On Monday, Nov. 18 the Washington State Board of Health expanded its emergency rule banning the sale of flavored vapor products containing THC to include a new section banning the sale of vapor products containing vitamin E acetate.

Vitamin E acetate is sometimes used as an additive in vapor products, often as a thickening agent. Recent findings from the Centers for Disease Control and Prevention (CDC) connects vitamin E acetate to vaping associated lung injuries.

“CDC has identified vitamin E acetate as a chemical of concern among people with e-cigarette or vaping, product use associated lung injury (EVALI). Recent CDC laboratory testing of bronchoalveolar lavage fluid samples (fluid samples collected from the lungs) from 29 patients with EVALI submitted to CDC from 10 states found vitamin E acetate in all of the samples,” according to the CDC website.

The CDC also recommends that people should not use e-cigarettes of vapor products that contain THC, particularly if they get them from informal sources such as friends, family, and unverified online retailers.

As of Nov. 13 over 2,000 cases of EVALI have been reported across the country with 42 confirmed deaths in 24 states.

According to the Washington State Department of Health, as of Nov. 15, there are 15 confirmed cases in Washington state, seven in King County, three in Snohomish, two in Spokane, and single cases in Pierce, Mason, and Kitsap counties. No reported deaths so far. Five cases involve the use of nicotine vapor products only, while only two cases involve the use of THC products, with four cases involving a combination. The majority of the cases seem to impact men between 30 to 40 years old, though there are at least eight cases involving children and young adults.

“We are deeply concerned by a new study finding vitamin E acetate at the primary site of injury in patients’ lungs,” said Secretary of Health John Wiesman. “While we still need more research to identify a definitive cause, the evidence we have linking vitamin E acetate to the outbreak demands immediate action to protect the public’s health. Furthermore, we are very aware there may be more than one cause for these lung injuries associated with vaping.”

The chair of the Washington State Board of Health Keith Grellner also made a statement.

“Today’s action by the Board of Health to remove vitamin E acetate from the vapor product market in Washington is based on the most current information from the national investigation into severe lung injury associated with vapor products,” said Grellner. “The Board knows this investigation is ongoing; as such, we will be monitoring the investigation daily and will be prepared to take further action as we learn more.”

The ban on the sale of flavored vapor products sent brick and mortar vape shops across the state into financial tailspins as they were required to pull thousands of dollars of product from their shelves. Owners of these shops had been telling the health department for years that it was vitamin E acetate and black-market products that were causing the health issues.

“No products that are in a legal shop will contain vitamin E,” Quinn Richards, owner of Partly Cloudy Vapors in Poulsbo said.

In September Richards had to pull brand new stock off his shelves when the temporary flavor ban went into effect, causing him to close another location in Port Townsend. Richards is now looking for a second job to get out of debt while maintaining his current shop in Poulsbo.

“It’s been horrible. We’re surviving, but it’s basically just super dead. We went from having 50 to 60 customers a day to having five to 15 customers a day,” Richards said of the ban. ” It’s affected my livelihood a lot, I’m actually picking up another job.”

The new section of the rule will take effect as soon as it is filed with the code reviser’s office and will remain in effect for 120 days. The rest of the rule will still expire on Feb. 7 of next year.