Not all vapes are equal: e-cigarettes and THC cartridges explained

The count of “vaping related illnesses” in the US has passed the 1,000 mark, going by CDC data released on October 3. With that rising case count has come a slew of potentially confusing terminology: headlines about people frantically trying to quit Juuling, stories of state-wide bans of e-cigarette flavors, and on top of it all, the bizarre phrase “Dank Vapes.” What are all of these things, and how are they connected — or not — to the vaping related illnesses?

Let’s break it down. 

Throughout numerous state, FDA, and CDC investigations, the party line has been that these illnesses are all associated with “vaping.” But “vaping” isn’t just one thing. Vaping is the act of putting some kind of substance, usually a liquid — but sometimes a solid — into a vaporizer and inhaling it. In the recent rash of illnesses, mostly liquids have been involved, but those liquids can contain any number of substances, ranging from the intoxicating to the just plain toxic.

There are e-cigarettes that deliver nicotine, like a JUUL, and then there’s THC vaping products — which are their own unique and complicated world. Here are some of the main differences, and how they relate to those “vaping related illnesses.”

What is a “THC vape?”

According to a release issued October 3 by the CDC, 78 percent of a sample of 514 patients with vaping-related illnesses used THC vapes, in addition to nicotine products. Thirty-seven percent used only THC vapes.

The phrase “vaping THC” most likely refers to vaping a form of cannabis concentrate. Concentrates are basically the result of taking marijuana and extracting all desirable flavors and active chemicals — like THC or CBD. This oily extract is often sold in a pre-filled vape cartridge. In cartridges, the concentrate could be a cannabis oil (replete with natural flavor compounds and THC, CBD, or both), or they could be filled with a distillate, which is highly refined and contains the cannabinoids THC or CBD and not a lot else.

Sometimes, manufacturers use flavoring or cutting agents to tweak oils or concentrates to get them to the right consistency and to create attractive flavor profiles.

Just as marijuana is only legal for recreational use in some states, so are THC vapes. That means that there are both legal and illegal THC vapes out there.

"The outbreak currently is pointing to a greater concern around THC containing products."

Legal companies are each licensed by their state to make and sell THC-laden vape cartridges. That means they’re tested robustly by labs to make sure harmful elements of the marijuana growing process —- like pesticides used to grow the plant — don’t end up in the final, concentrated product.

Then, there’s the black market side of things. These are unlicensed sellers who take distillate or oil and sell it in packages that look like real brands, but are actually not licensed. There is no authority overseeing what goes in those boxes.

Data from interviews with 86 patients in Wisconsin and Illinois revealed that patients with vaping-related illnesses report using numerous known black market “brands”, as well as some legal ones too, though it’s hard to tell who may have used both.

That’s where the famous brand Dank Vapes comes in. Out of the 86 interviewed patients in Wisconsin and Illinois, 57 had used a Dank Vape, making them perhaps one of the most dangerous and popular black market scams of all.

What is a Dank Vape?

Dank Vapes looks like a real company, but there is no central distributor or manufacturer that makes the products. The New York Times reports that there could be several large enterprises, or “pen factories”, where black market dealers churn out thousands of Dank Vapes and distribute them around the country. But those are just the big players.

"It’s just people in their garages filling them and selling them."

Smaller enterprises make Dank Vapes too and sell them on Instagram, pop-up websites, or Twitter. Mark Hoashi, the founder of the Doja app — like “Yelp” for the cannabis industry — put it this way to Inverse:

“These are just people filling cartridges as ‘Dank Vapes.’ It’s not a singular facility. It’s just people in their garages filling them and selling them.”

All these sellers look like the same company because they all use the same Dank Vapes logo that appears on their iconic black boxes.

These black boxes are easily found online: Over 11,000 of them were sold by a single manufacturer in China alone in early September.

Once you have one in hand, it’s easy to fill that box with whatever product you want, including a THC distillate or any number of other substances that add thickness or flavor.

That’s why it’s so hard to figure out what exactly in Dank Vapes could be making people sick: Not even the buyers know exactly what’s in each cartridge.

How are they different from Juuling or e-cigarettes in general?

Up until now, we’ve been discussing THC vapes, specifically the black market world of Dank Vapes. While they’ve been used by numerous people with vaping related illnesses, there are still some cases in which people only reported vaping nicotine products, commonly known as e-cigarettes.

The CDC’s October 3 update reports that 17 percent of a sample of 514 patients with vaping related illness said they only used products with nicotine in them.

The most famous e-cigarette company around right now is probably JUUL. JUUL sell nicotine products usually called pods, or the non-brand-specific term, e-liquids. These also contain flavoring agents in addition to nicotine.

Before vaping related illnesses struck, JUUL was already in hot water with the FDA for allegedly marketing its products to teenagers. Though JUUL did not agree with the FDA’s stance on this, the company has since suspended all advertising activity, as record numbers of teens turned to vaping in the last year

Scientists are looking into what the long-term health effects of using licensed e-cigarette products, including JUUL, could be — and early evidence suggests that they’re not exactly good for you.

ButBut at least for now, JUUL’s advertising practices and appeal to teens is somewhat parallel to the story of the vaping related illness that’s being investigated — an illness that appears to strike quickly and severely, landing people in emergency rooms in a matter or days or weeks, rather than years.

How does this all tie in to vaping-related illness?

This vaping-related illness or “injury” (now some experts are calling it injury, rather than illness) is very serious. As Brandon Larsen, Ph.D., a surgical pathologist at the Mayo Clinic, told Inverse previously, the damage to the lungs is huge.

“The lungs bear a very close resemblance to what we see in workers where an industrial accident has occurred, with a toxic chemical spill or toxic fume exposure, or perhaps a poisonous gas exposure,” Laden said.

Right now, no single chemical has been linked to the serious vaping related illnesses. But the CDC is noting that THC vapes are central to the investigation.

“The outbreak currently is pointing to a greater concern around THC containing products,” Anne Schuchat, the CDC’s Principal Deputy Director, told reporters on September 27. “However, we do not know whether the only risky substance for lung injury is the THC-containing products.”

What is in those vape cartridges that’s so dangerous? Previous investigations like New York State’s have focused on additives to THC vapes, including a thickener called vitamin E acetate, a common cut used in black market THC distillate vapes. Larsen’s running idea is that there is some kind of toxic chemical (or more than one) making people sick when they inhale it — though they haven’t identified a culprit.

This complicated landscape offers more questions than answers about what’s really making people sick. And while each cartridge that’s linked to an illness offers clues, that mystery has yet to be solved.