What should people avoid inhaling during mysterious lung disease outbreak? Health officials disagree

Health officials are warning consumers about a mysterious lung disease that has sickened hundreds and killed at least three people. What to avoid? That's where they disagree.

Federal health officials are reviewing 450 possible cases linked to vaping across 33 states and one territory. At least three people have died from the illness. It's too early to pinpoint what exactly is making people sick, Centers for Disease Control and Prevention and Food and Drug Administration representatives told reporters on a call Friday.

In many cases, people vaped both nicotine and THC, the marijuana compound that produces a high, the CDC said. Some reported using both THC and e-cigarettes while a smaller group reported using only nicotine.

Meantime, the Centers for Disease Control and Prevention on Friday urged people to avoid e-cigarettes, or electronic devices that deliver nicotine. Yet the Food and Drug Administration on Friday told people to avoid THC-containing vaping products.

Dana Meaney-Delman, who is overseeing the CDC's response, said the agency recommends people not use e-cigarettes while the investigation is ongoing and until officials identify a cause.

"That broad recommendation is because we do have a diversity of products … some containing nicotine and some containing THC," she said. "As more information comes about and we can narrow down the specific e-cigarette products, we intend to revise that."

In a consumer advisory published later Friday, the FDA warned people not to vape THC products. The advisory does not make any mention of e-cigarettes other than to encourage people to submit any product issues.

Cannabis oils are largely unregulated. States that have legalized recreational marijuana may oversee the products, but the FDA does not regulate illegal products. In absence of any oversight, the black market has flourished and with it, poor quality products.

While no one substance has been identified as the culprit, many samples showed high levels of vitamin E acetate, the FDA said. Vitamin E is typically used as a supplement or added to skincare products. But people are adding the oil and other substances to cannabis products to make the extracts form a vapor.

"You are not supposed to inhale oils into your lungs," said Dr. Melodi Pirzada, chief pediatric pulmonologist at New York University Winthrop Hospital, who has treated patients in the outbreak.

The FDA said it does not have enough data to say definitively that vitamin E oil is causing the lung injuries. Still, it recommends people do not inhale the substance.

"Because consumers cannot be sure whether any THC vaping products may contain Vitamin E acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores," the agency said.

Gavin Roth, a 20-year-old student at the University of California, Los Angeles, said he isn't concerned about the outbreak. He regularly uses Juul e-cigarettes but says everything he has heard indicates the illnesses are from bad "carts," or cartridges filled with THC oil.

Recreational marijuana is legal in California — only for adults 21 and older. Plenty of his peers are buying them from friends or dealers, he said.

"People aren't scared. They think, 'that won't happen to me,'" Roth said.

Some customers buying e-cigarettes have asked about the outbreak, said Furqan Kholani, who owns a smoke shop in Manhattan. At another store down the street, Dennis Droushiotis, 32, walked in to buy some mango e-cigarette cartridges. He said he has been using knockoff Juul pods and jokingly asked if those are the ones making people's lungs explode.

He said people keep sending him text messages about stories about the outbreak and begging him to quit. But he's not worried, he said.

"I've been vaping everything for as long as it's been a thing and I've had no problems," Droushiotis said.