Nearly there. Partial upload to Flickr, if you'd like to take a look.
"Those cannabidiol-laced gummy bears may be entirely legal, but they could still get you arrested on marijuana possession charges."
Click here to jump to the New York Times Article.
We were interviewed for this article months ago. It has no connection to VAPI. It talks about false THC positives in users who are CBD consumers only.
False positives occur both by derivatization and the Duquenois–Levine test. The DL test is commonly used to quickly detect THC at the roadside. It is an extremely unreliable test.
Both are blog posts for another day.
Photo Credit: Matthew Staver for The New York Times
#forensicconsulting, #falsepositive, #CBD, #THC, #CBDtoTHC, #coloradogreenlab, #frankconrad
©2019 Colorado Green Lab | coloradogreenlab.com
Y'all have been very patient with my painstaking approach (particularly my partner, Cindy); I am being appropriately careful about some of the conclusions drawn.
Here's a preview of Vape Pen Vivisection: Power Supply Connectors
A picture is worth a thousand words. These will be posted in higher resolution in the final version.
The top photo compares an auto vape pen to a non-auto vape pen (("external on/off switch").
The second photo is the external view of a #510 female thread connector (battery case removed) that connects to the male thread vape cartridge.
The third photo shows what is not typical visible: the internal view of six (6) vape pen power modules, and specifically the solder points connecting the battery and control circuit to the underside of the #510 femaled-thread connector (which connects to #510 male-thread cartridges to power heating coil).
A visible air channel in the center flange is how e-liquid enters the battery compartment. The underside of one of the #510s even has obvious verdigris (green scale from oxidized copper), probably from exposure of internal coper wiring to liquid condensing in the compartment.
The most significant take-home message is that there is a risk of short circuit between the large proximal globules of solder connecting the circuitry to the #510. In some cases (the far left example), the risk is minimal, but not in those with red circles. The solder points there are quite large and separated by no more than a millimeter or two. These solder points can be bridged by liquid entering the compartment and short circuit. Short circuits generate considerable heat and lead to solder fume production directly in the inhalation path of the vape pen user.
As an aside, I got to experience the phenomenon first hand when disassembling one of the pens. A short circuit caused a nasty little fire and plume of greyish-white smoke. I made a very undignified shriek and smothered the fire in a bucket of sand. I was working in the fume hood (no danger of exposure), but it was quite startling.
Cautionary note: Curiosity killed the cat, and more than a few scientists. Please don't play this way without safety precautions and appropriate PPE.
©2019 Colorado Green Lab | coloradogreenlab.com
As of October 8th, 2019, 1,299 vape product users have developed a condition now known as "Vaping-Associated Pulmonary Injury" or VAPI, and 18 deaths have occurred as a result of the illness. As the name implies, VAPI occurs in individuals who have used vaping products. Although THC products have been strongly correlated with development of the illness, 17% of patients with VAPI reported exclusive use of nicotine-containing products
Please consider refraining from the lettuce for a while
While it is true that millions of people in the United States enjoy vaping and experience no adverse effects, the current epidemic *is* linked to vaping.
For the duration of any epidemic with an identified source, the safest course is to refrain from the associated activity.
If romaine lettuce is identified as the source of a deadly E. coli outbreak, you would probably stop eating romaine lettuce until the CDC gives an all-clear. In the same mindset, the CDC/FDA currently recommend that you refrain from vaping until the cause of VAPI is determined.
Some of you are going to eat the lettuce anyway
No judgment if you choose to continue vaping, but please monitor yourself for symptoms (e.g., cough, shortness of breath, chest pain). If you have concerns about your health, seek medical attention. I recognize that can be a hard ask; many people (including me) endure illness and avoid accessing healthcare due to the financial cost, taking time off work, childcare issues, lack of access, etc. I can't address any of those things in a blog post, but I can ask that you please see a healthcare provider if you are experiencing symptoms that aren't getting better or symptoms that keep coming back.
More information on VAPI from the Centers for Disease Control (CDC)
For the Public: What You Need to Know
Más información de los Centros para el Control y la Prevención de Enfermedades
Para el público: Lo que debe saber
©2019 COLORADO GREEN LAB | COLORADOGREENLAB.COM
In the first of this three-part series on Vaping-Associated Pulmonary Injury (VAPI), I will introduce a compound with the motive, means, and opportunity to cause the illness. Part 2 will identify the common point of origin linking vape users in the United States and why Europe is unaffected, and, finally, Part 3 will outline a rational harm-reduction based approach for evaluating the safety and continued use of these products.
19_1006 update: Signs and symptoms of vaping-associated pulmonary injury (VAPI) are consistent with chemical inhalation. Analysis of symptoms, commonality of exposure source (vape pen battery cartridges), and mechanism ("vaping") may indicate cadmium-derived metal oxide fume inhalation (metal fume fever, cadmium pneumonitis) as a possible cause of the syndrome ("VAPI").
Public service announcement: Clinicians, when you hear vaping, think zebras, not horses.
The early symptoms of VAPI are often mild and resemble pneumonia ("horse"). Many of the VAPI ("zebra") patients presented in an outpatient setting, were initially diagnosed with respiratory infections, and treated with antibiotics (without improvement). Workups were negative for infectious agents, and chemical exposure of unknown type/origin is now believed to be the cause of VAPI. The majority of patients who develop this illness exhibit clinical improvement only after treatment with systemic corticosteroids.
The CDC encourages clinicians to report possible cases of e-cigarette or vaping-associated lung injury to their local or state health department for further investigation:
Vapi Data Set. The VAPI data set published (September) in the New England Journal of Medicine (Layden, Ghinai et al. 2019) is the most comprehensive study to date, and includes clinical findings from 53 patients in Illinois and Wisconsin (Full text: https://www.nejm.org/doi/full/10.1056/NEJMoa1911614). Unless otherwise indicated, signs, symptoms, data, etc are in reference to this publication.
July/August 2019. Hundreds of patients with an unusual respiratory illness began popping up in clusters across the United States. In the days and weeks prior to their hospitalization, these patients exhibited typical signs and symptoms of pneumonia and most were prescribed antibiotics as the first course of treatment. None of the patients (who were eventually diagnosed with vaping-associated pulmonary injury; VAPI) improved on antibiotics and lab workups revealed no evidence of pulmonary infection.
The full range of findings is conflicting and no clear pattern has emerged regarding the source or cause of the illness.
Patients have highly similar clinical characteristics and all developed the illness within a similar timeframe.
Most patients reported using vaping devices with THC and nicotine cartridges, but some reported exclusive use of only THC or only nicotine. A wide variety of cartridge brands and products were reported.
Cases are not specific to any one region of the United States, but the syndrome appears to occur only in vape users in the United States. Other parts of the world with a high prevalence of vaping (ex. the European Union) are not reporting similar illnesses. More on that in second and third part of series.
Correlation ≠ Causation
The underlying cause is now believed to be chemical exposure, and not an infectious disease. The VAPI syndrome is strongly correlated with the use of black market THC vape cartridges, but the CDC has yet to conclusively identify a vaping product, substance, or additive common to all cases.
Metal Fume Fever
Unless you're a metalworker, work for OSHA, or, in my case, previously employed at a respiratory hospital, you've probably never heard of Metal Fume Fever (MFF).
There are only 1500-2500 cases of MFF reported in the United States each year, and the illness is typically restricted to individuals with very specific occupations (e.g. welders).
MFF is caused by inhalation of metal-containing fumes (ex. zinc oxide) produced by welding, soldering, and brazing. Typical symptoms of metal fume fever are non-specific ("flu-like"), and can include cough, raised temperature ("fever"), headache, chills, aches, dizziness, and a sweet or metallic taste in the mouth. More severe exposure can result in gastrointestinal symptoms, including nausea, vomiting, and diarrhea. Metal fume fever caused by zinc oxide inhalation is the most frequently reported type of exposure and bears superficial resemblance to VAPI. Acute symptoms develop 4-12 hours following zinc fume exposure, but do not usually progress to lung damage. The zinc oxide-associated form of the illness typically self-resolves within 12- to 48-hours.
A far more serious form of metal fume fever occurs after inhalation of cadmium oxide fumes. The immediate effects are similar to those described above ("flu-like"), but unlike zinc oxide exposure, cadmium fume inhalation causes significant lung damage post-exposure (pneumonitis), and can progress to hypoxia, respiratory failure, and death.
The table below compares the clinical presentation of zinc oxide metal fume fever (MFF), cadmium pneumonitis (CP), and vaping-associated pulmonary injury (VAPI).
High Index of Suspicion
Silver solder (often contains cadmium) is used to make stable unions between dissimilar metals such as copper and stainless steel. In lower-end vape pens, large beads of this type of solder are present on positive and negative heating element connections. Most vape pens use cadmiun-free solder. Unscrupulous manufacturers have a financial incentive to cut corners. It's happened before: https://en.wikipedia.org/wiki/2008_Chinese_milk_scandal
Money and ease of use. Cadmium-containing silver solder is less expensive than cadmium-free alternatives, and has improved flow properties which facilitate the joining of dissimilar metals found in vape pen electrical components.
Cadmium is highly toxic to multiple organ systems. Upon inhalation, cadmium elicits a dose-dependent burst of inflammatory cytokines that promote the systemic effects (fever, headache, joint pain, etc) observed in metal fume fever (Blum, Rosenblum et al. 2014). Cadmium fumes also directly injure lung cells, leading to fluid accumulation, impaired lung function, and respiratory failure. Following absorption into the bloodstream, protein-bound cadmium slowly accumulates in the kidneys and may result in renal injury.
Upwards of 20-30 mg of solder alloy is permeated with vape juice liquid and directly in the airflow path through the vape pen.
Blood cadmium levels are indicative of recent exposure, whereas urinary cadmium is indicative of chronic, longer term exposure. Normal blood cadmium is <5.0 ng/mL, with most results in the range of 0.5 to 2.0 ng/mL, whereas tobacco smokers typically have blood and urinary cadmium levels more than double those of nonsmokers (Mannino, Holguin et al. 2004).
©2019 COLORADO GREEN LAB | COLORADOGREENLAB.COM
Continued in Part 2: Vape Pen Vivisection
I've been contacted frequently over the past few months regarding the basis for false-positive results from rapid screen THC immunoassays. These inquiries are usually in the context of pre-employment and random urine screening, but occasionally arise from more unusual circumstances (Hugo, CO). I was asked yesterday about the potential for false positive THC results in newborns, and after looking into it, the answer surprised me. It turns out false-positives for THC are fairly common. Upon observing that follow-up screening by GC-MS failed to verify the initial positive immunoassay test result in newborns, a team of social workers, care providers, hospital staff, and laboratory personnel at UNC - Chapel Hill investigated this issue. They determined that THC immunoassays react with, among other things, non-THC components of baby soap, including cocamidoprophyl betaine, polyquaternium 11, PEG 80 and sorbitan laurate, and numerous other compounds, thus leading to an unusual number of false-positives during newborn drug screening.
Negative Consequence of False-Positives
As legal cannabis becomes more widely available across the United States, it becomes even more important to be aware of the potential for false-positive results in many areas ranging from commonplace employment drug testing, to motor vehicle operation, and now to newborn drug screening. The negative legal, economic, and social consequences of false-positives are considerable and too lengthy a topic to go into here.
False-Positives in Newborns
Positive immunoassay results are confirmed or refuted with more sophisticated methods such as GC-MS, but a considerable amount of time (often days) may elapse between the preliminary result and verification. In that interim period there is potential for involvement by child protective services and allegations of child abuse. Given the seriousness of these consequences, it is incumbent on care providers and laboratory personnel to be aware of the limits of preliminary immunoassay screening and to consider secondary testing and confirmation prior to initiating costly and possibly unnecessary interventions.
Shout out to the team of social workers, care providers, hospital staff, and laboratory personnel from UNC-Chapel Hill who took the time to work out this puzzle.
Unexpected interference of baby wash products with a cannabinoid (THC) immunoassay.
Cotten SW, Duncan DL, Burch EA, Seashore CJ, Hammett-Stabler CA.
Clin Biochem. 2012 Jun;45(9):605-9. doi: 10.1016/j.clinbiochem.2012.02.029. Epub 2012 Mar 23.
©2016 COLORADO GREEN LAB | COLORADOGREENLAB.COM
Saturday's FrankTalk: Fear and Impairment
THC drug testing in the workplace and roadside - relevant intersection of science, society, and law.
A FrankTalk on cannabis DUI laws, workplace drug testing, and the current state of things.
Cost: Free event, open to the community
Time: 12:00 PM to 04:00 PM, talk begins at 01:00.
Location: Herman's Hideaway: 1578 S Broadway, Denver, CO 80210
Join Frank Conrad, Lab Director of Colorado Green Lab for The SCIENCE! of Cannabis.
Doors at noon. Frank will talk from 1-1:45 and then open the floor for questions for 30 minutes.
This is our first event on a Saturday! As always, we'll be there after the talk for a few hours or more having a few beers at the bar absolutely ready and thrilled to talk SCIENCE!
If you can't make the talk, come for the hanging out after. The patio is nice and the weather has been beautiful. There is always a great mix of industry, scientists, cannabis patients, recreational users and curious non users.
Another great FrankTalk last night, this one on the subject of cannabis terpenes and their role as antifungal compounds against powdery mildew and as insect deterrents. I'll post a link to the YouTube video of the talk once it's uploaded.
Thank you, World Viral, for recording and post-processing, and Herman's Hideaway for providing the venue!
Video of Monday's FrankTalk: The Science! of Cannabis
Cannabidiol Conversion to THC
15-August-2016dule Zero is real.
Bio: Owner, Laboratory Director, Disambiguator, and Chief Cannabis Scientist for Colorado Green Lab.