Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent

Abstract

Beginning in June of 2019, there was a marked increase in reported cases of serious pulmonary injury associated with vaping. The condition, referred to as e-cigarette or vaping product use-associated lung injury (EVALI), does not appear to involve an infectious agent; rather, a chemical adulterant or contaminant in vaping fluids is suspected. In August of 2019, the Wadsworth Center began receiving vaporizer cartridges recovered from patients with EVALI for analysis. Having no a priori information of what might be in the cartridges, we employed untargeted analyses using gas chromatography-mass spectrometry and high-resolution mass spectrometry to identify components of concern. Additionally, we employed targeted analyses used for New York medical marijuana products. Here, we report on the analyses of 38 samples from the first 10 New York cases of EVALI for which we obtained cartridges. The illicit fluids had relatively low cannabinoid content, sometimes with unusual Δ⁹-/Δ⁸-tetrahydrocannabinol ratios, sometimes containing pesticides and many containing diluents. A notable diluent was α-tocopheryl acetate (vitamin E acetate; VEA), which was found in 64% of the cannabinoid-containing fluids. To investigate potential sources of the VEA, we analyzed six commercial cannabis-oil diluents/thickeners. Three were found to be >95% VEA, two were found to be primarily squalane, and one was primarily α-bisabolol. The cause(s) of EVALI is unknown. VEA and squalane are components of some personal care products; however, there is growing concern that vaping large amounts of these compounds is not safe.

Keywords: cannabinoids; electronic cigarettes; vaping cartridges; vitamin E acetate.

Figure 1

Untargeted analysis of vaporizer fluid using GC-MS identifies VEA. Shown is the TIC chromatogram from the analysis of an EVALI case-associated vaporizer fluid. Identified cannabinoids and VEA are denoted.

Figure 2

Untargeted analysis of vaporizer fluids using LC-HRMS/MS. Shown in panel (A) is the TIC chromatogram from the analysis of a THC-containing vaporizer fluid in which MCT was identified. In panel (B), the TIC chromatogram from the analysis of a vaporizer fluid is shown in which Δ⁸-THC, Δ⁹-THC and VEA were identified. In panel (C), the high-resolution MS/MS spectrum recorded for VEA in the vaporizer fluid is shown in comparison with that of a VEA standard, with points of fragmentation in the VEA structure as indicated.

Figure 3

Analysis of cannabinoids in vaporizer fluids using HPLC-PDA. The cannabinoid profiles of a vaporizer fluid in which Δ⁹-THC is the most abundant cannabinoid (A) and one in which Δ⁸-THC is the more abundant than Δ⁹-THC (B) are shown. Chromatography of the cannabinoid standards is shown in panel (C). The internal standard, norgestrel, is indicated by I.S.

Figure 4

Analysis of commercial cannabis oil additives using LC-HRMS/MS. The TIC chromatograms from the analysis of diluents 1 and 2 and thickener 1 are shown together with that of the VEA standard recorded on the LC-tripleTOF system under the identical analytical conditions.

Figure 5

Analysis of cannabis oil additives using GC-MS. The TIC chromatograms from the analysis of diluent 3 and thickener 3 using the long GC-MS program for untargeted analysis are shown together with that of a squalene standard. Peaks representing additional components identified in diluent 3, triethyl citrate, and MCT are denoted.