose cases were reported in the New England Journal of Medicine. He said his "suspicion is this is not cumulative, (but) something new that people are being exposed to."

"The probability is very high it's one agent causing this illness, but this could be a number of things, the hodgepodge of what people are using and combining," Callahan said. "Young people are pretty nondiscriminatory in what they’re vaping."

Counterfeiters mass produce knockoffs of the packaging of products sold by the bigger-name weed brands and fill cartridges with oils containing contaminants.

The two men arrested in July in Mendocino County, Grant Anderson and Adam Bushaw, taught themselves how to manufacture THC cartridges through YouTube videos, said Davidson of the county's task force. Although Davidson said the CaliPiff brand was marketed on Facebook and Snapchat, the men also benefited from YouTube reviews to sell their product.

Inhalation of the detected pesticide, myclobutanil, could lead to health issues ranging from vomiting and shortness of breath to cancer and liver problems, said Dr. Charles Evans, an emergency medicine physician in Ukiah, California.

Mendocino County Sheriff Tom Allman said his undercover deputies are buying vape oil at dispensaries around the county and Kurzfeld's lab is performing the $500 to $1,000 tests for free.

Kurzfeld said his previous testing of marijuana heading to dispensaries found "tons of mercury" – as much as 40 times the allowable amount – and heavy metals including arsenic and lead.

Manufacturers typically dilute contaminated cannabis, which reduces the impact of the risky chemicals, but the heating process adds new dangers, experts say.

When vaping, "users are frying the oil to a temperature – above 400 degrees – where myclobutanil breaks down and emits hydrogen cyanide," said Foster Winans, a senior editor at Marijuana Times. That, he said, is "the same cyanide in the gas used by the Nazis to exterminate millions of Jews and other minorities."

In Phoenix, Tucker Reece and Kolby Stevens, both 23, were arrested in a house detectives believe was operating as a "Closed Loop BHO Manufacturing Lab." BHO stands for "butane honey oil" and is the most dangerous way of extracting cannabis, says Kurzfeld. Detectives found about 1,100 Dank brand packaged vape cartridges and eight jars of cannabis oil.

What Winans calls "outlaw growers" can have thousands of plants and Kurzfeld said most are unwilling to spend the money on taxes and the fees to have contaminants removed.

"People are greedy. They can't take the loss of an entire season's crop," he said. "Every bit of the dirty product is sold illegally."

'Not worth any high'
Taylor Fredette, 20, wonders if she got both tainted THC oil and bad hardware.

Like other lung injury victims, she had occasionally vaped nicotine and smoked marijuana since she moved from New York to Spring Hill, Florida, while in high school to live with her mother. A dealer she relied on for marijuana started offering THC oil cartridges in the spring so she decided to try it.

At first, a cartridge would last about a week and a half. When her depression and anxiety increased, she started going through a cartridge every four days, she said.

"I literally wanted to die," said Fredette. But after a hit off her vape, she was "the happiest person ever."

Fredette used a white dab pen she bought for $10 at a local vape shop. She could push a button and change the temperature, but it fell apart in her back pocket. Shortly after, on Aug. 20, she started getting very bad stomach pains and nausea and went to urgent care and then the hospital. She wound up with "acute pneumonia" and was hospitalized for 13 days, five of them on a ventilator.

Now off vaping and on the antidepressant Lexapro, Fredette wants to help others make better choices.


Taylor Fredette holds her $10 dab pen that fell apart shortly before she was admitted to the hospital. (Photo: Courtesy of Taylor Fredette)


"This whole situation opened my eyes," said Fredette. "I was meant to be here and should not allow myself to put such toxins in my body."

Ricky D'Ambrosio now agrees with Fredette: "The end result of what could happen is not worth any high in the world."