Two more Minnesotans have died from vaping-related lung illnesses, raising the state’s toll to three and prompting health officials to issue new warnings about vaping illegal cannabis substances.

The state’s first death was reported last month by the Minnesota Department of Health.

So far, the state has seen 73 confirmed or probable cases of severe lung injury associated with vaping, with an additional 32 cases under review.

Of those interviewed, most have reported using illegal products containing THC, the psychoactive component in marijuana. “It is particularly important for people to avoid vaping anything containing illegal cannabis products,” Minnesota Health Commissioner Jan Malcolm said Wednesday.

At the same time, health officials can’t rule out nicotine as a factor in the lung damage that has sent most of those affected to the hospital. About half the patients required intensive care.

The most recent deaths involved patients over age 50 who died in September after “complicated hospitalizations,” the Health Department said. One patient had vaped a number of products, including illegal THC. The second patient had severe underlying conditions and vaped nicotine as well as other unknown products.

Of the three deceased patients, one lived in the metro area while the other two lived outside the metro. Duluth-based Essentia Health confirmed that one of its patients was among those that died as a result of vaping but said it could not release more details due to privacy regulations.

“We hope we do not have any more deaths linked to this investigation,” said state epidemiologist Dr. Ruth Lynfield. “However, based on what we know about other patients, the seriousness of the injuries and the fact that we continue to see new cases, it is possible we will have more deaths.”

Nationwide, 1,300 lung injury cases have been linked to e-cigarettes or vaping products. Twenty-eight people have died.

Although the three Minnesotans who died were over 50, most of those affected have been younger, with an average age of 26. The youngest is 15.

Since the vaping-related illnesses were first reported in mid-August, health investigators have been working to identify the precise source and how the lung damage is caused.

Zeroing in on the cause is made more difficult because some patients reported using up to 75 different products, Lynfield said. In some cases, patients still had the vaping cartridges but there was no liquid left in them for testing.

Investigators are examining the chemicals in the cartridges themselves, as well as the chemical compounds that result when the cartridges are heated to create the aerosol that people inhale.

According to the Health Department, that aerosol contains harmful substances, such as ultrafine particles, oil and heavy metals like nickel, tin and lead.

Vaping behavior and past medical history are also being tracked. Lynfield said some of the patients had vaped “a huge, huge amount.”

Because recreational marijuana and THC use are illegal in Minnesota, most of the affected patients turned to the underground market for their THC vaping products, which could contain dangerous chemicals.

Lynfield warned that people “should not buy any type of vaping products off the street, particularly those containing THC or other illegal cannabis products.”

‘Seek immediate care’

Minnesota’s legal medical marijuana program does include some THC vaping products. Health officials advised users to talk with their doctors about possible alternatives.

“We recommend that people who do vape and experience signs of respiratory illness seek immediate medical care,” Malcolm said.

Vaping-related symptoms have included shortness of breath, fever, cough, vomiting and diarrhea. Some patients also reported headache, dizziness and chest pain.

People who took up vaping to quit using tobacco should consider other solutions, Malcolm said. The state’s free QuitPlan Services can be used for both tobacco and vaping.

“Until more is known, people looking to quit should use FDA-approved smoking cessation aids that are shown to be safe and effective, such as nicotine gum, lozenges and patches,” said Laura Smith, senior public affairs manager for ClearWay Minnesota, which runs the program.

Even before the vaping-related illnesses came to light, health officials were concerned about rising rates of vaping among teens and the potential for creating a new generation of people addicted to nicotine.

The 2019 Minnesota Student Survey found that 26% of 11th-graders had recently vaped, a 54% increase from 2016. Additionally, three-quarters of 11th-graders said there was “no, slight or a moderate risk to using e-cigarettes.”

“People can get addicted to these nicotine vaping products,” Lynfield said. “They are highly concentrated. It doesn’t take much to cause the addiction.”