(UPDATE: The situation was more dire than the public knew. After publication of this article, health officials told the Arizona Republic about several unconfirmed cases, and Phoenix New Times soon interviewed one man who said vaping put him in the hospital. On September 17, state officials announced that three cases were now classified as confirmed.)
Five people are dead and hundreds have been hospitalized across 33 states because of a mysterious pulmonary illness connected to THC- and nicotine-filled e-cigarettes.
But Arizona so far seems to be beating the odds, which is ironic considering that it's the only pot-friendly state where cannabis products aren't tested for contaminants.
According to Chris Minnick of the Arizona Department of Health Services, no cases have been reported in the state so far of the lung-damaging illness, which has caused symptoms from shortness of breath and diarrhea to weight loss and death.
"We are working closely with Arizona Poison Control to help identify potential cases," Minnick said.
"Our poison center and toxicologists are investigating the matter statewide," added Alexis Kramer of Banner Health.
Possibly, some of the first Arizonans to come down with the illness don't now it yet. Experts say symptoms could appear days or weeks after vaping. Some health care officials say it's best to quit vaping entirely, for now.
While Arizona health officials continue to investigate, Banner Health toxicology experts recommend refraining from, or at least minimizing the use of, vape pens and other vaping devices. In a press release today, Banner encouraged the public to report cases of vaping-related lung injury by calling 800-222-1222. Reported signs and symptoms include:
• Fever, nausea, and vomiting.
• Shortness of breath, coughing, and chest pain.
• Progression of symptoms over several days with similarities to a viral illness.
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Meanwhile, there doesn't seem to be much concern among Arizona vapers.
"The vapes definitely sell pretty well," said Eddie Garcia, manager of Just Blaze in Phoenix. "We let them know about the high nicotine content, but we haven't received any negative feedback."
Carly Contract, manager of TruMed Dispensary, echoed Garcia's sentiment. "If anything, I see an increase in the sales of cartridges — THC, CBD, and a combination of the two."
"We haven't really noticed much of an effect here; I haven't heard even one customer asking about it," said Angela Palmer, general manager of High Maintenance Smoke Shop in Tempe. "I read about it happening on the East Coast, so I wonder if it's something that just won't affect us."
Then there's the question of how all this bad press might affect the potential legalization of cannabis in Arizona if it lands on the 2020 ballot.
"Consumer safety is the exact reason we worked so hard on the testing bill and we're working to ban illicit delivery via initiative. We work tirelessly to ensure Arizona patients and consumers are safe," said Tim Sultan of the Arizona Dispensaries Association, which launched the campaign for the Smart and Safe Act measure.
Nationwide, the first death was reported in Illinois on August 23, after the individual, who had recently vaped, was hospitalized with severe respiratory illness. Oregon officials announced another fatality early last week, then Indiana, Minnesota, and California quickly followed suit.
Aside from the casualties, doctors with the Center for Disease Control and Prevention confirmed in a Friday briefing, a recording of which was obtained by Phoenix New Times, that they were "aware of over 450 total possible cases, including the 215 already reported." Many patients reported using products containing THC, while others said they vaped nicotine or a combination of the two.
"Based on the clinical and laboratory evidence to date, we believe that a chemical exposure is likely associated with these illnesses. However, and I really want to stress this, more information is needed to determine which specific products or substances are involved," said Dr. Dana Meaney Delman of the CDC in the phoned-in briefing.
The initial symptoms, such as chest pain, coughing, and shortness of breath, are what typically cause patients to be hospitalized, with some describing more serious symptoms like nausea, vomiting, diarrhea, and weight loss. Health officials are trying to determine whether the issue is new, or just newly recognized.
The mostly male patients were generally healthy before the illness set in, with a median age of 19, doctors said.
"All patients have abnormalities seen on lung imaging, apparent in both lungs," Dr. Jennifer Layden of the Illinois Department of Public Health told others in the briefing.
Dr. Daniel Fox of WakeMed Health & Hospitals in North Carolina noted in the telephonic forum that, "All of our patients underwent evaluation, and after the clinical evaluation we found a certain type of pneumonia that was noninfectious. It’s called lipoid pneumonia. Basically ... it can occur when either oils or lipid-containing substances enter the lungs."
Some patients are vaping materials they bought on the street or through the dark web, or even combining different substances, the experts said.
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There was also a lot of talk about vitamin E acetate, which was identified in high levels in almost all of the cannabis-containing samples analyzed by the New York Department of Health.
Also today, the U.S. Food and Drug Administration sent a warning letter to JUUL Labs, the ubiquitous e-cigarette company, ordering it to correct marketing claims that its e-cigs are less harmful than the traditional cigarette.
While health officials investigate further, experts urged people to refrain from using their vape pens.
"Our perspective at this moment is until we have a cause and while this investigation is ongoing, that we’re recommending individuals consider not using e-cigarettes. And that broad recommendation is because we do have a diversity of product, as you heard, some containing THC and some containing nicotine," said the CDC's Dr. Ileana Arias.