4、然後呼 吸 呼 吸！
废话不多说直接进入正题了！最近很多人都在讨论电子烟的危害。根据美国疾病控制与预测中心（简称CDC）在11月21日的报告，美国因抽电子烟而入院的案件一共有2290宗，其中有47个人不幸死亡。第一宗死亡案件是在10月8日发生的，死者是一名17岁的少年。经过调查这死者抽的是THC-based vape juice，THC全称四氧大麻酚，也就是大麻中的主要物质。
CDC Latest Update on November 21, 2019, at 1:00 PM EST
What is New
CDC has identified vitamin E acetate as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI). Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) from 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the samples. Vitamin E acetate is used as an additive, most notably as a thickening agent in THC-containing e-cigarette, or vaping, products.
CDC recommends that people should not use THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, or family, or in-person or online dealers. While this investigation is ongoing, vitamin E acetate should not be added to e-cigarette, or vaping, products.
In addition, people should not add any substance to e-cigarette or vaping products that are not intended by the manufacturer, including products purchased through retail establishments. CDC will continue to update guidance, as appropriate, as new data become available from this outbreak investigation.
EVALI: The name given to vaping-related illness is E-cigarette, or Vaping, product use Associated Lung Injury (EVALI).
What We Knowhttps://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
New Laboratory Findings:
Analyses of bronchoalveolar lavage (BAL) fluid samples (fluid samples collected from the lungs) of patients with e-cigarette, or vaping, product use associated lung injury (EVALI) identified vitamin E acetate, an additive in some THC-containing e-cigarette, or vaping, products.
Recent CDC laboratory test results of BAL fluid samples from 29 patients submitted to CDC from 10 states found vitamin E acetate in all of the samples.THC was identified in 82% of the samples and nicotine was identified in 62% of the samples.
CDC tested for a range of other chemicals that might be found in e-cigarette, or vaping, products, including plant oils, petroleum distillates like mineral oil, MCT oil, and terpenes (which are compounds found in or added to THC products). None of these chemicals of concern were detected in the BAL fluid samples tested.
This is the first time that we have detected a chemical of concern in biologic samples from patients with these lung injuries. These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs.
These findings complement the ongoing work of FDAexternal icon and some state public health laboratories to characterize e-liquid exposures and inform the ongoing multistate outbreak.
About the Outbreak:
As of November 20, 2019, 2,290* cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 2 U.S. territories (Puerto Rico and U.S. Virgin Islands).Forty-seven deaths have been confirmed in 25 states and the District of Columbia (as of November 20, 2019).
CDC continues to work closely with FDA, states, public health partners, and clinicians on this investigation.
About Patient Exposure:
All EVALI patients have reported a history of using e-cigarette, or vaping, products.Vitamin E acetate has been identified as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI).
THC is present in most of the samples tested by FDA to date, and most patients report a history of using THC-containing e-cigarette, or vaping, products.
The latest national and state findings suggest THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, or family, or in-person or online dealers, are linked to most of the cases and play a major role in the outbreak.
在这个update当中，CDC提到在所有受害者的支气管肺泡灌洗液样本（在肺提取的液体样本）中，所有样本都含有醋酸维生素E（Vitamin E Acetate)。Vitamin E Acetate 则是THC vape juice必须有的添加剂。其中82%的样本确认是含有大麻成分（THC）。这样看来，小编觉得抽电子烟致死的正真原因应该就是THC，大麻烟油。这纯粹个人观点。那美国CDC有什么建议呢？
What CDC Recommendshttps://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
CDC recommends that people do not use THC-containing e-cigarette, or vaping, products.
CDC also recommends that people should not buy any type of e-cigarette, or vaping, products, particularly those containing THC from informal sources like friends, or family, or in-person or online dealers.
Modify or add any substances to e-cigarette, or vaping, products that are not intended by the manufacturer, including products purchased through retail establishments.
Adults using e-cigarettes to quit smoking should not go back to smoking; they should weigh all risks and benefits as smoking is brings more damages to human body.
Adults who continue to use an e-cigarette, or vaping, product, should carefully monitor themselves for symptoms and see a healthcare provider immediately if they develop symptoms like those reported in this outbreak.
Irrespective of the ongoing investigation:E-cigarette, or vaping, products should never be used by youths, young adults, or women who are pregnant.
Adults who do not currently use tobacco products should not start using e-cigarette, or vaping, products. There is no safe tobacco product. All tobacco products, including e-cigarettes, carry a risk.
THC use has been associated with a wide range of health effects, particularly with prolonged frequent use. The best way to avoid potentially harmful effects is to not use THC-containing e-cigarette, or vaping, products. Persons with marijuana use disorder should seek evidence-based treatment by a health care provider.
People who have significant impairment or distress from ongoing problematic use of THC-containing e-cigarette, or vaping, products should seek evidence-based behavioral treatment and recovery services for cannabis use disorder.
另外还有这个washingtonpost.com 的新闻值得一看。新闻中提到有一部分的患者尽管口中说没抽大麻烟油，但是尿液检测结果显示THC positive。医生说部分患者可能不好意思承认使用大麻产品。
Is vitamin E acetate the culprit?https://www.washingtonpost.com/health/2019/09/07/what-we-know-about-mysterious-vaping-linked-illnesses-deaths/
The Post reported in early September that investigators at the Food and Drug Administration found the same vitamin E-derived oil in marijuana products vaped by multiple people sickened around the country.
The chemical, vitamin E acetate, was present in almost all of the cannabis samples from victims identified in New York, according to the state’s health department. New York Gov. Andrew M. Cuomo (D) has directed his health department to subpoena three companies selling “thickening agents” used to adjust THC levels in products found on the black market. The thickening agents are “nearly pure” vitamin E acetate, officials say.
Vitamin E acetate has also been found in samples collected from across the country and tested by the FDA. FDA testing has found THC in 70 percent of samples linked to patients. Half of those THC samples also contained vitamin E acetate in concentrations as high as 88 percent.
On Nov. 8, Anne Schuchat, CDC’s principal deputy director, said the discovery of vitamin E acetate in the lung fluids of 29 people sickened in outbreak “provide direct evidence of vitamin E acetate at the primary site of injury, within the lungs.” It points to growing evidence of vitamin E acetate as “a very strong culprit of concern,” she said in a briefing with reporters.
The findings don’t rule out other possible compounds or ingredients that may be causing the lung injuries. But CDC tested for a wide range of substances that might be found in patients’ lung fluids, including plant oils and petroleum distillates, such as mineral oil. None of the others were detected.
Potential culprit found in vaping-related lung injuries and deaths
Some patients have said they vaped only nicotine products, even though urine tests have showed the presence of THC, authorities said. Doctors say patients may be hesitant to admit to using marijuana.
The FDA disclosed that it has launched a criminal investigation with the Drug Enforcement Administration. That is happening alongside the probe by the CDC into the cause of the illnesses. Federal officials are not pursuing individual vapers. But if the FDA determines “someone is manufacturing or distributing illicit, adulterated vaping products that caused illness and death for personal profit, we would consider that to be a criminal act,” said then-acting FDA commissioner Norman “Ned” Sharpless.
In testimony before a House panel, Sharpless said the FDA has received 300 samples from vaping-related injury patients and tested 150. About 70 percent are products containing THC, and about half of those contain vitamin E oil, which Sharpless said has “no business” being in the lungs.
New York’s health commissioner, Howard Zucker, has urged medical marijuana patients to discuss alternatives with their doctors, although no sicknesses have been reported among patients in the state’s medical marijuana program.
Black market marijuana products, which industry experts say are typically cheaper than legally sold items, are drawing increasing scrutiny. California, home to the largest legal marijuana market in the world, has a black market three times that size. Changes in the ingredients used in popular marijuana vaping devices in the state could be making people sick, according to experts of the legal and illicit cannabis markets, as well as doctors and health officials. They say black market operators are using more thickening agents to dilute THC oil because of a crackdown by state authorities that has made the oil scarcer on the black market.
THC oil is used to fill tiny disposable containers known as vape cartridges, which are heated to create vapor that can be inhaled. Vaping cartridges are among the most popular items in the legal and illicit markets, industry analysts said.
RELX 是属于closed pod system，关闭式电子烟，也就是不可以自己换烟油的电子烟。那用户就不能擅自换THC烟油来抽，而且官方标配的烟油绝对是不含THC成分的。以下是RELX在国外的检测报告。