Vape Lung Disease in the COVID-19 Era: Where Do We Stand?

COVID-19时代的阴肺疾病:我们站在哪里?

2020-08-11 04:00:27 Ganjapreneur

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It might be hard to imagine in the face of an ongoing global pandemic, but one of the top stories this time last year was the presence of a few thousand cases of a mysterious disease associated with vaping. By the time officials scrambled to learn more about an underground vape industry they had long ignored, the crisis had already taken hold around the country. But when COVID-19 took over the news cycle, the focus on EVALI — short for “e-cigarette or vaping product use associated lung injury” — took a back seat. The crisis, however, is ongoing. The UK faced its first official vaping related death in July amid its response to the coronavirus pandemic and states like Utah and Minnesota have started seeing another influx of EVALI cases in hospitals. A total of 2,561 people were hospitalized due to vaping related lung injuries in 2019 and there were 55 confirmed deaths by December. These numbers may seem slight amid the deadly COVID-19 pandemic but, at the time, the EVALI vaping crisis was considered a national emergency. In November, the CDC identified the use of a cutting agent called vitamin E acetate as the likely culprit behind the spate of vaping-related hospitalizations and deaths. But the crisis was already in full swing. EVALI patients were diagnosed with lipoid pneumonia, a condition that occurs after inhaling an excess of mineral oil. Vitamin E acetate, which is typically used to play with oil viscosity and has been approved by the FDA for use in lotion and other topicals, was consistently found at the primary injury site in afflicted patients. One of the first states to see a flush of patients with vape-related pulmonary issues was Ohio, where some patients voluntarily turned in cartridges they were using and most products were in turn traced to the legacy or unregulated markets. From there, multi-million dollar busts occurred in the Midwest along the I-80 in Wisconsin, Minnesota, Iowa, Indiana, and Illinois. As more hospitalizations rolled in, police, lawmakers, and citizens were all seeking a common thread. Crafty producers even managed to create off-brand versions of popular licensed vape manufacturers like TKO and Stiizy, but one brand — Dank Vapes — rose above the rest as it appeared to knit together the most cases. With Dank Vapes’ flashy little boxes that so mathematically mimicked legal cartridge packaging and the slurry of easily accessible online markets, there were paths leading to the unlicensed operation everywhere. “Who created Dank Vapes?” was the question on everyone’s mind but the answer was obviously more complicated than the question implied — simply put, Dank Vapes appeared to come from … well, everywhere. People in prohibition states could easily access Dank Vapes products online, making it particularly popular for people outside of state-legal markets. But Dank Vapes packaging, and other common black market cart packaging like Mario Carts, Exotic, and Dankwoods, could also be easily purchased online from overseas factories. And, with the ability to purchase extraction equipment and set up an illegal lab almost anywhere — coupled with easy access to professional-looking packaging and cartridge tech — it wasn’t long before the underground vape industry cast a deep and expansive net across the United States. Ultimately, getting started in dealing Dank Vapes was almost as simple as buying some for yourself. By the time officials could muster a response, Dank Vapes’ production was on the decline but the renegade vaping brand had already shone its light on exactly how prolific the legacy market had remained despite legalization footholds around the country. Eventually, Dank Vapes sank back into the shadows but the damage was done. Perhaps most frustrating, however, is that while the true origins of the contaminated vape products will likely be forever unknown, it stands to reason that federal legalization, coupled with reasonable regulatory guidelines, could have curbed the crisis from the very beginning. In response to the crisis, law enforcement shifted its focus to shutting down unlicensed dispensaries in cities like Los Angeles, where the unregulated market still thrived. Websites and social media pages that previously advertised and shipped out unlicensed cartridges eventually started to disappear. Additionally, with the death toll climbing, many governors in adult-use states took action. Washington Gov. Jay Inslee banned all non-native vape additives including vitamin E acetate and plant-derived terpenes. In California, Gov. Gavin Newsom focused on quelling the unregulated market and recommended more education and warnings around the dangers of vaping. Massachusetts, on the other hand, opted to quarantine some 600,000 cannabis vaporizer products in December due to the ongoing confusion circulating those products, which were only just released from quarantine this week. Today, even with vitamin E acetate having been identified as the culprit behind the EVALI crisis, many of the restrictive responses including bans on plant-derived terpenes and flavorings have remained in place. As the COVID-19 pandemic tightened its grip on the world, medical professionals understandably shifted their focus to the respiratory virus, which happens to have very similar symptoms to EVALI. And, while the news cycles and national attention have obviously moved on, it’s very likely that EVALI never actually stopped presenting in hospitals. This is made extra complicated not only because the condition reflects symptoms of the coronavirus, but also because patients in prohibition states often remain reluctant to admit that they have been vaping cannabis. If THC use was legal and regulated, however, then patients would be more willing to share such activities with medical professionals. Last November, the CDC’s Principal Deputy Director Anne Schuchat quietly admitted that regulating cannabis vaporizer products, including lab test and labeling requirements, would help protect consumers from EVALI. Legalization would also require regulatory bodies to focus on understanding the industry for the purpose of regulating the wholesale shipment of industrial goods, including vape technology. With those regulations in place, many legal companies would likely not have been forced to forfeit and quarantine their products, which led to compounded profit losses. Ultimately, that lack of government oversight allowed for a blindspot in vape tech and hardware regulations. There may not have been a way to fully avoid the crisis but a country equipped with a legal and regulated marketplace for cannabis vape products would have been significantly better prepared for identifying the issue and taking action to keep the general public safe. And, although the EVALI vape crisis must feel distant to most Americans after the wild and unprecedented year we’ve had so far, it’s never too late to get started.
可能很难想象,面对一场持续的全球大流行,但去年这个时候最重要的故事之一是有几千例与吸血有关的神秘疾病。当官员们争先恐后地了解他们长期忽视的地下钱庄时,这场危机已经席卷了全国。但当 COVID-19接管新闻周期时,对 EVALI 的关注——简称“电子香烟或吸食产品使用相关肺损伤”——占据了后座。然而,危机仍在持续。 在应对冠状病毒大流行的过程中,英国于7月面临首次官方的吸食相关死亡,犹他州和明尼苏达州等州已开始在医院看到另一批 EVALI 病例。2019年共有2561人因吸食相关肺损伤住院,截至12月已确认死亡55人。在致命的 COVID-19大流行期间,这些数字可能显得微不足道,但当时, EVALI 评估危机被认为是一场全国性的紧急事件。 去年11月,疾病预防控制中心(CDC)发现使用一种叫做维生素 E 的切削剂可能是导致大量与吸食有关的住院和死亡的罪魁祸首。但危机已经全面爆发。EVALI 患者被诊断为类脂性肺炎,这种情况发生在吸入过量矿物油之后。维生素 E 醋酸盐,通常用来与石油粘度玩,并已被 FDA 批准用于洗剂和其他外用,一致发现在主要损伤部位的患者。 俄亥俄州是最早发现大量与吸食有关的肺病患者的州之一,一些患者自愿使用他们使用的墨盒,而大多数产品则被追溯到遗留或不受监管的市场。从那里,数百万美元的破产发生在中西部沿 I-80在威斯康辛,明尼苏达州,爱荷华州,印第安纳州和伊利诺伊州。随着越来越多的住院病人涌入,警察、立法者和公民都在寻求一个共同的线索。手工艺生产商甚至成功地创造出了流行的授权盗版制造商,如 TKO 和 Stizy ,但一个品牌, DankVapes ,上升高于其他品牌,因为它似乎编织了最多的案件。 由于 DankVapes 华丽的小盒子在数学上模仿了合法的墨盒包装,以及大量容易进入的在线市场,有一些途径导致无证操作无处不在。“谁创造了丹麦人?“这是每个人心中的问题,但答案显然比隐含的问题更复杂——简单地说, DankVapes 似乎来自……好吧,无处不在。 禁酒州的人们可以很容易地在网上获得 DankVapes 产品,这使得它特别受州法律市场以外的人欢迎。但 DankVapes 包装,以及其他常见的黑色市场购物车包装,如 MarioCarts , Exotic 和 Dankwods ,也可以很容易地从海外工厂在线购买。而且,由于有能力购买提取设备并在任何地方建立非法实验室,再加上容易获得专业的包装和墨盒技术,地下吸尘器行业不久就在美国投下了一个深邃而广阔的网络。最终,开始交易 DankVapes 和为自己买一些东西一样简单。 当政府官员们能够拿出应对措施时,丹克•维普斯( Dank Vapes )的产量正在下降,但这个被叛变的品牌已经清楚地表明,尽管全国各地的合法化站稳了脚跟,但遗留市场仍有多么丰富。最终,丹克·瓦普斯沉没在阴影中,但损害已经完成。 然而,最令人沮丧的或许是,尽管受污染的 vape 产品的真正来源可能永远不为人所知,但有理由认为,联邦立法加上合理的监管准则,本来可以从一开始就遏制危机。 为应对这场危机,执法部门将重点转移到关闭洛杉矶等城市的无证药房上,那里的无监管市场仍在蓬勃发展。网站和社交媒体的网页,以前的广告和运输出未经许可的墨盒最终开始消失。 此外,随着死亡人数的攀升,成人使用州的许多州长采取了行动。华盛顿政府.Jay Inslee 禁止所有非本土的 vape 添加剂,包括维生素 E 醋酸盐和植物衍生的萜烯。在加利福尼亚, Gov 。Gavin Newsom 着重于平息不受监管的市场,并建议更多的教育和警告有关的危险,虚张声势。另一方面,马萨诸塞州在去年12月选择隔离大约60万种大麻蒸发器产品,原因是这些产品目前的混乱状况,这些产品本周才刚刚从检疫中释放出来。 今天,即使维生素 E 醋酸盐已被确定为 EVALI 危机的罪魁祸首,许多限制性反应仍然存在,包括禁止植物衍生的萜类和香料。 随着 COVID-19大流行加强对世界的控制,医学专业人员可以理解地将他们的注意力转移到呼吸道病毒上,呼吸道病毒恰好与 EVALI 有非常相似的症状。而且,虽然新闻周期和全国的关注已经明显地发生了变化,但很可能 EVALI 从来没有停止在医院出现。这种情况变得格外复杂,不仅是因为这种情况反映了冠状病毒的症状,而且还因为处于禁忌区的患者往往不愿承认他们一直在吸食大麻。然而,如果 THC 的使用是合法的和受监管的,那么患者将更愿意与医疗专业人员分享这种活动。 去年11月,疾控中心首席副主任 Anne Schuchat 悄悄承认,规范大麻汽化器产品,包括实验室测试和标签要求,将有助于保护消费者不受 EVALI 影响。 合法化还需要监管机构集中了解该行业,以便监管工业产品的批发运输,包括 vape 技术。随着这些规定的实施,许多法律公司可能不会被迫没收和隔离他们的产品,从而导致了复杂的利润损失。 最终,由于缺乏政府的监督,虚拟技术和硬件监管出现了盲点。也许没有办法完全避免这场危机,但一个拥有合法和受管制的大麻吸食产品市场的国家,本应为确定这一问题和采取行动确保公众安全做好更好的准备。 而且,尽管 EVALI vape 危机对于大多数美国人来说,在我们经历了前所未有的狂野一年之后,我们必须感觉很遥远,但开始并不是太晚。

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