What’s the news: E-cigarettes have been linked to more than 1,000 cases of vaping-related lung injury and 18 deaths. The AMA is urging e-commerce CEOs to vigorously enforce their existing policies to keep illicit vaping products off their platforms and be vigilant against the sale of empty vaping cartridges and other items used to create counterfeit vaping products.

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The letter was sent to the CEOs of Amazon, Microsoft, LinkedIn, Facebook and Instagram, and cited a recent article in The Wall Street Journal, which reported that “the street” where one used to buy illicit materials “has morphed into a global digital marketplace packed with materials used to manufacture cartridges.”

“It is time for e-commerce companies to take action to ban the sale of materials fueling the counterfeit-vaping crisis,” wrote AMA Executive Vice President and CEO James L. Madara, MD. “Given the pace at which vaping-related lung illness is expanding, there is no time to waste.”

The AMA also is urging broadcasting companies to ban advertisements for e-cigarettes.

Why it matters for patients and physicians: All the patients documented in the recent outbreak have a history of e-cigarette product use, reports the Centers for Disease Control and Prevention (CDC). 

About 77% of these patients reported using tetrahydrocannabinol (THC) containing vaping products, with 36% reporting exclusive use of THC-containing products. About 57% reported using nicotine-containing products, with 16% reporting exclusive use of nicotine-containing products, according to the CDC.

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The Wall Street Journal reported that a California-based testing laboratory found pesticides and high amounts of vitamin E acetate in many black-market THC cartridges. The CDC, however, says it is unclear which substances are causing the outbreak.

“The specific chemical exposure(s) causing lung injuries associated with e-cigarette product use, or vaping, remains unknown at this time,” the CDC reports. “No single product or substance has been linked to all lung-injury cases.”

In the CDC’s investigation of the outbreak in Illinois and Wisconsin, 86 patients reported using 234 unique vaping products with 87 different brand names. The patients said 100 of the 112 THC-containing products were acquired from “informal sources” such as friends, family, school, dealers or off the street.

While the search for a definitive cause continues, the AMA urged the tech companies to take immediate action to police their content, rein in the problem and use their influence to protect public health.

“The rapid growth of vaping-related illness is frightening in scope and unexplained in nature,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in the letter to the tech CEOs. “Clearly, the problem is escalating.”

The CDC reports that there is “a class of largely counterfeit brands, with common packaging that is easily available online and that is used by distributors to market THC-containing cartridges with no obvious centralized production or distribution.” Learn more from the CDC about the vaping-related lung injury outbreak.

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In March, the AMA called on tech giants to do more to stem the “proliferation” of “vaccine-related misinformation” that has helped vaccine-preventable diseases to reemerge. In the subsequent months, several well-known tech firms have reportedly taken actions aimed at making it harder for such anti-vaccine misinformation to gain a foothold online.

What’s next: The CDC continues to collaborate with the Food and Drug Administration, state health departments and others to monitor the outbreak. It has developed definitions and standardized data sets for confirmed and probable cases to be used in medical chart abstractions and interview forms.

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