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Contents Around the Rotunda Report provided courtesy of: KSA Group October 4 - 10, 2019 Contents Around the Rotunda ...... 1 Around the Rotunda Committee News ......... 6 DEPARTMENT OF HEALTH URGES CAUTION AND AWARENESS OF VAPING MAAC .................. 6 DANGERS Bullet.in.Points ........... 6 By Jeff Cox, Pennsylvania Legislative Services | October 4, 2019 Cosponsor Memos ........ 6 Pennsylvania Secretary of Health Dr. Rachel Levine today held a news conference to caution Bill Actions .............. 7 Pennsylvanians regarding the dangers of vaping and vaping associated lung disease. She also announced the department has reported one fatality along with nine confirmed cases of Upcoming Events ......... 9 vaping associated lung disease and 12 probable cases to the Centers for Disease Control In the News ............. 11 and Prevention (CDC) in Atlanta who is leading the national investigation. SESSION STATUS Sec. Levine told reporters, “As this investigation continues, it has really become clear that At 12:59 p.m. on Wednesday, we do not really know what is causing this serious life threatening and even fatal lung September 25, 2019 the injury cases to occur.” She continued, “I strongly urge anyone who is vaping illegally bought Senate stands in recess until products, in particular illegally bought products with THC, to stop.” Sec. Levine stated, Monday, October 21, 2019 “The fact that we have seen a death in addition to patients with very serious lung disease at 1:00 p.m., unless sooner underscores the importance of being aware of the symptoms associated with this illness.” recalled by the President Pro Tempore. The signs and symptoms of a potential lung injury associated with vaping include: • Cough At 4:02 p.m. on Wednesday, • Shortness of breath September 25, 2019 the • Chest pain House stands adjourned until • Nausea or vomiting Monday, October 21, 2019 • Diarrhea at 1:00 p.m., unless sooner • Fatigue recalled by the Speaker. • Fever UPCOMING SESSION DAYS • Weight loss House Oct. 21, 22, 23, 28, 29, 30 Sec. Levine suggested, “Please see your health care provider immediately if you or a loved Nov. 12, 13, 14, 18, 19, 20 one are showing these signs or symptoms.” She reported that in all of the cases so far, both Dec. 9, 10, 11, 16, 17, 18 nationally and statewide, the only common factor is people using vaping devices, particularly those devices associated with THC. Sec. Levine said, “The investigation into these cases, Senate both in Pennsylvania and nationally, is very complex and is evolving and changing every Oct. 21, 22, 23, 28, 29, 30 day.” She also said, “Generally, e-cigarettes are not safe for youth, young adults, pregnant Nov. 18, 19, 20 women or adults who do not currently use tobacco products.” Sec. Levine cautioned, “It is Dec. 16, 17, 18 also important to remember that e-cigarette aerosol is not harmless “water vapor.” It can contain harmful substances, including nicotine and ultrafine particles that can be inhaled deep into the lungs; flavoring such as diacetyl, a chemical linked to a serious lung disease; volatile organic compounds; cancer-causing chemicals and heavy metals such as nickel, tin and lead.” She also expressed support for legislation raising the legal age for the purchase of tobacco products to 21 as well as legislation allowing the Governor to declare a public health emergency. “Many medications carry risk and vaping medical marijuana products sold in our dispensaries carries risk in the same way that other medications do,” Sec. Levine said. “If you are vaping, whether as part of the medical marijuana program or not, it is essential that you have an honest conversation with your physician about the potential risk for serious illness. For those who are part of the medical marijuana program and have concerns, we encourage you to talk to your physician or the pharmacist at the dispensary.” Sec. Levine responded to questions from the news media. You said you support legislation to declare health emergencies. Is this something that has the potential to be as serious as the opioid epidemic? I would not say at this time that this is as serious as the opioid epidemic. We have had one death in Pennsylvania. In 2017, we had 5,400 overdose deaths. Even with an 18 percent decrease in 2018, we had approximately 4,400 deaths. So I would not say it would rise to that level but I think it is important for the secretary or the Governor on the advice of the secretary had the ability to declare a public health emergency to be able to address serious public health concerns that can occur in our state. When was the first case reported in Pennsylvania? Dr. Sharon Watkins, director, Bureau of Epidemiology: At this time, in our records, the first case occurred in June of this year. Vaping has been around for nearly a decade. Is there any evidence of why suddenly in 2019 all of these cases are coming up? That is a very good question and I have to say the CDC does not have an answer to that question. Some of it might be a combination of factors. That it might have been some cases beforehand but were not recognized as they are now as being associated with vaping. Certainly, the proliferation of illegal vaping cartridges, especially those containing THC, has been one of the main triggers and we have seen in the news about arrests of people who have thousands of these illegally produced cartridges mixing many different chemicals in them. So it seems likely that has caused this surge, but we don’t know why we did not see or if we really didn’t see cases beforehand. We do not know definitively yet. What would be the benefit of calling a public health emergency? Associated with a public health emergency, it would give the Governor and the secretary the ability to do certain things. We might be able to change some regulations or taken an action that we might not be able to take without that such as the Governor did with the disaster declaration. The disaster declaration was originally designed for things such as a hurricane or flooding and things like that. We adapted that and the Governor was extremely progressive and innovative in adapting that to the opioid crisis. A public health emergency would be more targeted, so we support legislation. I am not really saying whether we would declare it for this or not but that type of legislation is important and has been discussed. Is there any ongoing investigation of the death that has been reported and is there any demographical information you can provide? I don’ t think we can really provide any information because it is just one patient and we don’t like to identify patients so we cannot give you any specific features. I can tell you that our investigation under Dr. Watkins’ leadership is extremely intense and they are exhaustive. We are continuing to investigate all of those cases but because it is one patient it would break patient confidentiality to identify him. Why should people using medical marijuana should not necessarily be concerned with this? We want to highlight this, but we have an excellent medical marijuana program. We have approved and certified grower- processors. All of that product is laboratory tested twice by laboratories which we also certify. We actualy do know what is in those cartridges so we have a lot of confidence in our medical marijuana program. The issue raised by the CDC is vaping itself safe and I think that question is still being investigated. Have the reported cases come from certain geographical areas in Pennsylvania or has it been literally statewide? It has been statewide. For a while, most of the cases were in the southwest. We now have had more cases in the southeast. But it really does span the state. Of course, in the southwest we have Pittsburgh and in the southeast we have Philadelphia so there are more people there but there is not just one specific geographical area. When did the patient die in Pennsylvania? In September. 2 Right now, there is a push for recreational marijuana in Pennsylvania. Are we learning anything about vaping itself that might cause you some concern towards legalizing marijuana? Potential recreational marijuana is kind of over there. We are concentrating on the risk of vaping and, particularly, the risk of these illegal cartridges. You have to understand we have drug dealers and some of them are actually a couple of people in a basement throwing together various chemicals and solvents to dissolve medical marijuana and then slapping a label on it and selling it in the market. The biggest concern with these illegally produced cartridges is the type of chemicals that might be in there. What we do know about the vaping and lung disease is there is no evidence it is infectious. At first, some people thought this was some sort of infection. There are no infectious agents that are known. It seems to be a chemical injury and the biggest risk is from these chemicals people are throwing into these illegal cartridges. What is the actual injury to the lungs? It looks primarily like an inflammation in the lungs. It is a chemical injury to the lungs and it has a certain appearance on x-rays. I want to emphasize that we have, tragically, had a death. All of these patients are almost all hospitalized and some are in intensive care are very, very ill patients. ### ACLU ANNOUNCES CHALLENGE TO LEBANON COUNTY POLICY PROHIBITING ACCESS TO MEDICAL MARIJUANA FOR THOSE ON SUPERVISED RELEASE By Sheri Melnick, Pennsylvania Legislative Services | October 8, 2019 Representatives from the American Civil Liberties Union (ACLU) were joined by clients and medical marijuana patients this afternoon to announce the filing of a lawsuit against Lebanon County courts, challenging a policy prohibiting people on supervised release from taking their medication.
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