A few days before Thanksgiving, the woman realized she needed to refill her marijuana vape pen, which helped her relax and cope with migraines.
The 33-year-old veterinary technician perused her dealer’s menu and texted her order for delivery to her home north of Boston. She chose his cheapest option: a $40 prefilled cartridge of cannabis oil branded Dabwoods. A better deal, she reasoned, than the $70 she would spend at a licensed cannabis store for what she thought was the same product.
It never occurred to her that the container of amber oil, smaller than her pinky and wrapped in purple packaging, could be dangerous. Like her friends and many others, she thought the cartridges held only a pot extract and that the recent headlines about lung illnesses caused by vaping were overblown.
Advertisement
She was feeling good at the time. Accomplished. She had finished 200 hours of yoga teacher training and was supposed to teach her first class that week. She had learned to focus on her breath, how deep inhales and exhales could regulate her emotions.
But after puffing on her vape pen a few times over two nights, she had a fever and pounding headache. She was eventually hospitalized and placed on a ventilator in a medically induced coma. She was one of 2,600 people stricken across America by vaping-related lung injuries in an outbreak that has claimed 57 lives — four in Massachusetts.
“It seemed like such a myth, like it can’t happen to me, but my life came crashing down overnight,” said the woman, now 34, who spoke on condition of anonymity for fear of career repercussions.
. . .
The vaping illnesses that exploded last fall spotlighted a vast underworld of illicit marijuana vape sellers. Unburdened by safety rules, unlicensed producers often use pesticides that can turn into hydrogen cyanide when heated, and their vapes may contain formaldehyde or lead, according to published reports.
Advertisement
But most of the hospitalizations appear caused by vitamin E acetate, an additive used largely by dealers, according to the US Centers for Disease Control and Prevention.
For years, scores nationwide used illicit vapes without getting sick. Many consumers believed that vaping was healthier than smoking and they liked that it is odorless. Like the Boston-area woman, many customers prefer illicit vapes’ price and trust their labels claiming regulatory compliance and testing. But the packaging is fake. Any dealer can buy labels like Dabwoods, which the local woman vaped, online. Dabwoods didn’t respond to an e-mail seeking comment.
In Massachusetts, 110 people have fallen ill from vaping. The Cannabis Control Commission, which requires testing, has found no vitamin E in licensed cartridges.
But it’s impossible to know what’s in unlicensed vapes. Now, a debate is raging over whether to crack down on the state’s illicit market, which accounts for an estimated three-quarters of cannabis sales. Some cannabis advocates argue the unlicensed services fill a need amid a lack of legal delivery and pot stores — there are just two near Boston — and that law enforcement often targets people of color.
Federal authorities last month shut down 44 websites selling illicit vapes, but virtual marketplaces abound where dealers and consumers chat.
“Either [of] y’all die from it, I just got one?” someone wrote in December on Dabwoods’ Instagram, next to a picture of a strawberry-flavored vape beside strawberries.
Advertisement
“Haha nope still kicking it lol,” another replied, “and my neighbor has been getting one every week since I posted this and he’s not dead.”
. . .
The morning after Thanksgiving, about 36 hours after she first vaped the new cartridge, the woman awoke with a headache. She lay in bed, sweating and cold. Nauseous, she couldn’t eat or drink. A thermometer showed a 103-degree fever.
She tried to rest, but she wondered whether she should see a doctor. She drove to an urgent care center in Cambridge. Her vital signs were normal. Tests for flu and strep throat were negative. A doctor advised her to take flu medicine and return if she didn’t improve in five days.
At home, she tried to sleep but her fever was too severe. She spent the next day, a Saturday, in bed.
On Sunday, the fever still burned and her headache throbbed. She panicked about what her body was telling her. Her breathing felt short. She thought it was anxiety.
She went to another urgent care, in Chestnut Hill. A reading showed her blood oxygen levels were around 75 percent, far lower than the normal 95 to 100 percent. A chest scan showed signs of abnormalities all over her lungs. Doctors suspected pneumonia or an infection.
She was transferred to an intensive care unit at Beth Israel Deaconess Hospital in Needham. There, a doctor asked if she vaped.
Advertisement
Yes, she said. She vaped a Juul to stay off cigarettes and cannabis oil to ease her migraines and anxiety.
The clinicians appeared concerned about the marijuana oil, she recalled.
She felt faint and foggy. She figured she had pneumonia and her vaping had exacerbated it.
They placed her on oxygen. A few nights later, she dreamed she was in a canoe at summer camp, swallowing clouds from the sky that never seemed to fill her lungs. When she awoke, she told a doctor that breathing hurt and she couldn’t breathe on her own. Doctors placed her on a ventilator. Without it, her oxygen levels had plummeted to 40 percent.
Clinicians sedated her and transported her to Beth Israel’s intensive care unit in Boston.
While the woman was unconscious, her mother texted daily from Florida.
“I will be there very soon,” she wrote. “Please come back to us, we can’t bear being without you.”
The next day: “Stay strong honey. I love you so very much <3”
. . .
When the illnesses first emerged in August, health investigators scrambled to uncover what was causing young healthy people to lose lung function and sometimes die within days.
Now, doctors understand the injuries better, though questions remain. Contrary to misconceptions, the injury is not caused by oil getting caught in the lungs but resembles something closer to chemical burns, said Dr. Yasmeen Butt, a Mayo Clinic pathologist whose team examined vaping patients’ lung tissues under a microscope.
Advertisement
“It’s the kind of injury we would see in someone in a factory who had an accident or someone in a war being exposed to mustard gas,” Butt said. The burns are similar to what would happen “if you poured hydrochloric acid on yourself.”
The burn damages cell walls in the air sacs, preventing oxygen from entering the bloodstream, she said. Patients struggle to breathe because tissue damage and cell death in the lining of the airways and lungs causes swelling as the lungs try to heal. That tightens the airways, and dead cells slough into the airways, obstructing them further, Butt said.
The long-term effects of vaping are still unknown. Butt anticipates future health problems emerging, even for people who use uncontaminated products.
“It’s like in the ’20s and ’30s with tobacco,” Butt said. “We’re at the beginning of this story.”
. . .
Groggy from sedatives, the woman awoke after five days unconscious. Her father had visited from Florida, sitting beside her. She never saw him. Her mother would arrive shortly.
She felt choked. A ventilator tube carried oxygen down her throat. The machine was beeping as it breathed for her. She started to panic because she couldn’t inhale.
She ripped the tube out.
The machine screamed. Nurses rushed in and placed an oxygen mask over her face. She feared she would die in her sleep. She dreamed she was running home, unable to breathe enough to run faster.
Hours later, she awoke surrounded by her husband, mother-in-law, and sisters, including one from Florida.
They told her about her injuries caused by vaping, and that doctors discussed placing ports on her body to deliver oxygen to her blood long-term.
Guilt washed over the woman. She felt embarrassed, like she didn’t deserve to take up hospital space.
“How could I have done this to myself?” she recalled thinking. “How could I have been so dumb?”
Her dealer texted his latest menu randomly. She wasn’t mad at him. She didn’t think he knowingly sold poison.
“Hey friend,” she texted. “Reaching out to let you know something is very wrong with the [Dabwoods] carts. I was in the ICU on a ventilator for several days, then on oxygen for another 10. . . . I need you to know now so nobody else gets hurt.”
“I’m so sorry,” he replied. “I will be taking them off the menu and putting them in the trash.”
After two weeks hospitalized, the woman went home with orders to not vape or smoke. She could barely walk.
Her friends were shocked to hear the illness was real. Like her, many had rejected the legal market for its high prices and long lines. (The woman had been so tuned out of the legal pot world around Thanksgiving that she didn’t know licensed vapes had been temporarily removed from store shelves.)
“It’s really important for people to know you can die,” she said. “A lot of people have the excuse ‘I only do it once in a while.’ That’s all it takes.”
She has now regained strength, although her lungs may be forever changed. On Thursday night, she prepared to teach her first yoga class. She practiced poses that recently seemed impossible, balancing on one foot, hands in prayer.
She sat cross-legged, inhaling and exhaling slowly. Her breaths still felt short and strained. She appreciated them more than ever.
Naomi Martin can be reached at naomi.martin@globe.com. Follow her on Twitter at @NaomiMartin.