As someone who has experience in this industry I can point to the cause. Biomas... | Hacker News

Isn’t the vast majority of vaping not marijuana? I’m surprised there was such conflation in the article. And this reply speaks solely about cannibus.

The article implies that the problem seems to be caused not necessarily vaping as such, but by two things: 1) vaping things that really should not be vaped, resulting in oil droplets getting in your lungs. e.g. "cannabidiol oil, which is not designed for vaping but has been used that way." Apparently some vaping fluids are much worse than others, thus the recommendation to "stop buying bootleg and street cannabis and e-cigarette products, and to stop modifying devices to vape adulterated substances." 2) people not seeking timely medical attention and lying about the causes, as marijuana possession is still a crime where they live.

The vast majority of vapers are unaffected. From the article: ----- > The patient’s older brother, a police officer, was suspicious. He rummaged through the youth’s room and found hidden vials of marijuana for vaping. > Health investigators are now trying to determine ... whether the risk stems from a broader behavior, like heavy e-cigarette use, vaping marijuana or a combination > Many vaping ingredients are not listed on the products. Vitamin E oil appears to have been a common substance associated with the severe and sudden respiratory problems in some of the New York cases, according to state health officials. It is not known how it was used. Vitamin E is sometimes advertised as a supplement in cannabidiol oil, which is not designed for vaping but has been used that way. ----- Nicotine is typically in a base of propylene glycol or vegetable glycerine (I think I got those right). I believe both are cheaper than the "adulterants" such as vitamin e oil being used to cut the THC oils, so it is unlikely that people vaping exclusively nicotine products are being affected. There's been some concern around certain flavorings being much riskier than others (i.e. popcorn lung) though I suspect it'll be some years yet before the effects from those start playing out.

Judging from the handful of vaping articles linked here on HN over the past few weeks, they seem to involve cannabis or cbd oil, whatever it's called. But they are all titled in a way that doesn't reveal this potential link for whatever reason.

Do you think that pesticide use could be a contributing factor as well? I ask because my hemp mentor will never touch concentrates. He argues that even the tiniest bit of pesticides or inorganic fertilizers will also be more concentrated and he’s not willing to gamble on it. There’s just too many unknowns when it comes to that.

If they are extracting from trim and other low-value parts of the plant, yeah that is a possibility. Myclobutanil has a boiling point around 200 C, THC around 155 C. They have similar hydrophobic nature. So any extraction process favoring THC will also likely partition myclo. If you are making concentrate from buds, this isn't an issue, as your ratio of active components to pesticide is going to be similar. However if you are extracting low-density plant matter, your ratio of myclo to actives will be higher. However, the highest number I've seen reported was just shy of 1 ppm myclobutanil. Not great, but that's still pretty low. https://www.thestranger.com/slog/2018/12/20/37272899/no-one-...

I've seen 700ppm total pesticides and typically between 50-300ppm in the CA medical market of 2015-2017. Myclo up to 150ppm was pretty common in the crude I was testing. I tested at SClabs, Anresco, Steep Hill, CW Analytical, etc. depending on client preferences.

Is this specific to vaping supplies, or would it also impact CBD oil tinctures?

Got it. Thanks for the extra reference. Definitely seems like it’s a moot point and something else is at play, giving more credence to the OPs speculation.

No, I don't. There's some talk about neem oil(azadirachtin) being the cause of cannabis hyperemesis syndrome. People have been consuming large quantities of cannabis oil that were saturated in pesticides for over a decade without this kind of crisis. I run a cannabis copacking company and one of my clients was the first to go pesticide free back in 2016. It was near impossible to source material for them. Prior to 2018 about 95% of material was sprayed with pesticides. Because black market distillate is typically made from mixed batches of oil there was higher contamination rates than that. I think it's questionable to consume cannabis in general and especially concentrates. The safest method is likely oral consumption. I have seen contaminants in concentrates, such as fire retardant, that pass all screening tests. Neem oil, for example, is an approved pesticide for CA but is really nasty stuff to be smoking.

> People have been consuming large quantities of cannabis oil that were saturated in pesticides for over a decade without this kind of crisis. This. People have been vaping THC e-cig cartridges for years. Same for using other concentrated products like wax. Yet it seems only very recently that this has become some kind of 'epidemic'. I'm not saying that it's safe, but it seems very sudden that all these cases show up. Or maybe they were happening before, but because it seemed so hard to diagnose, people weren't connecting the cases?

> There's some talk about neem oil(azadirachtin) being the cause of cannabis hyperemesis syndrome. My worst episodes of CHS I've had from smoking synthetic cannabinoids, I'm not aware of neem oil having any relevance in the production of those. Imho a large factor could simply be an overabundance of product leading to people overconsuming because "Cannabis has no negative effects", so nobody cares about basics like tolerance breaks anymore [0], instead people just keep upping their THC doses to get past their tolerance threshold. [0] https://psychonautwiki.org/wiki/THC#Dependence_and_abuse_pot...

I guess you could say that. I’m in my first year as a farmer growing hemp. It’s pretty fun and interesting stuff!

You should write something up and submit it here. I'd read it for sure.

This comment was great, until the last sentence. What is your basis for that claim? Do you know of some particular cutting agent that causes these symptoms? Speculation should not be presented as fact. We don't know what is causing these cases but you have presented a reasonable hypothesis.

None of these cutting agents are approved for human inhalation and no studies will be done. From an epidemiological perspective these cases are tightly clustered both temporally and location wise which really limits the possibilities. Common cutting agents in the licensed market are PEG200, PEG300, and MCT oil. None are those are proven safe from what I know. In the black market the initial cutting agent was PEG600. Then TrueTerpenes came out with Viscosity ( https://trueterpenes.com/products/diluent/viscosity-extract-... ). Initially they said it was all terpenes (simple alcohols found in cannabis responsible for some effects and flavor) to sell it. It later came out that it was "mineral oil" but the reality is no one knows exactly what it is but it's a petroleum-based product of some kind. There was backlash against TrueTerpenes for this but selling mineral oil at $1500/liter (price point for cutting agents) is profitable. Some reports have described the symptoms as consistent with lipid pneumonia. Next FloraPlex released their thickening agent. Then HoneyCutt. I started hearing stories of people selling 0% THC epoxies to unsuspecting buyers as distillate starting a few months ago. Now there are people making their own thickening agents. Is it a theory? Yes. I'm normally scientifically conservative but I'd place a friendly wager on this one.

I perform with and breath fire as a hobby. The single biggest risk to firebreathers isn't burns, but chemical pneumonitis, due to fuel inhalation (basically synthetic mineral oil with chain lengths 12-18). Took one look at that xray and thought, "yup, chemical pneumonitis" [1]. Also known as lipoid pneumonia. In my research, one finding that stuck out [2] was that natural oils (triglycerides, saturated or unsaturated) are more pro-inflammatory than straight-chain mineral oils. MCT oil would absolutely cause acute inflammation and in severe cases, collapse of alveoli. However, the long chains, longer than C14, have half-lives measured in months to years. The effects of these is harder to know, but excessive exposure causes essentially COPD. Edit: oh look, here's an article specifically pointing out lipoid pneumonia [2]. I actually disagree with their thesis, that vegetable glycerine is causing the inflammation. I would bet it's more likely to be one of these thickeners, or a carrier agent for a flavor, causing the inflammation. I know people who go through over an ounce per day of VG solution that aren't getting chemical pneumonitis, but inhalation of sub-milliliter amounts of oils has sent friends of mine to the hospital. Basically, if it's not air, it doesn't belong in your lungs. However, the degree and character of the damage done depends on the chemical composition. Shorter molecules, molecules with more hydrophilic nature (alcohols, polyols, ketones, acids), biologically active molecules, are more acutely inflammatory, but usually the body can deal with them. Longer molecules, biologically inert ones, are less acutely reactive to the immune system, but can cause disruption of membranes and long term toxicity. Unsaturated fatty acids are especially bad because they can be oxidized directly into inflammatory signal chemicals. [4] [1] https://en.wikipedia.org/wiki/Chemical_pneumonitis [2] pdf - https://www.ajronline.org/doi/pdf/10.2214/AJR.09.3040 "Mineral oil (a mixture of inert, long-chain, saturated hydrocarbons obtained from petroleum) and vegetable-based oils tend to cause minimal to mild inflammatory reactions (Fig. 3). The intraalveolar oils can coalesce in the alveoli and become encapsulated by fibrous tissue, resulting in a nodule or mass (paraffinoma) (Fig. 4). Conversely, animal fats are hydrolyzed by lung lipases into free fatty acids that trigger a severe inflammatory reaction that manifests as focal edema and intraalveolar hemorrhage [5]. " [3] html - https://casereports.bmj.com/content/2018/bcr-2018-224350 [4] https://www.frontiersin.org/articles/10.3389/fimmu.2014.0048... "unsaturated fatty acids can be oxidized in a tightly regulated and specific manner to generate either potent pro-inflammatory or pro-resolving lipid mediators. "

I have used an MCT vape before. I've made some of my own carts with it as well. I wonder if you have any words on "MCT" being too broad a term. I made my carts with Bulletproof's Brain Octain, which claims to be 100% caprylic acid (C8). I'm not naive enough to ask "Is it safe?" But I'm curious if you think an 8-chain MCT would treat your lungs significantly different than a 12-chain MCT? I could easily imagine someone learning that you can make carts with MCT, and finding something cheap, only to be unknowingly using 100% C12. Cue the lipid pneumonia.

I've breathed fire with MCT oil (the storebought stuff that is basically liquid coconut oil). It's somewhat irritating, and I imagine if deliberately inhaled chronically it would cause harm. C8 is really fascinating because, I reckon, it's too short to set off the inflammation cascade directly, so it would be up to macrophages to alert the body "hey this doesn't belong". However you still have the usual risk from hydrophobic product in the lung. Personally, I would use vegetable glycerine and nothing else if you can at all avoid it. PG is a bit more irritating than VG, but any short polyol is going to be diffused away into the mucous much more easily than hydrophobic products.

100% agree with the VG (Vegetable Glycerin) recommendation, you will have to add a small 20-30% percentage of PG Propylene Glycol to decrease the viscocity (or alternately use pure VG and cut with small amount of normal saline but it won't make as nice a vapor) and then can use it in any actual vape device used for nicotine as these are meant to use water-based not oil-based mixtures. For marijuana/hemp you can make a water-based tincture using VG as the solvent just using dried plant matter. A magical butter machine can do it, putting it in a bottle and shaking it up every day for a few months, there are likely other methods. It's similar to making a CBD/THC oil but instead using VG as the carrier. Making your own tincture from decent-quality dried plant matter is the most economical and surefire way to know that it unadulterated and limited in contaminants.

Yes, sorry the wording was a bit ambiguous. MCT is almost entirely saturated. Any natural oils can be broken down into free fatty acids which have a pro-inflammatory effect when "not where they belong", i.e. in the interstitial space. However, unsaturated fats have the fun additional property that they can be "oxidized in a tightly regulated and specific manner to generate either potent pro-inflammatory or pro-resolving lipid mediators" [1]. So MCT oil is probably pro-inflammatory in the lungs, but vegetable oil even more so. [1] https://www.frontiersin.org/articles/10.3389/fimmu.2014.0048...

THC oil doesn't mix with glycerine. You can mix it with propylene glycol if you are using other diluents as well.

Scientific wild-ass guess: Polyols (ethylene glycol, propylene glycol, glycerine) are very hydrophilic. It would be trivial to detect presence in oil concentrates - just shake with a known quantity of distilled water. The polyols will be pulled into the water layer and increase the volume. It's not quantitative but if you know the 'ol in question you can calibrate a curve and get within a few percent of actual with just graduated cylinders.

Is "approved for human inhalation" a thing? Don't regular cigarettes have tar that people inhale?

The only thing I know of approved for deliberate human inhalation are things like inhaler and nebulizer based drugs. Those are usually carried in a fluorcarbon (HFA-134a aka 1,1,1,2-tetrafluoroethylene in Ventolin inhaler, which just evaporates) or saline in the case of nebulizers. Theatrical fog causes "irritation of mucous membranes such as the eyes and the respiratory tract associated with extended peak exposure to theatrical fog. " Another study "also found long-term exposure to smoke and fog was associated with both short-term and long-term respiratory problems such as chest tightness and wheezing". Cigarettes are terrible, but vaping ain't vitamins. https://en.wikipedia.org/wiki/Fog_machine#Adverse_health_eff...

The only instances I could find of respiratory irritation requiring medical intervention related to fog machine use where involving oil based fog machines, or mixed-use but have so far been unable to find case reports of Glycol or Glycerin based fogs alone. Not all theatrical fog is the same as vaping as far as I am aware. If you have any articles specifically dealing with the components used for vaping I would be interested to read them. Vaping does not use oil.

Vitamin vapes are a product that is actually being sold now, I know someone who has tried one. reply

I would agree that your guess is probably better than mine and I would be disinclined to bet against you. I hope the CDC has access to all this information so they can evaluate this as a potential cause. My issue was only that you followed a bunch of informative facts with an untested theory that was not differentiated from the facts that preceded it.

My apologies, I didn't mean to come off as abrasive. Yes, I see your point about the presentation of facts.

I didn't find you abrasive and I appreciate you sharing your information and insights with us.