Which vapes should you be avoiding during the 'vaping crisis'?

In the New England Journal of Medicine earlier this month, the Wisconsin Department of Health Services (WDHS) and the Illinois Department of Public Health (IDPH) published preliminary results of their ongoing investigation into reports of lung disease that was probably associated with using e-cigarettes or related products. The majority of patients examined said they had used devices containing tetrahydrocannabinol (THC, the compound in weed that gets you high). Does this mean that weed e-cigarettes are the only vapes that are dangerous? Is everything else safe?

Not exactly. We got a little clarification what exactly you should hold off on smoking until experts have a definitive answer on what's been harming (and even killing) people.

While the illness hasn’t yet been traced to a single product or substance, the report supports the Center for Disease Control’s recommendation to avoid using vapes, especially unauthorized products, until researchers pinpoint the culprit, and other experts Mic spoke to agreed. Media coverage of the vaping crisis, which has spread beyond Wisconsin and Illinois to numerous other states, emphasize that vaping is bad for health, but it may not necessarily be the case that all vapes cause the perplexing lung illness. According to the recent findings, it's unauthorized vapes — which include those that contain THC — that pose an especially big risk.

First, some background info on the WDHS and IDPH investigation: On July 10, the Children’s Hospital of Wisconsin notified WDHS of five otherwise healthy adolescents admitted during the previous 30 days with worsening shortness of breath, fatigue, and abnormally low oxygen levels. All had reported using e-cigs in the days or weeks before their symptoms began. Later that month, the WDHS requested that clinicians report similar cases to public health authorities. A doctor in Illinois then contacted WDHS about a patient that seemed to fit the criteria, prompting the WDHS and IDPH to launch an investigation to identify other cases and characterize the illness on August 1, which a CDC field team joined on August 20.

The WDHS and IDPH defined “case patients” as people who reported using e-cig devices and related products in the 90 days prior to their symptoms beginning and whose chest scans displayed lung infiltrates. Their illnesses weren’t explained by other causes. Fifty-three cases met the criteria, 28 in Wisconsin and 25 in Illinois. (As of September 17, 530 similar cases from 38 states and one US territory had been reported to the CDC.)

Of the 53 case patients, the median age was 19 years, and 83% were male. Nearly all — 94% — were hospitalized, and 32% had to be intubated or hooked up to a ventilator. There was one reported death.

THC-containing e-cig devices were the most commonly reported e-cig product, with 84% of the patients reporting use of them. But patients reported using other types of products, too; 17% reported consuming only nicotine-based products, and 44% reported puffing on both THC- and nicotine-based products. To be sure, the findings were based on patient reports, and patients may have been hesitant to report illegal drug use.

While THC-based oils and waxes are illegal in most states, including Wisconsin and Illinois, they’re still widely available for purchase. “The content of these products is largely unknown and unregulated,” the paper authors wrote. Since the FDA hasn't approved weed as a safe and effective drug, THC-based vapes aren't FDA-regulated, meaning companies that manufacture them aren't required to test them make sure they do in fact contain the ingredients listed on the label.

Indeed, the authors, the CDC, and other experts point to unauthorized vapes in particular as a major source of concern. Aaron Riley, president of CannaSafe, an accredited cannabis testing lab in Los Angeles, tells Mic that many of the adulterants he found in such products, often sold in convenience stores, included metals and vitamin E oil, to name a few. We just don’t know yet if these are the culprits making people sick, but regardless, they shouldn’t be in these products, he says. So basically, until researchers get to the bottom of what’s making people fall ill, lay off the vapes for now, especially products from anywhere other than an authorized retailer — and that includes THC-containing weed pens.