It seemed like food poisoning.
All weekend, I lay in bed with such abdominal pain that I cried, moaned, even yelled. It was the worst stomach bug I had experienced in my 40 years. By Sunday, I began to improve. I held down fluids, I ate a banana. But that night I grew sicker. No matter how much water and sports beverage I drank, my mouth dried out and my fever rose. Instead of immersive fever dreams, my dreams were of a single object, receding into the distance, emptiness all around me.
The Atrius Health advice line thought I had food poisoning, but by Monday morning they agreed that I should go to the hospital. I took a Lyft and walked into the emergency department of Mt. Auburn Hospital. I tried to send text messages while waiting, but the letters melted before my eyes.
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I next remember having an oxygen mask on my face. Someone told me I was blue when I arrived, with blood oxygen only 63 percent saturated, near pulmonary arrest, coma, brain damage, or death. Hadn’t I noticed shortness of breath? With guts inflamed such that you can’t twist at the middle, it’s tough to breathe. I hadn’t started coughing until Sunday night.
My daughter’s fourth birthday would be the next day, Nov. 5, and I didn’t want to spend it in the ICU. I admitted that I had vaped THC, the active ingredient in marijuana, but this pain was in my abdomen, and I’d vomited. My chest X-ray indicated pneumonia reaching into both lungs; apparently, an internal infection was spreading. For one day, they bombed me with intravenous antibiotics, with no effect. I needed more oxygen.
On Tuesday morning, the doctors asked again about vaping. I rephrased their question: “You’re asking me how much I’ve lied to my wife? That’s OK, good question.” I told them of four to five months of daily vaping, a one-gram cartridge every three days.
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They gave me steroids, with tremendous effect. I still had abdominal pain, I still needed oxygen, but I consumed broth and clear juices, sat up and talked, and watched the evening news. On Thursday, I ate solid food. On Friday, I stepped down from the ICU and went for walks wheeling an oxygen tank.
Hospital employees knew I was the vaping guy, and many had questions. Which cartridges did I use, were they from a legal store? I gave my best summary: I ordered online and a courier delivered legitimate-looking products — fancy boxes with serial numbers, sealed by stickers that tore upon opening. Literature described an organic farm where cannabis is extracted using carbon dioxide, the cleanest method there is. If illegitimate, I couldn’t tell using guides posted online.
Some drugs, though not harmless, are accepted by society. We tolerate alcohol despite its costs. Smoking cannabis is often a social experience, like sitting around a campfire, that lowers barriers between people. Vaping THC more readily becomes a solitary, furtive practice.
A “vaping pen” can be hidden in your pocket; I never let anyone see mine. You push a button, a light turns on, and you get a dose of THC. You can take a hit or two at a time, enough to ease stress, get a light buzz, perhaps during bathroom breaks at work. It’s convenient, there’s no preparation required, no fire, no lingering smell. I hid it from my wife and co-workers for months. Comparing the health impacts of vaping THC and smoking cannabis requires longitudinal studies that take decades to execute. Until then, we’re all guinea pigs.
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Friends, relatives, and especially students confirm the recent proliferation of vaping. Sales data for marijuana products show that, after legalization, extracts for vaping are the fastest growing product share by revenue, on pace to surpass flower for smoking within a few years. My experiences ordering cannabis flower and then vaping products online over the past 18 months tracked this development here in Massachusetts.
We’re seeing this epidemic of reported vaping illnesses now because we have reached a critical mass of people who are vaping THC, but we can mitigate the health impact.
Users and call centers should know that an apparent stomach bug might be vaping illness. Users should tell their doctors about vaping THC, or risk treatment with ineffective antibiotics instead of incredibly effective steroids.
Users are safer by avoiding the black market, but a gray market could emerge. Counterfeit cartridges are most prolific in states with legal marijuana, and unregulated sources are the only ones available to many users. These are sometimes cash-only businesses, untraceable. There is no federal agency charged with fighting counterfeit vaping products as the Bureau of Alcohol, Tobacco, and Firearms does for cigarettes and alcohol.
We should recognize that vaping THC is not safe and avoid premature conclusions about a single chemical culprit. Vitamin E acetate has been associated with the vaping illness, and I have detected it in one of my old cartridges after the fact, but no evidence of causation has been shown. Vitamin E acetate, THC, and natural compounds that flavor marijuana are terpenes, biochemicals composed mostly of carbon and hydrogen. They are water-resisting oils that disrupt cell membranes, and the lungs have no mechanism to address them. If vaping such compounds causes acute illness to some, it may harm all. Consider the greasy scum on the fume hood above a deep fryer. Whether you were frying with peanut oil, canola oil, or hemp oil, it’s still grease.
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One month ago, I nearly died from vaping THC. Today, my lung function is above average. We can save lives without drastic measures, such as lung transplants, when users and doctors are informed. We must also burst the bubble of complacency that surrounds vaping.
Jeff Rawson is a postdoctoral research fellow at Harvard University.