Wednesday, October 16, 2019

New Mexico hits the panic button with medical cannabis vape warning label, despite facts from CDC.

“WARNING: Vaping cannabis-derived products containing THC has been associated with cases of severe lung injury, leading to difficulty breathing, hospitalization and even death”
(Emergency Rule Amendment filed by NM Health Cabinet Secretary Kunkel on Oct. 4 2019)


First, it is important to note that this illness is not caused by anything intrinsic to cannabis.
New Mexico regulators have unfairly singled out medical cannabis vape products to include a health warning, despite facts from CDC.

The Centers for Disease Control and Prevention issued vaping guidance noting that "products containing THC, particularly those obtained off the street or from other informal sources...are linked to most of the cases and play a major role in the outbreak" and recommending that... "persons consider refraining from using e-cigarette, or vaping, products that contain nicotine."

Why has the state singled out products in the New Mexico medical cannabis program for ‘warning labels’ amidst the Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping, known as Vaping-Associated Pulmonary Illness (VAPI)? 

Safe Access New Mexico has ask the Department of Health to reconsider the current language now being used as a “warning label” for medical cannabis vaping products. The warning label is very misleading and to clear that up, Safe Access New Mexico suggested adding the following factual statement to the Warning Label: “It is important to note that this illness is not caused by anything intrinsic to cannabis.”

New Mexico should have also conducted a public meeting, like held Tuesday night in Colorado, where regulators held a public hearing on proposed rules to ban certain additives in cannabis vaping products.

Medical cannabis manufacturers and producers in New Mexico must label their THC-containing vape products with: “WARNING: Vaping cannabis-derived products containing THC has been associated with cases of severe lung injury, leading to difficulty breathing, hospitalization and even death,” MJ Business Daily reported. 

Nor has the NM Department of Health posted anything about this “warning label” to the state’s medical cannabis program website to inform the medical cannabis program participants, as of Friday morning October 11 2019.  [Link: https://nmhealth.org/about/mcp/svcs/]

And the statement made on these warning labels are not entirely accurate based on CDC Data for VAPI.  [Link to all that CBD data: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/resources/index.html]

The New Mexico Health Department did not require any “Warning labels” on nicotine vaping products. 
The New Mexico Environment Department has not required any “Warning labels” on any Hemp CBD vaping products. 
The state hit the panic button with it's warning label singling out products in the state's medical cannabis program.

The state of New Mexico has ignored the true problems causing the outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping.

Problems the CDC has found, that state has failed to mention; such as adulterants, contaminants, heavy metals, residual solvents, chemical residues, and other health concerns, such as mold and dangerous bacteria.

It is important to note that this illness is not caused by anything intrinsic to cannabis and the state of New Mexico has failed to mention that key fact.
The state should be encouraging participation in the state’s medical cannabis program amidst the Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping instead using scare tactics on a warning label. The focus of the problem for New Mexico should be on improving the lab testing standards for cannabis products, the blackmarket, and those promoting the use of the blackmarket.

The available evidence from the CDC indicates that the vast majority of those who were sickened after using a vaporizer cartridge purported to contain THC purchased their cartridges not through legally licensed stores, but through unregulated, illicit channels.

Additionally, CDC data indicates that 16% reported the exclusive use of nicotine-containing products in the 30 days prior to symptom onset.

But no “warning label” for those nicotine vape products in New Mexico.

Some operators are cashing in on the Hemp CBD craze by substituting cheap and illegal synthetic marijuana for natural Hemp CBD in vapes and CDC data shows this has caused Vaping-Associated Pulmonary Illness (VAPI).

The AP News commissioned laboratory testing of 29 vape products sold as Hemp CBD around the country, with a focus on brands that authorities or users flagged as suspect. Ten of the 30 contained types of synthetic marijuana — drugs commonly known as K2 or spice that have no known medical benefits — while others had no CBD at all.

And we have seen two Albuquerque news stations expose some Hemp CBD retail stores for selling questionable/mislabeled products, but no “warning label” for those Hemp CBD vape products in New Mexico.
[KOAT News Hemp CBD Investigative Story: https://www.koat.com/article/mixed-bag-of-results-whats-really-in-your-cbd-products/27532208

KOB News Hemp CBD Investigative Story: https://www.kob.com/new-mexico-news/4-investigates-cbd-industry-is-operating-in-the-dark/5359467/?cat=500 ]

The New Mexico Department of Health also forgot to mention how they decided not to test New Mexico medical cannabis products for Heavy Metals, Pesticides and other dangerous toxins - All of which have been found in vaping products by the CDC that are making people sick.

Steep Hill labs warned lawmakers and the Department of Health about this in October 2017 at a Legislative Health and Human Services Committee Meeting and the state did nothing.
[Link to those Steep Hill Handouts: https://www.nmlegis.gov/handouts/LHHS%20101617%20Item%209%20Dr.%20Reggie%20Gaudino%20Testimony%20with%20NM%20Samples%2010_17_17.pdf ]

And a California based cannabis testing lab, CannaSafe, found that out of 12 illicit cannabis vape cartridges they tested, nine contained high levels of Vitamin E acetate and ALL contained pesticides, while none of the 104 legal products they examined had those contaminants.
[Link to that testing: https://www.businessinsider.com/study-counterfeit-vapes-contain-vitamin-e-pesticides-and-hydrogen-cyanide-2019-10 ]

Nor did the Department of Health consult any national organizations that are experts in cannabis policy, medical cannabis regulatory affairs, or in medical cannabis scientific research before issuing this biased health warning.

Americans For Safe Access(ASA) points out that as of yet, CDC investigators have not been able to pin down one factor or set of factors that is likely to result in illness. Vitamin E (tocopherol) acetate has been implicated as a potential cause of illness and injury in many of the cases involving illicit cannabis cartridges, but it has not been present in all samples. CannaSafe, a PFC-certified lab in California, recently revealed results from a small study that showed black market cartridges can contain extremely high concentrations of other dangerous chemicals, such as myclobutanil, a pesticide routinely found in cannabis samples that is converted to the poison hydrogen cyanide when heated to 400 °F (204.4 °C). CannaSafe also tested 10 illicit cartridges for myclobutanil and found it in each one, highlighting the need for patients and consumers to purchase products that have been subjected to mandatory testing for dangerous chemicals and other hazards. Additionally, such cartridges can contaminate their contents with heavy metals like arsenic and lead. However, the recent disclosure that at least one death has been linked to a legally purchased product underscores that this risk is not just confined to the illicit market.

ASA Recommendations

Whether due to better healthcare surveillance and reporting, the addition of new cutting agents or other additives, the presence of pesticides or other contaminants, issues with certain types, brands, or manufacturers of cartridges and other delivery mechanisms, a combination of these factors, or something else, it is clear that the use of ENDS is not without risk. ASA strongly recommends patients and consumers stop using cannabis-containing cartridges entirely (or at least to the extent possible) until there is clarity as to what is causing these illnesses and deaths.

ASA does not support outright bans on cannabis-containing cartridges or devices intended for the consumption of cannabis concentrates, which could simply drive more people to the unregulated market and exacerbate the spread of VAPI. Rather, we recommend bans on the inclusion of any additives (e.g., diluents, thickeners, flavoring agents) not derived from cannabis. Additionally, ASA recommend patients and consumers only purchase cannabis products that have undergone testing at an independent, third-party laboratory that has verified composition and potency and screened for adulterants, contaminants, heavy metals, residual solvents, chemical residues, and other health concerns, such as mold and dangerous bacteria.

Vape Alternatives

ASA understand that for many patients, inhalation may be the preferred - or the only effective - method of delivery. Historically, inhaling cannabis vapor has been considered a safer alternative to inhaling cannabis smoke because the toxic byproducts of combustion are avoided. While this is still believed to hold true for dry herb (flower) vaporizers, vape pens, though convenient and easy to use, should be avoided at this time. ASA recommends that patients and consumers who currently use a vape pen instead use other delivery mechanisms, such as dry herb vaporizers, tinctures, edibles, or topicals. Patients who must be able to medicate discreetly and rely on vape pens because they don’t produce cannabis’ signature scent may find combining the use of a flower vaporizer and a personal smoke filter to be a workable solution.

Conclusion

Americans for Safe Access started out in 2002 with the mission to not just ensure access to medical cannabis to patients across the county, but to ensure safe access. As a patient-focused organization, they take the safety of patients very seriously, and the emergence of VAPI has caused us great concern. The current health crisis that is being linked to the use of illicit concentrate vaporization products highlights the importance of legalization, regulation, laboratory testing of all cannabis and cannabis-derived products (most critically when they are in their final form), and third-party certification, such as that offered through ASA's Patient Focused Certification (PFC) program.

Since 2014, ASA has urged the industry to adopt third-party certification for all cannabis businesses. Through the PFC program, companies are required to adhere to safety, quality, manufacturing, testing, packaging, and labeling standards beyond those set by most jurisdictions where the medical and/or adult use of cannabis has been legalized.

PFC companies are subject to both routine and unannounced inspections by independent auditors, which is especially important in light of the fact that jurisdictions may not have enough inspectors to ensure that all licensed operators are complying with all regulations. Patients and consumers may wish to encourage the dispensaries they patronize and the brands that produce the products they use to explore PFC certification to ensure patient and consumer safety and product quality. ASA will continue to do our part for patients, who are and always will be our highest priority, by keeping up the pressure on industry to adopt regulations that promote patient and consumer safety and by persisting in our advocacy for safe access to cannabis for patients everywhere.


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