The past year-and-a-half have been somewhat treacherous in terms of public health concerns; a vape-lung crisis erupted in August 2019 and now, a lung-attacking coronavirus (COVID-19) has claimed thousands of lives globally. With the vape crisis creating a lasting effect on the cannabis industry – forcing consumers to seek out alternative products – a new study suggests that vaping may not be so dangerous after all. 

According to researchers who conducted the JAMA Network Open study, there is significantly less chance of a respiratory condition transpiring if consumers purchase their vape products from the legal and regulated market; as opposed to the black market. Based on data published in February by the Centers for Disease Control and Prevention (CDC), E-cigarette– or vaping–associated lung injury (EVALI) affected almost 3,000 people and was responsible for 60 fatalities.

Although the definitive root cause of EVALI has not been determined quite yet, scientists believe that it can be traced to the black market. The study hypothesized that consumers residing in legal adult-use markets are less likely to buy vaporizable products, due to the fact that recreational [cannabis] states had among the lowest EVALI rates of all states.” 

Lack of access to legal markets to blame for EVALI cases, say researchers

In order to conduct their research, the team analyzed data from the CDC database. Confirmed cases were compared with the frequency of e-cigarette consumption; data was gleaned from the Behavioral Risk Factor Surveillance System. The findings of this study paint a clear picture of the risks that consumers face when purchasing products on the black market. Considering the fact that most EVALI cases occurred in nonlegal states, it is clear that lack of access to the plant is pushing consumers to desperate measures.

“The data suggest that EVALI cases were concentrated in states where consumers do not have legal access to recreational [cannabis] dispensaries,” researchers wrote. “This association was not driven by state-level differences in e-cigarette use, and EVALI case rates were not associated with state-level prevalence of e-cigarette use. One possible inference from our results is that the presence of legal markets for [cannabis] has helped mitigate or may be protective against EVALI.”

An average of 1.7 confirmed EVELI cases were recorded in states that had legalized adult-use cannabis. It was a different story in medical cannabis-friendly states — an average of 8.8 EVALI cases were confirmed per million people. Since concentrated cannabis products are not on offer in many states with medical programs, it’s likely that consumers may have turned to street dealers instead. In states that have not enacted any cannabis laws, there were 8.1 EVALI cases per million population.

“The reason for this association is not yet clear,” researchers concluded. “It is possible that in recreational states, people tend to purchase [cannabis] products at legal dispensaries, which may be less likely to sell the contaminated products that are thought to cause EVALI.”

Vitamin E acetate was the primary culprit of EVALI cases 

Even before this research was published, there was speculation about the black market playing a role in EVALI cases. Black market dealers try to maximize profit and reduce production costs by cutting their products with alternative – and often harmful – ingredients. Vape sales sunk soon after the news broke that cartridges had become contaminated.

Investigations into the cause of vape-related illnesses and deaths have revealed that the vast majority of tainted cartridges contained vitamin E acetate. This study discovered vitamin E deposits in the lung tissue of 48 EVALI patients; out of a total 51 who partook in the study. Many black market distributors use this ingredient as a thickening agent, proving the importance of purchasing lab-tested and regulated products from the legal market.