E-cigarette or vaping product use-associated lung injury (EVALI) was severe and affected mostly young, otherwise healthy patients in California — a state with a legal recreational cannabis market.1

“Outreach by clinicians and public health departments is needed to educate patients and the public about the health risks associated with vaping, particularly vaping of unregulated cannabis products,” the researchers of a new study wrote.

The study looked at data from 160 hospitalized patients with EVALI in California. The majority of patients were male (62%) and the median patient age was 27 years.

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Of the 156 patients with full data available, almost half (46%) were admitted to the intensive care unit and about one-third (29%) required mechanical ventilation. Additionally, 4 in-hospital deaths occurred.

The researchers were able to interview 86 patients, the majority of whom (83%) had vaped tetrahydrocannabinol (THC)-containing products. Despite California’s legal cannabis market, 75% of products that contained THC were obtained from informal sources, such as friends, acquaintances or unlicensed retailers. These patients reported using 130 unique vaping products in the 90 days prior to EVALI symptoms.

The most common symptoms were cough, shortness of breath, and subjective fever or chills. A majority of patients also reported at least 1 gastrointestinal symptom.

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“The findings of this case series suggest that many patients with EVALI present with a severe inflammatory response, including signs, symptoms, and laboratory findings often presumed to be infectious by both outpatient and inpatient health care providers,” the researchers wrote. “These findings underscore the importance for all clinicians, including outpatient health care providers, to consider EVALI in patients with a history of vaping who present with typical findings of infection, as well as monitor their clinical course and respiratory status closely for decompensation, in accordance with CDC guidance.”

The FDA also recently announced its ongoing work related to cannabidiol products with a focus on protecting public health.2 Among these efforts is work to close the knowledge gaps in both safety and potential benefits by obtaining reliable and high-quality research data, and monitoring of the marketplace with a focus on greatest risk to public harm.

“We also have serious concerns about products that put the public at risk in other ways,” the FDA wrote. “We are committed to working efficiently to further clarify our regulatory approach to these products — as always, using science as our guide and upholding our rigorous public health standards.”


  1. Heinzerling A, Armatas, C, Karmarkar E, et al. Severe lung injury associated with use of e-cigarette, or vaping, products—California, 2019. JAMA Intern Med. 2020;DOI:10.1001/jamainternmed.2020.0664.
  2. US Food and Drug Administration. FDA advances work related to cannabidiol products with focus on protecting public health, providing market clarity. Published March 6, 2020. Accessed March 9, 2020.