Based on reporting by Masslive, the Massachusetts Department of Public Health (MDPH) has determined that Harrington Hospital, a hospital in Southern Worcester County, Mass., saw the highest number of vaping lung disease cases in the state, but the reasons are still unclear. Information regarding the specifics of these cases is particularly hard to come by due to Mass. public record laws meant to protect the privacy of patients.

The MDPH found that Harrington Hospital reported 54 potential cases of vaping lung disease between Sept. 2019 and the end of Jan. 2020. The hospital with the second most cases was Mass. General Hospital reporting 43 potential instances of vaping related lung issues.

“Harrington Hospital is a hotbed of vaping-related injury,” said vice-chairman of critical care operations for UMass Memorial Medical Center Craig M. Lilly. UMass Memorial is planning to acquire Harrington Hospital.

Causes of Vaping Lung Disease

Vapes or e-cigarettes are devices used to heat liquid, usually containing nicotine or tetrahydrocannabinol (THC), into an aerosol to be inhaled by the user. The U.S. Surgeon General lists ultrafine particles, flavorants linked to lung disease, volatile organic compounds, and heavy metals as potentially harmful ingredients commonly found in vapes.

The Centers for Disease Control and Prevention (CDC) have determined that e-cigarette related lung illnesses have been closely linked with vitamin E acetate. Vitamin E has been found in vapes and the lungs of those with vaping lung disease. However, there are other possible causes.

The CDC states that chemicals in THC may also be a factor. Most cases of vaping lung disease have been linked to products containing THC, especially products from an informal source.

The CDC also notes a rise in deaths related to vaping lung disease.

Vaping Lung Disease and Socioeconomics

MassLive used data gathered by MDPH to analyze connections between poor areas and a prevalence of vaping lung disease. The town in which Harrington Hospital is located, for instance, has the third-highest smoking rate, 25 percent, in the state and a medium income of just under $50,000. Sturbridge, on the other hand, had a much lower smoking rate of 12 percent and a much higher median income of roughly $72,000.

“These are all older industrial communities leftover from the recession,” said Tina Grosowsky, project coordinator for Central Mass. Tobacco-Free Community Partnership. “There’s not as much community-organized support for programs to help people quit.” There is also less access to mental health services in these areas, according to Gorowsky. 

Vaping on the Black Market

One of the reasons cannabis experts believe the outbreak of illicit-vaping lung disease has been under-addressed is the opioid epidemic. According to David Downs, California bureau chief of cannabis news site Leafly says law enforcement may not be making illicit vaping products a priority.

“The challenge facing law enforcement is that they have made it a priority to interdict opioid transactions, because so many people are dying of opioid overdoses,” he said. “Attention wasn’t focused on what was happening in the cannabis extract space.”

Southbridge has seen no incidents of “illegal vaping, or of illicit vaping-related activity”, according to MassLive, despite having the highest reported number of potential cases.

One reason black-market vapes may be common in Mass. is the relatively low number of marijuana dispensaries in the state. Mass. has one recreational store per 100,000 residents compared to roughly 16 per 100,000 residents in Oregon and Oklahoma.

“Most cannabis consumers in Massachusetts do not yet have a viable option in terms of a store that’s close by with affordable, tested products,” Downs said.