1 00:00:02,000 --> 00:00:05,000 JUDY WOODRUFF: States around the country continue to crack down on flavored e-cigarettes and 2 00:00:05,000 --> 00:00:07,066 other vaping products. 3 00:00:07,066 --> 00:00:11,500 Much of that is in response to the deaths and illnesses that began coming to light this 4 00:00:11,500 --> 00:00:13,533 summer. 5 00:00:13,533 --> 00:00:16,866 But even as lawmakers are trying to determine what to do, researchers are still trying to 6 00:00:16,866 --> 00:00:20,133 better understand the cause of these illnesses. 7 00:00:20,133 --> 00:00:24,966 Miles O'Brien has been looking into that very question for our regular series on the Leading 8 00:00:24,966 --> 00:00:27,033 Edge of science. 9 00:00:27,033 --> 00:00:31,633 MILES O'BRIEN: Like at least five million young Americans, 18-year-old Adam Hergenreder 10 00:00:34,033 --> 00:00:38,333 started vaping electronic cigarettes two years ago, because everyone else was doing it. 11 00:00:39,833 --> 00:00:41,566 He loved all the flavors. 12 00:00:41,566 --> 00:00:44,266 ADAM HERGENREDER, Former E-Cigarette User: Mint tasted just like a mint. 13 00:00:44,266 --> 00:00:45,566 Mango tasted just like a mango. 14 00:00:45,566 --> 00:00:47,333 Cucumber tasted just like a cucumber. 15 00:00:47,333 --> 00:00:49,633 So I didn't really know that it had nicotine in it. 16 00:00:49,633 --> 00:00:53,300 MILES O'BRIEN: It is an extremely potent punch of nicotine. 17 00:00:53,300 --> 00:00:57,166 He preferred the strong pods made by Juul. 18 00:00:57,166 --> 00:01:02,133 Each carries as much of the highly addictive drug as a pack of cigarettes. 19 00:01:04,166 --> 00:01:07,233 E-cigarettes, or vape pens, use a battery to heat a coil, which turns a nicotine infused 20 00:01:08,933 --> 00:01:11,666 liquid into an aerosol. 21 00:01:11,666 --> 00:01:15,366 Before too long, Adam was inhaling a pod-and-a-half a day. 22 00:01:15,366 --> 00:01:16,833 ADAM HERGENREDER: I was hooked. 23 00:01:16,833 --> 00:01:19,466 I mean, I knew I was addicted, but I just couldn't quit. 24 00:01:19,466 --> 00:01:24,466 MILES O'BRIEN: Eventually, the nicotine rush from Juul wasn't enough for him. 25 00:01:26,000 --> 00:01:28,566 So he bought some black market vape pens containing cannabis oil. 26 00:01:28,566 --> 00:01:33,566 And, soon, he was enjoying head rushes from both nicotine and THC,the psychoactive ingredient 27 00:01:35,933 --> 00:01:37,433 in marijuana. 28 00:01:37,433 --> 00:01:39,833 ADAM HERGENREDER: The Juul lasted about 10 seconds. 29 00:01:39,833 --> 00:01:43,000 The THC product lasted about an hour. 30 00:01:43,000 --> 00:01:44,666 That's why I switched over to that. 31 00:01:44,666 --> 00:01:48,733 MILES O'BRIEN: But at the end of August, he got sick, very sick. 32 00:01:48,733 --> 00:01:53,700 ADAM HERGENREDER: I started to experience some tremors. 33 00:01:55,800 --> 00:01:57,866 And then that was for about a day. 34 00:01:57,866 --> 00:02:01,766 And then the next three days, I started throwing up violently, again, throughout the whole 35 00:02:02,733 --> 00:02:05,366 day. 36 00:02:05,366 --> 00:02:08,733 MILES O'BRIEN: He ended up here at the Advocate Condell Medical Center in Libertyville, Illinois. 37 00:02:10,633 --> 00:02:14,400 Pulmonologist Stephen Amesbury showed me Adam's initial chest X-ray. 38 00:02:14,400 --> 00:02:17,233 All that haziness is inflammation. 39 00:02:17,233 --> 00:02:21,633 When you see a 17- or an 18-year-old with a chest X-ray like that, what is the next 40 00:02:21,633 --> 00:02:22,633 step? 41 00:02:22,633 --> 00:02:23,633 What do you do as a doctor? 42 00:02:23,633 --> 00:02:25,666 DR. 43 00:02:25,666 --> 00:02:27,733 STEPHEN AMESBURY, Advocate Condell Medical Center: Many months ago, the consideration 44 00:02:27,733 --> 00:02:30,633 would primarily be pneumonia or some possible toxins or if they have taken some drugs. 45 00:02:32,666 --> 00:02:35,600 Nowadays, in light of all the vaping illnesses, that's one of the first questions we ask young 46 00:02:35,600 --> 00:02:37,933 people when they come in with breathing problems. 47 00:02:37,933 --> 00:02:42,933 MILES O'BRIEN: Adam had EVALI, or E-cigarette or Vaping Product Use-Associated Lung Injury. 48 00:02:45,266 --> 00:02:49,466 The condition emerged in Illinois and Wisconsin in April. 49 00:02:49,466 --> 00:02:54,433 As of December 3, it had sickened nearly 2,300 mostly young people nationwide. 50 00:02:56,433 --> 00:03:01,100 Half of them, like Adam, end up in intensive care, many attached to ventilators. 51 00:03:02,500 --> 00:03:05,666 One young person required a lung transplant. 52 00:03:05,666 --> 00:03:08,100 And 48 have died. 53 00:03:08,100 --> 00:03:09,833 Adam came close. 54 00:03:09,833 --> 00:03:10,833 It's killed some people. 55 00:03:10,833 --> 00:03:11,833 Could it have killed him? 56 00:03:11,833 --> 00:03:13,833 DR. 57 00:03:13,833 --> 00:03:15,000 STEPHEN AMESBURY: If he hadn't come in, and just tried to stick it out at home a few more 58 00:03:15,000 --> 00:03:17,133 days, absolutely. 59 00:03:17,133 --> 00:03:21,000 MILES O'BRIEN: All those young people with very sick lungs triggered a series of investigations 60 00:03:23,000 --> 00:03:25,600 by state health authorities and the Centers for Disease Control and Prevention. 61 00:03:25,600 --> 00:03:26,600 REAR ADM. 62 00:03:26,600 --> 00:03:28,566 DR. 63 00:03:28,566 --> 00:03:30,600 ANNE SCHUCHAT, Centers for Disease Control and Prevention: What we know now is that the 64 00:03:30,600 --> 00:03:33,600 vast majority of individuals have a history of using vaping products that contain THC. 65 00:03:35,033 --> 00:03:38,833 MILES O'BRIEN: Anne Schuchat is the principal deputy director. 66 00:03:38,833 --> 00:03:39,833 REAR ADM. 67 00:03:39,833 --> 00:03:41,833 DR. 68 00:03:41,833 --> 00:03:45,833 ANNE SCHUCHAT: So, our laboratory tested 29 samples from 29 patients from 10 different 69 00:03:47,733 --> 00:03:51,433 states around the country and looked at 12 different chemical tests. 70 00:03:52,866 --> 00:03:56,533 And we found 29 of 29 patient specimens had vitamin E acetate. 71 00:03:59,000 --> 00:04:02,533 MILES O'BRIEN: Vitamin E acetate, the nutritional supplement is inexpensive, unregulated and 72 00:04:04,933 --> 00:04:06,900 widely available. 73 00:04:06,900 --> 00:04:11,733 It's fine to ingest or use topically, but when inhaled, the sticky substance interferes 74 00:04:12,933 --> 00:04:15,466 with normal lung functions. 75 00:04:15,466 --> 00:04:20,466 It nevertheless became a favored choice in the black market as a way to dilute pure cannabis 76 00:04:21,600 --> 00:04:25,566 oil, which has a similar color and viscosity. 77 00:04:25,566 --> 00:04:30,566 Testing labs in states where cannabis use is legal analyze marijuana for its potency 78 00:04:32,266 --> 00:04:35,900 and screen for contaminants, heavy metals, pesticides and mold. 79 00:04:35,900 --> 00:04:39,600 But, before this crisis, they weren't looking for vitamin E acetate. 80 00:04:39,600 --> 00:04:42,633 MICHAEL KAHN, President, MCR Labs: We don't have screen for everything. 81 00:04:42,633 --> 00:04:44,300 We're not "Star Trek." 82 00:04:44,300 --> 00:04:47,233 We can screen for specific compounds. 83 00:04:47,233 --> 00:04:52,233 MILES O'BRIEN: Michael Kahn is president and founder of MCR Labs in Framingham, Massachusetts. 84 00:04:54,500 --> 00:04:59,500 As EVALI emerged, he and his team quickly developed a way to screen for vitamin E acetate. 85 00:05:01,566 --> 00:05:04,700 MICHAEL KAHN: It was an immediate public health concern to us, so we offered it for free, 86 00:05:04,700 --> 00:05:09,433 and we still do, to anybody who needs to bring in samples just to make sure they're safe. 87 00:05:09,433 --> 00:05:13,400 We have received 56 samples from regular walk-in citizens. 88 00:05:13,400 --> 00:05:18,400 MILES O'BRIEN: They found nine of those cannabis oil samples were tainted with vitamin E acetate. 89 00:05:20,400 --> 00:05:24,500 MICHAEL KAHN: Every instance of vitamin E acetate was from somebody who walked in, not 90 00:05:25,800 --> 00:05:28,333 through the marijuana establishment regulated market. 91 00:05:28,333 --> 00:05:32,200 MILES O'BRIEN: But the EVALI case is still not closed. 92 00:05:32,200 --> 00:05:37,200 Twenty percent of patients afflicted do not admit vaping THC. 93 00:05:38,800 --> 00:05:42,100 There is evidence other substances could pose a danger as well. 94 00:05:42,100 --> 00:05:45,366 And so some urgent research continues. 95 00:05:45,366 --> 00:05:50,366 Pulmonologist Jeff Gotts is an assistant professor at the University of California, San Francisco. 96 00:05:52,300 --> 00:05:56,700 He has built a device that systematically exposes the aerosols from e-cigarettes to 97 00:05:58,566 --> 00:06:02,400 cells cultured from donor human lungs rejected for transplantation. 98 00:06:04,433 --> 00:06:08,200 The work is ongoing, but, so far, cells exposed for an hour a day, three days in a row, to 99 00:06:10,200 --> 00:06:14,300 the chemicals used to dissolve nicotine in Juul e-cigarettes show preliminary signs of 100 00:06:15,533 --> 00:06:16,533 damage. 101 00:06:16,533 --> 00:06:18,600 DR. 102 00:06:18,600 --> 00:06:20,566 JEFF GOTTS, University of California, San Francisco: It may be the case that this had 103 00:06:20,566 --> 00:06:22,600 been going on for a while in different forms in a low level, and we're going to be able 104 00:06:22,600 --> 00:06:27,500 to see a lot better what the real incidence of disease from all of these exposures is 105 00:06:27,500 --> 00:06:30,000 now that we have everybody's attention. 106 00:06:30,000 --> 00:06:34,200 MILES O'BRIEN: First touted as a smoking cessation tool, e-cigarettes got very popular very quickly, 107 00:06:36,466 --> 00:06:41,466 with virtually no regulatory oversight, and no research on its implications to human health. 108 00:06:42,400 --> 00:06:45,000 DR. 109 00:06:45,000 --> 00:06:47,033 JEFF GOTTS: In many senses, it is a horrifying experiment that people are performing on themselves 110 00:06:47,033 --> 00:06:51,200 with these different inhalational exposures, that we have absolutely no sense of their 111 00:06:51,200 --> 00:06:53,266 long-term safety. 112 00:06:53,266 --> 00:06:57,266 MILES O'BRIEN: With THC vaping oil, not only is there the same lack of safety data, but 113 00:06:58,666 --> 00:07:02,933 there are extra daunting hurdles to filling the research gap. 114 00:07:02,933 --> 00:07:07,933 The federal government still considers marijuana a controlled substance, in the same legal 115 00:07:08,800 --> 00:07:11,400 category as heroin and LSD. 116 00:07:11,400 --> 00:07:16,400 It means scientists can only procure marijuana for research from one federally sanctioned 117 00:07:17,133 --> 00:07:19,033 site in Mississippi. 118 00:07:19,033 --> 00:07:23,566 And it doesn't produce the sort of cannabis oil products people are inhaling. 119 00:07:25,600 --> 00:07:28,666 To what extent is this a result of the confusion and the discontinuity in all the laws and 120 00:07:31,700 --> 00:07:33,733 regulations across this country? 121 00:07:33,733 --> 00:07:34,266 KATE PHILLIPS, Cannabis Community Care and Research Network: Oh, I think it's a direct 122 00:07:34,266 --> 00:07:36,400 result. 123 00:07:36,400 --> 00:07:39,500 MILES O'BRIEN: Kate Phillips is director of education for the Cannabis Community Care 124 00:07:39,500 --> 00:07:41,666 and Research Network in Massachusetts. 125 00:07:41,666 --> 00:07:45,633 KATE PHILLIPS: We have an industry that's supported by the state, and then everything 126 00:07:45,633 --> 00:07:47,866 after that's hands up. 127 00:07:47,866 --> 00:07:52,866 So, when a problem like this happens, everyone's scattered, and nobody really knows who's the 128 00:07:52,866 --> 00:07:56,600 point person to go to, who needs to collaborate, who needs to lead on this. 129 00:07:56,600 --> 00:07:58,733 And, again, it's up to the companies. 130 00:07:58,733 --> 00:08:01,533 It's up to the public health officials in each state. 131 00:08:01,533 --> 00:08:04,300 And that's where we got to where we are today. 132 00:08:04,300 --> 00:08:09,300 MILES O'BRIEN: Meanwhile, the vaping trend keeps growing, especially among teens. 133 00:08:11,366 --> 00:08:15,933 Public health experts worry, if no action is taken, this health crisis will only get 134 00:08:17,066 --> 00:08:20,700 worse in the short and long term. 135 00:08:20,700 --> 00:08:25,300 For the "PBS NewsHour," I'm Miles O'Brien in Gurney, Illinois. 136 00:08:25,300 --> 00:08:27,966 JUDY WOODRUFF: Such important reporting.