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A Marin Vaping Death Hits Close to Home

The estimated 40th death nationwide from a still-unexplained vaping-related lung illness outbreak tragically occurred locally, in nearby Marin County. A 45-year-old woman named Amanda “Mandy” Arconti was rushed to the Novato Community Hospital emergency room on Nov. 6 with respiratory symptoms, and died of double pneumonia within a day.

“With sadness, we report that there has been a death in our community suspected to be caused by severe lung injury associated with vaping,” Marin Health & Human Services public health officer Dr. Matt Willis said in a statement six days later. That announcement described the victim as a “previously healthy woman in her 40s who took up vaping six months ago.”

But early evidence suggests she may not have taken up vaping cannabis or THC, even though cannabis vaping products have been widely blamed in the recent outbreak of e-cigarette vaping-associated lung injury ( EVALI).

In an interview with SF Weekly, Dr. Willis says that none of the vaping product samples collected from the victim’s family initially appeared to be THC.

“They were common and commercially available brands of nicotine-containing vaping products,” Dr. Willis tells us. “Many were recognizable and had brands’ names on them, and some did not.”

The fact that some of the boxes were unlabeled means we can’t say for sure that THC was not a factor. “Just on that visual inspection, we’re not able to see that,” he says.

“In many cases of EVALI, we’re able to interview the user themselves to determine what products they were using and where they purchased them,” Willis says. “In this case, we weren’t able to get the history from the woman who passed, because she was so ill from the first point of our awareness. She passed within 24 hours of arriving at the hospital.”

One other way to alert the public as to which vaping products are potentially lethal would be to just release images of them. But that’s something that county health departments, the California Department of Public Health (CDPH), and the U.S. Centers for Disease Control (CDC) are unwilling to do.

“We’re not able to provide a photo,” Willis tells us. “The photographic evidence is obtained by the California Department of Public Health. They’ve visited our offices here where we were storing the products that we had obtained from the family. The chain of custody involves inventorying all of the products that can be identified by name, and photographing them.”

So SF Weekly reached out to the CDPH requesting photos of the incriminating products. “The California Department of Public Health is unable to provide photos of products,” a CDPH spokesperson said via email. “Since the investigation is ongoing, CDPH cannot release details of the investigation.”

Meanwhile, Marin County officials have finished both autopsy and toxicology reports on the victim, which could tell us what was in her system. But they’re not sharing this information either.

“The autopsy has been completed, but the results will not be available for some time,” Willis says. “It’s more usually on the order of weeks rather than days.”

Nationally, the CDC has been issuing weekly updates on how many people have gotten sick or died from EVALI symptoms. They also note what surviving victims say they’ve been vaping, and their latest report points out that 83 percent of victims say they had vaped THC.
But they also note that 13 percent of victims say they only vaped nicotine products. The Marin County victim may be part of that 13 percent, though these numbers are self-reported, and the victims’ claims aren’t verified.

But the CDC has been clear on one thing — they have identified a common, black-market cutting agent called vitamin E acetate as “a chemical of concern” in the ongoing EVALI crisis. The agency performed an analysis of 29 victims’ lung fluid samples and “found vitamin E acetate in all of the samples.”

Dr. Willis would not directly acknowledge whether that compound was in this victim’s samples. “Some of the substances that have been established as culprits nationally were present in our case here in Marin,” he says. “The CDC had determined that vitamin E acetate is commonly found in some cases. That’s clearly a substance of concern for us.”

Vitamin E acetate is a synthetic version of vitamin E that’s been used for years in skin care items and diet supplements. It’s been clinically proven as safe to eat or apply to your skin, but no one had ever considered smoking it.
That is, until last year when vitamin E acetate suddenly became a popular vape oil diluting agent on the underground vaping cartridge scene. Unlicensed, illegal operators could jack up their profits by adding this “hamburger helper” to their THC or nicotine oil pods.

Many operators would then buy fake Juul or marijuana company packaging on Chinese online retail sites, and sell their fake vape cartridges as the real thing on the street or at unlicensed dispensaries and delivery services.
And the volume of vitamin E acetate in illegal THC cartridges has been topping out at levels “close to 50 percent,” according to a recent study from San Francisco cannabis testing company Anresco Laboratories. That means up to half of your underground marijuana vape oil could be toxic filler.

While this diluting agent is generally associated with THC, “a nicotine producer could have started using it as well,” Anresco Laboratories director of cannabis services Josh Richard tells SF Weekly. “Although all of our data does point to the illicit market, it doesn’t necessarily point to THC.”

Anresco also tested more than 200 different legal THC vape cartridges, and found absolutely no vitamin E acetate in any of the legal California brands they assessed. Similarly, legal Juul nicotine pods don’t contain any of it either. But on the underground vape pod market, anything goes.
For now, state and federal authorities are telling us that we shouldn’t vape anything until they discover the culprit in this deadly mystery. But they haven’t told us which vape products have been shown to kill people, what these products look like so users can avoid them, or when we can expect any real answers to these questions.