For CBE contributors often appearing under ‘Advertising, Marketing, & PR’ covering any topic other than the outbreak of vaping-related sickness nationwide would be tone... Reacting to “Vape Lung”

For CBE contributors often appearing under ‘Advertising, Marketing, & PR’ covering any topic other than the outbreak of vaping-related sickness nationwide would be tone deaf. The issue has demanded attention from the industry for some time but developments continue to unfold, some as recent as Monday of this week. We have surveyed the landscape of public reaction and news coverage to suggest some strategies for managing the message for cannabis businesses. Our suggestions may be able to provide some assistance to those seeking the best approach to reaching and educating understandably concerned consumers.

Not that anyone seems to have a full understanding of the situation. We are all seeking answers. At present, signs point to a dangerous additive used in black market vaping products as responsible for causing what’s come to be known as “vape lung”. As of this writing, reported cases have spread to over thirty US states and nearly five hundred patients, including at least five fatalities. Yet no one common cause has been identified. 

Samples collected by investigators suggest an oil used in other products as a thickener and preservative (Vitamin E acetate) has been introduced into illicit THC vaping products. This form of vitamin E is commonly found in skin creams, lotions, vitamins, and supplements. To date the substance has been easily available online. Generally considered safe when ingested or applied topically, the same chemical could pose a serious health risk when heated and aerosolized. Using the chemical as a thickener has enabled makers of illicit products and street dealers to disguise diluted oil. As use of vitamin E acetate has spread, products of unknown origin and questionable safety have turned deadly.

On Monday, New York Governor Andrew M. Cuomo ordered the state health department to subpoena three companies known to produce and market vitamin E acetate as a diluting agent. The initial targeted companies include Honey Cut Labs (makers of “Honey Cut Diluting Agent”), Floraplex Terpenes for its “Uber Thick” agent, and Mass Terpenes for its “Pure Diluent”. More companies are likely to be investigated as well. The challenge lies in isolating the oil as the culprit.

A report published Friday in The New England of Journal of Medicine identified 53 patients in the Midwest recently treated for the vaping illness. (Including the death of an adult Illinois resident, the first in the country.) Of those 53 patients, 41 were extensively interviewed. The results underline the uncertainty surrounding the toxins triggering the outbreak and the problem for the cannabis industry. Most reported using nicotine (61%), THC (80%), or both (44%). In a letter accompanying the report, Dr. David C. Christiani of the Harvard School of Public Health plainly states “no conclusions can be drawn” which, while true today, shouldn’t take away from a point appearing earlier in his writing. That is, we know e-cigarette fluids, even those on the legal market, can contain a toxic cocktail of compounds such as benzene and heavy metals. No one understands how adding compounds such as CBD or THC to the mix might interact with other ingredients nor did anyone (to our knowledge) anticipate homebrew mixtures of e-liquids and cannabis. 

Further, and most critically, nearly all of the patients bought the THC products on the black market under a hodgepodge of brands. In interviews, the only named THC product that cropped up often (59%) was “Dank Vapes”. But Dank Vapes doesn’t exist. That is, there is no central organization operating under the oversight of any regulatory agency. In an August 19 Inverse.com article on the elusive brand, the risk to consumers is made clear:

The myth of the “real” Dank Vapes has allowed hundreds of Dank Vape sellers to get away with selling their unlicensed products to consumers — not all of whom are even aware that Dank Vapes isn’t a single company, but a packaging company, with no quality control or oversight.

The company behind Dank Vapes manufacturers packaging, not cannabis products. No one has a perfect understanding of what reaches consumers. A box of Dank Vapes’ “Banana OG” sold in Wisconsin may have been shipped from California but the actual contents could have been literally brewed in a basement in what has become the 21st Century version of “bathtub gin”.

Examples of black-market vape products including “Dank Vapes”. Published by the New York State Department of Health

Problematically for the cannabis industry, at least one fatality may have come about from tainted vape products via state-licensed retailers. Last Thursday, Oregon officials confirmed that the state’s first victim shopped two licensed cannabis retailers prior to falling ill. Similar to the confusion surrounding the compounds and chemicals involved however, officials are not releasing any further information as it’s unclear if the individual actually purchased the contaminated product from a dispensary or via another channel.

How can all this uncertainty be addressed? Consumers need to better understand the dynamics of the black market, the uncertainty behind the formulation of products reaching consumers through the black market, the potential risks of those products, and somehow also hear how much ambiguity exists in identifying the causes behind the outbreak. However this level of detail doesn’t lend to concise articles and soundbites. Even with the best of intentions – which can’t be said for all, as the cannabis opposition has certainly not missed this opportunity – this story doesn’t lend well to clear and digestible communication.

In response, the industry has rightly messaged that the outbreak underlines the value of testing and transparency required in licensed markets. Legalization prevents poison, in effect. Individual businesses are wisely taking proactive steps to issue statements and communicate via social channels. (For example, Cresco Labs has messaged the issue via a post on the company website, Facebook, and Instagram.) Here are some suggested paths to follow as the nature and scope of the illness or illnesses involved come into focus:

  • Address community safety by reiterating company policies and values related to preventing diverted product and special considerations taken to keep product out of underage hands
  • Continue to talk about responsible and transparent sourcing, particularly for companies working with extracts, oils, and distillates
  • Seek creative means to communicate the manufacturing process of pens and oils to consumers. Leverage capabilities such as video and animation to enable the curious and concerned to “watch” as product goes from plant through processing to finished product
  • Highlight partnerships with community and issues advocacy organizations that promote responsible business practices and public health
  • Educate store associates. Because both new and existing customers see the budtender as subject matter expert, staff must be well prepared to answer questions and address concerns with a message that aligns with the company identity – be it safety, purity, transparency, or other core values

Even in adult use markets, a significant number of cannabis consumers will inevitably remain in the black market. Unless the outbreak reaches truly epidemic proportions, it’s unlikely “vape lung” will steer many into (or back to) the legal market. We know barriers to access and high prices resulting from regulation and taxation will remain a challenge for some time in many states. Even so, cannabis businesses shouldn’t feel the need to limit communication just to website visitors and Instagram followers. A message of safety and caution is relevant to all consumers. This episode can be used to further illustrate the integrity and professionalism of the emerging cannabis industry.

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