The Boston Globe - 07.09.2019

SEPTEMBER 7, 2019 11

pods could leach heavy metals
into the vapor they create.
Experts warned the lack of
oversight around vape addi-
tives leaves consumers at risk,
and the state flying blind into
an emerging public health cri-
sis.
“It’s not enough to say, ‘We
know what the active ingredi-
ent is, so it’s fine,’ ” said Dr.
Sharon Levy, director of Bos-
ton Children’s Hospital’s sub-
stance use program, adding
that popular vape cartridges
bear little chemical resem-
blance to the marijuana plant,
which has a long history of hu-
man consumption. “Actually,
very small differences matter.
We’re ignoring all of that. That
is a very basic problem.”
So far, none of the patients
whose cases are under investi-
gation are from Massachusetts,
but state officials said they are
investigating “several” possible
cases. One patient who died
had used a marijuana vape
from a licensed store in Ore-
gon.
Cannabis commissioner Jen
Flanagan said the agency
should discuss whether to reg-
ulate additives.
“Everyone should be on
alert when they’re vaping any-
thing,” she said.
Vaporizers typically heat
concentrated marijuana oil
with battery-activated coils.
Experts say the resulting vapor
can harm the lungs.
The US Centers for Disease
Control and Prevention has
identified an oily vitamin E-de-
rived compound as a possible
common link among some cas-
es, The Washington Post re-
ported. However, federal offi-
cials stressed they have yet to
make a definitive determina-

uVAPING
Continued from Page 1

tion, and continue to analyze

samples for a broad range of

chemicals, including “cutting

agents.”

The state cannabis commis-

sion is investigating whether

products sold at licensed mari-

juana stores in Massachusetts

include the vitamin E-related

compound, a spokeswoman

said.

Several Massachusetts mar-

ijuana executives said they are

unaware of any licensed com-

panies that use the compound,

but that it is sometimes used

by unregulated manufacturers

to lighten their extracts’ color.

While questionable addi-

tives are more common in illic-

it marijuana cartridges, they

are also present on the shelves

of state-regulated marijuana

shops.

“There are no rules about

what can and can’t go in a vape

pen,” said Chris Hudalla, a

chemist who runs Milford-

based marijuana testing com-

pany ProVerde Laboratories.

“It’s absolutely problematic.”

New England Treatment

Access, which runs a cannabis

store in Brookline, sells inex-

pensive vape pens cut with

propylene glycol, a common

food additive that experts said

could be dangerous to inhale.

And Alternative Therapies

Group, which runs a pot store

in Salem, uses a similar chemi-

cal, polyethylene glycol, in

some of its vapes. A study pub-

lished this week in the Journal

of Clinical Investigation found

that inhaling the vapor of pro-

pylene glycol harmed the lungs

of mice.

NETA said propylene glycol

is safe, and no customers have

reported negative health ef-

fects. Still, the company is de-

veloping other inexpensive

vape cartridges that are free of

the substance.

“I’m a chemist and I

wouldn’t want to vape propyl-

ene glycol,” said Michael Kahn,

the president of MCR Labs in

Framingham, adding that the

drug has only been shown to

be safe for oral consumption.

While Chris Edwards, the

chief executive of ATG, said he

believes polyethylene glycol is

safe, his company — like many

others — is phasing it out in fa-

vor of terpenes, a class of aro-

matic chemicals found in can-

nabis and other plants.

While tiny amounts of ter-

penes are naturally present in

marijuana and give different

strains their scents, marijuana

companiessometimes add sig-

nificant quantities of both can-

nabis-derived and other ter-

penes to state-approved vape

pods to improve flavor and vis-

cosity.

That practice concerns even

some marijuana company

owners.

“Terpenes are pretty caus-

tic,” said Brandon Pollock,

chief executive of Theory Well-

ness, a marijuana retailer.

“Take limolene — we use that

to clean stainless steel tables.

To put something like that in a

vape that you’re going to heat

up and inhale seems risky.’’

Recently, Pollock said, cus-

tomers have been asking Theo-

ry Wellness about the safety of

its vape cartridges. The firm’s

vapes contain only cannabis

and small quantities of canna-

bis-derived terpenes, he said,

adding that the state should

consider making that the rule.

“The whole point of legal-

ization is to protect public

health and make sure people

are getting a product that’s

tested and safe,” he said.

Marijuana consumers were

surprised to learn that Massa-

chusetts imposes no limits on

vape additives.

“It’s messed up — who

knows how they’re deriving

it?” said Steven Cerrato, 27, a

musician from Dedham who

has regularly visited NETA.

“Twenty, thirty years might go

by and everyone might have a

weird cancer.”

State rules require that

marijuana products be tested

for pesticides, heavy metals,

potency, mold and other mi-

crobes, and residual solvent

chemicals used in processing.

Manufacturers also must list

ingredients on product labels.

However, the commission

doesn’t verify whether the list-

ed ingredients are accurate, or

that additives are safe to heat

and inhale.

Hudalla, the chemist, said

he is also concerned about the

cartridge hardware, nearly all

of which is made in China. Us-

ing a “smoking machine” that

puffs on vaporizers, his lab has

found metals such as alumi-

num and chromium in the va-

por from unregulated cartridg-

es that were not present in the

concentrate itself, suggesting

the contamination came from

the device’s heating coils.

While the commission

doesn’t require regulated man-

ufacturers to test their car-

tridges, some operators includ-

ing Garden Remedies and NE-

TA said they do so voluntarily.

Public health experts said

regulated cartridges, which are

tested and labeled, are far safer

than those purchased on the

street, but they said it’s a dan-

gerous oversight to allow the pot

industry to add any chemicals it

chooses to vape cartridges.

At the same time, they con-

ceded that state regulators face

a difficult challenge: There is

little data on the safety of mari-

juana vaporizers because the

drug is still illegal under feder-

al law.

Dr. Michael Siegel, a public

health professor at Boston Uni-

versity, said state marijuana of-

ficials should probably regu-

late additives, but that con-

sumers should not panic.

“These products have been

on the market for awhile and

we haven’t seen a problem

with them,” he said.

Dan Adams can be reached at

[email protected].

Naomi Martin can be reached

at [email protected].

About 22 percent of soccer
players 14 years old and
younger are hobbled by over-
use injuries, according to the
American Academy of Ortho-
paedic Surgeons’ OneSport In-
jury campaign, the academy’s
latest initiative to reverse the
trend of overuse injuries in
children and teens. The per-
centages are even higher for
young baseball (25 percent)
and football players (28 per-
cent).
“In middle school and high
school kids, 50 percent of inju-
ries we are seeing are prevent-
able if these kids weren’t play-
ing year-round,” said Dr. Eliza-
beth G. Matzkin, chief of
women’s sports medicine at
Brigham and Women’s Hospi-
tal and an associate professor
at Harvard Medical School.
The lure of mastering a
sport at a tender age to gain
college scholarships or entree
into the pros can be a big driv-
er of these overuse injuries,
said Matzkin. She advises chil-
dren to play multiple sports
throughout high school, rather
than specializing in one.
“These kids and parents,
they all live the dream,” Matz-
kin said. “I see it everyday in
my clinic, and I get it. I have
three kids and they all play
sports. It’s their life. It’s their
identity.”
Sportsmedicinespecialists
say they try to encourage en-
thusiasm for youth sports,
which are beneficial for young
bodies and minds. But they
want to help kids avoid inju-
ries and burnout, and to un-
derstand the reality: A small
percentage of young athletes
will be recruited to play at col-
lege, and a vanishingly small
fraction make it to a profes-
sional level.
Fewer than 10 percent of
high school athletes, with the
exception of ice and field hock-
ey, and lacrosse, will go on to
play at college, according to
the latest data from the Na-
tional Collegiate Athletic Asso-
ciation. Fewer than 2 percent
of college athletes will become
professional basketball or foot-
ball players, and less than 10
percent will make it to the ma-
jors in baseball and hockey.
Still, it’s often hard for some
players and their parents to
keep these statistics in per-
spective, said Haley’s father,
Craig Lewis, who has coached

uINJURIES
Continued from Page 1

youth soccer in Newton for

more than a decade, including

his three daughters’ teams.

Over that time, he said, it’s

been increasingly difficult to

keep youngsters from playing

their chosen sport constantly.

“If one kid hears another

kid is doing it, then they all are

doing it,” Lewis said. “We try in

the summer to give our girls

time off, but it’s very hard. The

club team is non-negotiable. If

you don’t come to 90 to 95 per-

cent of practices, they won’t

keep you on the team.”

Dr. Matthew Salzler, chief

of sports medicine at Tufts

Medical Center, said he has

seen a fairly significant in-

crease in hip, knee, and ankle

injuries in young athletes,

most typically in gymnastics

and endurance running, such

as cross country and track.

He’s also seeing an increase in

shoulder injuries in young

baseball players.

“Their bodies are still devel-

oping, so stress fractures sug-

gest that there is too much

stress on the bone, and as their

bodies grow, they can be at risk

for stunted or abnormal

growth,” he said.

Dr. Nancy Robnett Durban,

a physical therapist at Cincin-

nati Children’s Hospital and

Medical Center, and a spokes-

woman for the American Phys-

ical Therapy Association, said

areas around the growth plates

— the places where the bone

lengthens in still-growing

young bodies — are often

where she sees overuse injuries

in young athletes.

“We see a lot of Sever’s Dis-

ease in the heel at the bottom

of the foot, where they bear

weight,” she said. “We see a lot

of little soccer players with

this.”

Sportsmedicinespecialists

say they worry that a genera-

tion of overly ambitious young

athletes will face the agony of

osteoarthritis, particularly in

their knees, before they’re

middle-aged. Of particular

concern are knee injuries in-

volving the anterior cruciate

ligament, or ACL.

“ACLs, we can reconstruct

them, and they will be out on

the playing field again and do

great,” said Matzkin, the

Brigham and Women’s physi-

cian. “But 25 to 30 years from

now, you will have degenera-

tion in the knee.”

Just a couple of decades

ago, it was rare to see ACL in-

juries in college athletes. Now,

Matzkin said, it’s pretty com-

mon to see them in young

teenagers, as young as 13,

which means some may devel-

op osteoarthritis in their knees

in their early 30s.

Matzkin said the college

athletes she sees tend to have

coaches doing a better job of

monitoring strength training

and nutrition to help athletes

adhere to proper techniques

and avoid injuries. The prob-

lem, she said, is for younger

athletes and their volunteer

coaches, who may not have ac-

cess to the same resources or

information.

Matzkin and Salzler, the

Tufts physician, recommend

that young athletes take one

day off a week from all sports

to give their bodies a rest. They

also suggest children try differ-

ent sports to give overused

parts of their bodies a break.

“Even if you are a runner or

swimmer, find a day or two for

another activity to build differ-

ent muscles,” Salzler said.

Both specialists say proper

strength training, such as

squats or lunges, are fine for

athletes as young as 7 or 8, but

caution against weight lifting

and resistance training until a

child’s growth plates are

closed, typically around age 13

or 14. Both physicians also ad-

viseyoungsters to rest if they

feel an injury coming on, and

seek medical attention if the

pain persists more than a

week.

Haley Lewis, who is start-

ing her junior year in Newton

and wrapping up physical

therapy for her knee injury,

said her high school and club

soccer teams are diligent about

proper stretching and strength

exercises before practices and

games. Still, she has endured

overuse injuries because, she

said, she compensates when

playing through her pain, plac-

ing more weight on the other

side of her body and getting in-

jured, again.

Her physical therapist has

cautioned her to come back

slowly, and has not cleared her

to play soccer again for at least

another two weeks. Lewis can’t

imagine not playing soccer

someday. But she realizes col-

lege competition is a long shot.

“I am just enjoying it for

now,andIdon’twantittobe

ruined for me,” Lewis said. “I

want to be a healthy person

when I’m older and go to the

gym.”

Kay Lazar can be reached at

[email protected] Follow

her on Twitter

@GlobeKayLazar.

By Peter Baker

and Sarah Mervosh

NEW YORK TIMES

WASHINGTON — The hur-

ricane was accelerating away

from the Mid-Atlantic coast. In

the Bahamas, victims were

picking through the devasta-

tion. In the Southeast, they

were cleaning up debris. And in

Washington, President Trump

waged war over his forecasting

skills.

On Friday, for the sixth

straight day, Trump continued

his relentless campaign to

prove that he was right when he

predicted that Hurricane

Dorian could hit Alabama re-

gardless of what the scientists

said, a quest that has come to

consume his White House and

put his veracity to the test.

And once again, Trump’s

government came to his aid.

Late Friday afternoon, the par-

ent agency of the National

Weather Service issued a state-

ment declaring that its Bir-

mingham office was wrong to

dispute the president’s warning

that Alabama “will most likely

be hit” by the hurricane despite

forecasts to the contrary.

“The Birmingham National

Weather Service’s Sunday

morning tweet spoke in abso-

lute terms that were inconsis-

tent with probabilities from the

best forecast products available

at the time,” the parent agency,

the National Oceanic and At-

mospheric Administration, or

NOAA, said in the statement.

Neither the White House

nor NOAA responded to inqui-

ries about whether the state-

ment was issued at the direc-

tion or in consultation with the

president’s aides. But it fol-

lowed a concerted effort by

Trump and his team to use the

levers of government to back up

a presidential claim that has

been widely discredited and

ridiculed, including posting

outdated weather maps and

having his homeland security

adviser issue a statement back-

ing him.

“The Fake News Media was

fixated on the fact that I proper-

ly said, at the beginnings of

Hurricane Dorian, that in addi-

tion to Florida & other states,

Alabama may also be grazed or

hit,” he wrote. “They went Cra-

zy, hoping against hope that I

made a mistake (which I

didn’t). Check out maps.

“This nonsense has never

happened to another Presi-

dent,” he added. “Four days of

corrupt reporting, still without

an apology.”

It started Sunday when the

president warned on Twitter

that Alabama, among other

states, could be hit by the storm

“(much) harder than anticipat-

ed.”

In an attempt to head off

panic, the Birmingham fore-

casters quickly sent out their

own tweet, assuring residents

that they were not, in fact, in

harm’s way. “Alabama will NOT

see any impacts from #Dorian,”

the local office wrote.

Angry at the mockery that

followed, Trump has ever since

sought to justify his conten-

tions to the point that he even

called on his homeland security

secretary to display a map in

the Oval Office that appeared to

have been altered by a black

Sharpie pen to suggest Ala-

bama was in the potential path

of the storm.

Trump’s wrath at his critics

left the Birmingham forecasters

caught in the path of a presi-

dential storm. For five days,

NOAA had no public objection

to this conclusion. Only after

Trump insisted on sticking by

his disputed claim did NOAA fi-

nally weigh in — and no spokes-

person attached a name.

Jason Simpson, chief mete-

orologist at WHNT, the CBS af-

filiate in Huntsville, said he

tried to reel in partisan com-

mentary on his Facebook page.

“My point was, you should

never listen to a politician for

the weather, anyway,” Simpson

said. “That’s why we have the

National Weather Service.”

Storm

is still

raging for

Trump

NOAAdrawn

intobattleover

hisAla.forecast

Injuries plague one-sport athletes

DAVID L. RYAN/GLOBE STAFF

Haley Lewis received physical therapy for her knee: “I want to be a healthy person when I’m older and go to the gym.”

State doesn’t regulate additives to marijuana vapes

JIM WILSON/NEW YORK TIMES/FILE

Experts say vapor from heating concentrated marijuana

oil with battery-activated coils can be dangerous.

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