THE PROGNOSIS

Sen. Bernie Sanders (I-Vt.) is intensifying his calls to legalize marijuana products. That could help the federal government prevent more vaping-related deaths in the future.

The Centers for Disease Control and Prevention confirmed Friday what many had already suspected: That most people who died from a spate of vaping-related injuries used products containing illegal THC oil, the psychoactive ingredient in marijuana, my colleague Lena H. Sun reports.

“Based on data available from 860 of the 1,604 patients who have fallen ill with the disease, about 85 percent reported using THC-containing products, compared to about 10 percent who reported exclusively vaping nicotine-containing products,” Lena writes. “Many sick patients said they bought THC vape products on the black market, and those have come under increased scrutiny.

“The data do continue to point towards THC-containing products as the source of individuals’ injury,” said CDC principal deputy director Anne Schuchat. Officials don’t know what about the products are harmful, “but we’re seeing THC as a marker for products that are risky,” she said.

As we wrote last month, illegal vape cartridges containing THC also contain significant amounts of vitamin E acetate. Because cannabis oil is expensive, producers use the acetate to dilute and thicken it without affecting its flavor or smell. But the vitamin’s oil-like properties are associated with the kinds of respiratory problems many patients have reported, including cough, shortness of breath and chest pain.

Abraham Gutman, editorial writer for the Philadelphia Inquirer:

So if it’s THC oil at the root of the injuries – and not vaping itself – that raises questions about what regulators can do to make sure the compound is safe. And the answer is: Not much.

While 11 states and the District of Columbia have legalized marijuana use to some degree and many more allow its medical use, marijuana and marijuana-derived products remain illegal federally. That means the Food and Drug Administration can’t exert oversight over even the riskiest marijuana products – or even evaluate claims made by the manufacturers selling devices for cannabis.

The FDA is working with U.S. Customs and Border Protection officials at international mail facilities to trace the supply chain of potential illicit vaping products, Lena reports. But while THC remains illegal under federal law, the door is closed to federal agencies who might otherwise be able to evaluate how these compounds are manufactured and marketed.

The result, former FDA commissioner Scott Gottlieb wrote recently, is an “impasse.”

“Federal agencies exert little oversight, and regulation is left to a patchwork of inadequate state agencies,” he wrote in an op-ed for the Wall Street Journal. “The weak state bodies sanction the adoption of unsafe practices such as vaping concentrates, while allowing an illegal market in cannabis to flourish.”

“The recent lung injuries and deaths confirm the market has become a Wild West of potent and shadowy products,” he continued.

Look at Washington State. The state has a regulated cannabis market and it requires that vape products sold in stores be checked for potency, toxins and residual solvents. But there’s little state regulators can do when it comes to black market vapes often found to contain “cutting agents” like the harmful vitamin E acetate.

Marijuana legalization hasn’t occupied much time on the Democratic debate stages so far, perhaps because most of the candidates agree on it.

But Sanders, who has long supported legalizing marijuana, is leaning into the issue on the campaign trail. He released a proposal last week to legalize pot and expunge criminal convictions related to the drug, my colleague Sean Sullivan reports.

“Sanders’s plan, which aims to overhaul an approach he argues has unfairly hurt minorities, calls for using executive power to reclassify marijuana as a dangerous controlled substance and passing legislation to permanently legalize the drug,” Sean writes. “It would direct federal and state authorities to review, vacate and expunge past marijuana convictions.”

Former vice president Joe Biden and Sen. Elizabeth Warren (D-Mass.), who are polling ahead of Sanders, have also proposed sweeping changes to the country’s marijuana laws. Their proposals are emblematic of a broader shift among both Democrat and Republican politicians favoring more tolerant drug laws instead of more toughness.

Early on in the Trump administration, former attorney general Jeff Sessions signaled he would crack down on marijuana in a reversal from the Obama administration’s policy of turning a blind eye to states that had legalized it. But the administration ultimately changed little about its approach, and recently, President Trump didn’t rule out legalizing marijuana during his presidency.

“We’re going to see what’s going on,” the president said in late August. “It’s a very big subject. And right now we’re allowing states to make that decision. And a lot of states are making that decision.”

Meanwhile, the CDC is erring on the side of caution with its recommendations to the American public. Agency officials are continuing to recommend that people refrain from using all e-cigarettes even though most people who have fallen ill used products containing THC.

AHH, OOF and OUCH

AHH: Trump’s campaign has been privately pushing the White House to walk back its proposed ban on flavored vaping products, warning that it could hamper the 2020 reelection efforts, our Post colleagues Michael Scherer, Josh Dawsey, Laurie McGinley and Neena Satija report.

The president’s campaign manager Brad Parscale commissioned an internal campaign poll aimed at bolstering the idea Trump supporters who use e-cigarettes might waver on supporting Trump next year if the administration actually bans some products.

“The political lobbying effort comes as the Trump administration is considering whether to continue allowing menthol- and mint-flavored e-cigarette products, according to three people familiar with the deliberations,” our colleagues write. “Allowing these sales would mark a major retreat from a proposed ban announced in September on 'all non-tobacco' flavors. Government data shows that nearly two-thirds of high schoolers who use ­e-cigarettes use mint or menthol flavors.”

Anti-tobacco activists and health groups are angry about the possibility of the White House softening its initial proposal. “Excluding menthol would be huge — it means that kids will buy menthol,” said Desmond Jenson, an attorney with the Public Health Law Center at the Mitchell Hamline School of Law in St. Paul, Minn. “If you give them one flavor, that’s what they will buy. It doesn’t solve the problem.”

 Such a move could also be a boon to e-cigarette producers. Former FDA Gottlieb suggested tobacco companies Altria and Reynolds would benefit if mint and menthol e-cigarettes remain on the market.  

OOF: A hearing before a state commission starts this week to determine whether the last abortion clinic in Missouri will keep its license.

The Administrative Hearing Commission will weigh arguments over the fate of the clinic after the federal judge referred the case to the commission over the summer. “The Missouri health department has said the Planned Parenthood clinic failed to correct all of the deficiencies it found during an annual inspection in the spring, emphasizing concerns over its compliance and patient safety,” the Wall Street Journal’s Jennifer Calfas reports.

“In documents filed to the state commission, the attorney general’s office also argued against a constitutional right to abortion in the state. ‘The right to abortion is not deeply rooted in Missouri’s unique history and traditions,’ the response, signed by Missouri Attorney General Eric Schmitt, said.”

But lawyers representing Planned Parenthood say the licensing battle is the latest in a serious of efforts by the state to limit abortion access. The state is currently one of six that have just one abortion clinic. 

OUCH: Divisions within the Democratic Party on proposals to lower drug prices may hamper the effort altogether, especially as potential impeachment proceedings present a hurdle to any legislative efforts.

Some progressives say House Speaker Nancy Pelosi’s (D-Calif.) legislation to allow the federal government to negotiate some drug prices covered by Medicare and the private market doesn’t go far enough. They say the bill “falls short of full negotiation for all drugs in Medicare,” the Wall Street Journal’s Stephanie Armour reports. “The dissent means a full House floor vote won’t occur until November at the earliest.”

That’s just in the House. In the Senate, there are disagreements over drug-pricing legislation in a bipartisan proposal from Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Sen. Ron Wyden (D-Ore.). The bill, which in part would have drug companies reimburse Medicare if prices increase more than the inflation rate, “is seen as anti-free-market by some Senate Republicans,” Stephanie writes.

The divisions in both chambers could mean the White House won’t get a win on drug pricing this year.

MEDICAL MISSIVES

— As the Kincade Wildfire raged through some parts of Sonoma County in California, some farmworkers in regions not immediately threatened continued to work through the dangerous smoke and heat.  

For those in wine country, this time of year is not just the peak of fire season in the state but the peak of grape harvest, Kaiser Health News’s Anna Maria Barry-Jester reports. That means some farmworkers are putting their health at risk in order to try to harvest hundreds of thousands of dollars’ worth of grapes.

“As wildfires of this strength and intensity grow more frequent, so do concerns for field workers, who can face conditions that jeopardize their health, wages and housing,” Anna writes. “Outside of the fire itself, the main health concern in wildfire conditions is smoke, which produces particulate matter, a mix of gases and microscopic pieces of solid matter. The particles can penetrate deep into the lungs, increasing the risk of respiratory diseases and asthma, as well as heart problems.”

— And here are a few more good reads: 

HEALTH ON THE HILL

Democrats are arguing that a small reduction in biomedical innovation is worth a massive reduction in drug prices.
Stat
Vulnerable GOP senators up for reelection next year are giving the cold shoulder to a bipartisan bill aimed at lowering drug prices.
The Hill
South Bend Mayor Pete Buttigieg joined The Nevada Independent on the Indy Matters podcast this week to talk about his prior support for Medicare for all, whether he would break up Facebook and other big tech companies as president and how he is trying to broaden his appeal before the early nominating contests next year.
The Nevada Independent

TRUMP TEMPERATURE

Predict, a government research program, sought to identify animal viruses that might infect humans and to head off new pandemics.
New York Times

INDUSTRY RX

Health
“We rush into burning fires or deal with the worst injuries — that’s our job. . . . But we’re also human, and sometimes our brains can’t compute the horrible things we see.”
Rene Ebersole

OPIOID OPTICS

DAYBOOK

Coming Up

  • The House Veterans' Affairs Subcommittee on Oversight and Investigations holds a hearing on protecting whistleblowers and promoting accountability on Tuesday.
  • The House Judiciary Subcommittee on Immigration and Citizenship holds a hearing on the Impact of Current Immigration Policies on Service Members and Veterans, and their Families on Tuesday.
  • The House Veterans' Affairs Subcommittee on Health holds a hearing on native veterans' access to healthcare on Wednesday.
  • The Senate Health, Education, Labor and Pensions Committee holds a business meeting on Thursday.

SUGAR RUSH