UPDATE, Oct. 9: Washington state has passed an emergency ban on flavored vaping products in response to the nationwide outbreak of vaping related illnesses.
On Wednesday afternoon, the State Board of Health voted in favor of the proposal. Some who attended the meeting warned about the potential unintended consequences, including the possibility that it will drive people to the black market or back to smoking cigarettes.
The new regulations cover both cannabis- and nicotine-flavored vaping products.
Before voting for the ban, state Secretary of Health John Wiesman acknowledged it was a contentious issue, but stressed that it was the best course of action at this time.
"I do want to be clear that by eliminating flavors we are not saying that the flavors are what are causing this current lung injury or illness," Wiesman said. "We obviously don't yet know what that is."
Wiesman said the new rule is aimed at curbing the epidemic of youth vaping.
The ban is only temporary and the board said it can be rescinded, if necessary.
Washington state is poised to ban flavored vaping products in hopes of curbing the spread of vaping related illnesses that have sickened more than 1,000 people across the country.
On Wednesday, the State Board of Health will vote on the proposal, advanced by Gov. Jay Inslee, that would prohibit cannabis and nicotine vaping products.
The Centers for Disease Control and Prevention has yet to identify a single source of the illnesses. Increasingly, public health agencies are advising consumers to avoid vaping altogether.
Nationally, many of those who have fallen ill reported using cannabis vaping products or some combination of nicotine and cannabis. A smaller proportion have only used nicotine.
Warnings about vaping don’t appear to have translated into slower sales at dispensaries such as House of Cannabis in Tacoma.
“We haven’t really seen a dip in the market,” said Kevin Heiderich, co-owner of the cannabis retail store.
When the news of vaping illnesses emerged, Heiderich and co-owner Michael McDonald started looking into their own inventory. Over the summer, they reached out to suppliers to understand what was in their vaping cartridges.
“We started contacting our vendors, making sure everyone was using high-grade materials,” Heiderich said.
So far, it appears many of the vaping related illnesses identified in other states originated with bootleg cartridges sold on the black market. Testing has shown those products often contain dangerous additives, such as Vitamin E acetate, which isn’t safe for inhalation.
As with most states where cannabis is legal, Washington doesn’t actually regulate the use of such chemicals as “cutting agents” in products sold on the regulated market.
“It is entirely possible that there are players who are trying to make some money by using thickening agents,” Heiderich said. “Hopefully any regulation that does come down, puts an end to those business practices.”
On a given day, McDonald estimates less than a third of the vaping products on the shelves of their store qualify as “flavored.”
“We have gotten quite a bit of feedback from customers that they are disappointed to lose out on some of their favorite flavors,” McDonald said.
Retail cannabis stores in Washington have been required to hang a sign warning consumers of the dangers associated with vaping.
ILLNESS PROMPTS LAWSUIT
While some states have seen a steady uptick in vaping-related illnesses, Washington’s share of cases has remained in the single digits and with no fatalities.
Some of the cases have been connected to THC products and others only to those containing nicotine.
Charles Wilcoxen, 44, had been vaping cannabis for nearly two years when he woke up one morning last month and could barely breathe.
“Literally, I took five steps and would have to hunch over and try to catch my breath,” the Tacoma resident recalled.
Wilcoxen had spent the weekend with flu-like symptoms, but hoped it would resolve without medical care.
As his symptoms worsened, he started to suspect the THC vape could be the underlying cause. Wilcoxen, a Puyallup Tribal Police officer, would vape while off duty to relieve stress.
“I felt the vaping was a safer alternative than smoking,” he said. “I truly believed that.”
A competitive runner and Army veteran, Wilcoxen only bought the products from a licensed cannabis store.
He ended up in the hospital for three days with a severe respiratory illness. Doctors analyzed the build- up in his lungs and concluded it was “lipoid pneumonia,” a rare diagnosis that has been identified in other people who have fallen ill after vaping.
Wilcoxen is now suing a handful of manufacturers and distributors of the vaping cartridges and of the pen device he used, which was made in China. The lawsuit alleges defects in the products led to Wilcoxen’s illness.
“Buy something off the black market, you are taking your chances,” said Mark Lindquist, Wilcoxen’s attorney. “If you buy something from a state-licensed store, you should know you are getting a safe product.”
Wilcoxen’s case raises a troubling question about the safety of products in regulated stores.
State Health Officer Kathy Lofy says the Washington Department of Health is keeping an “open mind about what could be the cause of the outbreak.”
“Until we can really figure out what substance, product or device it actually is, we are concerned about both THC and nicotine vapor products,” Lofy said.
While the majority of cases are associated with cannabis, Lofy notes that some who have fallen ill only used nicotine products.
“While we don’t yet know exactly what’s causing severe lung injury, we did like the option of banning flavors because we know that youth are very attracted to the flavors,” she said.
She said Washington state health officials haven’t ruled out a full vaping ban sometime in the future.
In his executive order, Inslee also called for a ban on harmful additives in cannabis products once those have been identified.
“We are watching other states closely to determine what is the most effective approach and also to see if unintended consequences will be occurring in other states,” Lofy said.
Some who study public health warn that bans may simply drive more people to unsafe products.
“The efforts to shut down even more legal activity is not likely to stop all vaping,” said Lynn Kozlowski, a professor at the School of Public and Health Professions at the University of Buffalo. “It is likely to encourage the production of more black market vaping products.”
Kozlowski says it’s also important to distinguish between nicotine and THC products, as well as between legally manufactured products and black market products.
“There has been an outbreak, something has changed, and you should put all your effort into figuring out what’s actually happening,” he said. “There needs to be a less stigmatized reaction.”