JUDY WOODRUFF: States around the
country continue to crack down
on flavored e-cigarettes and

other vaping products.

Much of that is in response to
the deaths and illnesses that
began coming to light this

summer.

But even as lawmakers are
trying to determine what to do,
researchers are still trying to

better understand the
cause of these illnesses.

Miles O'Brien has been looking
into that very question for our
regular series on the Leading

Edge of science.

MILES O'BRIEN: Like at least
five million young Americans,
18-year-old Adam Hergenreder

started vaping electronic
cigarettes two years
ago, because everyone
else was doing it.

He loved all the flavors.

ADAM HERGENREDER, Former
E-Cigarette User: Mint
tasted just like a mint.

Mango tasted just like a mango.

Cucumber tasted just
like a cucumber.

So I didn't really know
that it had nicotine in it.

MILES O'BRIEN: It is
an extremely potent
punch of nicotine.

He preferred the strong
pods made by Juul.

Each carries as much of
the highly addictive drug
as a pack of cigarettes.

E-cigarettes, or vape pens,
use a battery to heat a coil,
which turns a nicotine infused

liquid into an aerosol.

Before too long, Adam was
inhaling a pod-and-a-half a day.

ADAM HERGENREDER: I was hooked.

I mean, I knew I was addicted,
but I just couldn't quit.

MILES O'BRIEN: Eventually,
the nicotine rush from
Juul wasn't enough for him.

So he bought some
black market vape pens
containing cannabis oil.

And, soon, he was enjoying head
rushes from both nicotine and
THC,the psychoactive ingredient

in marijuana.

ADAM HERGENREDER: The Juul
lasted about 10 seconds.

The THC product
lasted about an hour.

That's why I switched
over to that.

MILES O'BRIEN: But at the end of
August, he got sick, very sick.

ADAM HERGENREDER: I started
to experience some tremors.

And then that was
for about a day.

And then the next three days, I
started throwing up violently,
again, throughout the whole

day.

MILES O'BRIEN: He ended
up here at the Advocate
Condell Medical Center in
Libertyville, Illinois.

Pulmonologist Stephen
Amesbury showed me Adam's
initial chest X-ray.

All that haziness
is inflammation.

When you see a 17- or an
18-year-old with a chest X-ray
like that, what is the next

step?

What do you do as a doctor?

DR.

STEPHEN AMESBURY, Advocate
Condell Medical Center: Many
months ago, the consideration

would primarily be pneumonia
or some possible toxins or if
they have taken some drugs.

Nowadays, in light of all the
vaping illnesses, that's one of
the first questions we ask young

people when they come in
with breathing problems.

MILES O'BRIEN: Adam had EVALI,
or E-cigarette or Vaping Product
Use-Associated Lung Injury.

The condition emerged in
Illinois and Wisconsin in April.

As of December 3, it had
sickened nearly 2,300 mostly
young people nationwide.

Half of them, like Adam, end
up in intensive care, many
attached to ventilators.

One young person required
a lung transplant.

And 48 have died.

Adam came close.

It's killed some people.

Could it have killed him?

DR.

STEPHEN AMESBURY: If he hadn't
come in, and just tried to
stick it out at home a few more

days, absolutely.

MILES O'BRIEN: All those
young people with very
sick lungs triggered a
series of investigations

by state health authorities
and the Centers for Disease
Control and Prevention.

REAR ADM.

DR.

ANNE SCHUCHAT, Centers for
Disease Control and Prevention:
What we know now is that the

vast majority of individuals
have a history of using vaping
products that contain THC.

MILES O'BRIEN: Anne Schuchat is
the principal deputy director.

REAR ADM.

DR.

ANNE SCHUCHAT: So, our
laboratory tested 29
samples from 29 patients
from 10 different

states around the
country and looked at 12
different chemical tests.

And we found 29 of 29 patient
specimens had vitamin E acetate.

MILES O'BRIEN: Vitamin E
acetate, the nutritional
supplement is inexpensive,
unregulated and

widely available.

It's fine to ingest or use
topically, but when inhaled,
the sticky substance interferes

with normal lung functions.

It nevertheless became a favored
choice in the black market as
a way to dilute pure cannabis

oil, which has a similar
color and viscosity.

Testing labs in states where
cannabis use is legal analyze
marijuana for its potency

and screen for
contaminants, heavy metals,
pesticides and mold.

But, before this crisis,
they weren't looking
for vitamin E acetate.

MICHAEL KAHN, President,
MCR Labs: We don't have
screen for everything.

We're not "Star Trek."

We can screen for
specific compounds.

MILES O'BRIEN: Michael
Kahn is president and
founder of MCR Labs in
Framingham, Massachusetts.

As EVALI emerged, he and his
team quickly developed a way to
screen for vitamin E acetate.

MICHAEL KAHN: It was an
immediate public health
concern to us, so we
offered it for free,

and we still do, to anybody
who needs to bring in samples
just to make sure they're safe.

We have received 56 samples
from regular walk-in citizens.

MILES O'BRIEN: They found
nine of those cannabis
oil samples were tainted
with vitamin E acetate.

MICHAEL KAHN: Every instance
of vitamin E acetate was from
somebody who walked in, not

through the marijuana
establishment regulated market.

MILES O'BRIEN: But the EVALI
case is still not closed.

Twenty percent of
patients afflicted do
not admit vaping THC.

There is evidence
other substances could
pose a danger as well.

And so some urgent
research continues.

Pulmonologist Jeff Gotts
is an assistant professor
at the University of
California, San Francisco.

He has built a device that
systematically exposes the
aerosols from e-cigarettes to

cells cultured from donor
human lungs rejected
for transplantation.

The work is ongoing, but, so
far, cells exposed for an hour
a day, three days in a row, to

the chemicals used to dissolve
nicotine in Juul e-cigarettes
show preliminary signs of

damage.

DR.

JEFF GOTTS, University of
California, San Francisco: It
may be the case that this had

been going on for a while in
different forms in a low level,
and we're going to be able

to see a lot better what the
real incidence of disease
from all of these exposures is

now that we have
everybody's attention.

MILES O'BRIEN: First touted
as a smoking cessation
tool, e-cigarettes got
very popular very quickly,

with virtually no
regulatory oversight,
and no research on its
implications to human health.

DR.

JEFF GOTTS: In many
senses, it is a horrifying
experiment that people are
performing on themselves

with these different
inhalational exposures,
that we have absolutely
no sense of their

long-term safety.

MILES O'BRIEN: With THC vaping
oil, not only is there the
same lack of safety data, but

there are extra daunting hurdles
to filling the research gap.

The federal government still
considers marijuana a controlled
substance, in the same legal

category as heroin and LSD.

It means scientists can only
procure marijuana for research
from one federally sanctioned

site in Mississippi.

And it doesn't produce
the sort of cannabis oil
products people are inhaling.

To what extent is this a
result of the confusion
and the discontinuity
in all the laws and

regulations across this country?

KATE PHILLIPS, Cannabis
Community Care and
Research Network: Oh,
I think it's a direct

result.

MILES O'BRIEN: Kate Phillips
is director of education for
the Cannabis Community Care

and Research Network
in Massachusetts.

KATE PHILLIPS: We have an
industry that's supported by
the state, and then everything

after that's hands up.

So, when a problem like
this happens, everyone's
scattered, and nobody
really knows who's the

point person to go to,
who needs to collaborate,
who needs to lead on this.

And, again, it's up
to the companies.

It's up to the public health
officials in each state.

And that's where we got
to where we are today.

MILES O'BRIEN: Meanwhile, the
vaping trend keeps growing,
especially among teens.

Public health experts worry,
if no action is taken, this
health crisis will only get

worse in the short
and long term.

For the "PBS NewsHour,"
I'm Miles O'Brien
in Gurney, Illinois.

JUDY WOODRUFF: Such
important reporting.