December 19, 2010
By David Downs
Everyone who shopped for cannabis exclusively in a licensed medical or adult-use store in 2019—give yourself a pat on the back, you’re excused.
As for the rest of you: Sit down.
More than 2,409 people got sick and 52 died from VAPI (vaping associated pulmonary injury, which federal authorities have relabeled EVALI) in 2019. How they got sick and died isn’t a mystery, either.
Investigators traced VAPI back to disposable vaporizer cartridges filled with tainted cannabis oil and purchased off the street in prohibition states and counties.
Vape lung injuries, mapped
Don’t let anyone get it twisted: 2019 turned out to make the strongest case ever for regulating cannabis markets. VAPI proved that testing regulations protected cannabis consumers in legal states.
This wasn’t a viral or bacterial infection. VAPI was not an “outbreak.” It was a mass poisoning that resulted from poor quality control of a popular consumer product—akin to bathtub gin, or opioids cut with fentanyl, or baby formula cut with melamine.
A new analysis compiled by Leafly from publicly available data found that cannabis prohibition states had ten times the number of vape injuries per capita as states that offered licensed, tested, and legal cannabis vape products. There have been zero confirmed VAPI cases exclusively associated with a licensed store or product in the US.
VAPI or EVALI?
Yes, we know the Centers for Disease Control is calling the lung malady EVALI, for e-cigarette or vaping lung injury.
Respectfully, we are resisting that name change. EVALI is inaccurate. The original VAPI term was changed by federal authorities in order to include e-cigarettes, which misinforms the public.
This is not an injury caused by nicotine e-cigarettes. It is caused by tainted THC cartridges bought on the street market.
Simple solution: legalize
If you want to cut VAPI cases to zero in 2020, just allow folks access to legal, licensed vaping products. It’s as simple as basic quality control, says NORML Deputy Director Paul Armentano.
“Consumers must be aware that not all cannabis vaping products are created equal,” he says. “Quality control testing is critical and only exists in the legally regulated marketplace.”
Prohibition states have 10 times more EVALI cases per capita
At the national level, vaping injuries strongly map to weak quality control over electronic drug-delivery systems. Consider the following comparisons:
Utah vs California
Utah had more than 10 times more cases of VAPI per capita than California.
The difference? Cannabis vaping products are legal in California but not in Utah. The result? Utah averaged 38 VAPI cases per million residents this summer. California averaged 3.6 cases per million.
New York vs Colorado
This ‘legal vs. prohibition states’ pattern bore out nationally. The mature legalization state of Colorado—a huge vaping state—had 2.1 VAPI cases per million residents.
New York—which has no legal adult-use cannabis market—had 23.8 VAPI cases per million residents.
Wisconsin vs Washington
Washington state, a cannabis legalization pioneer, had 2.8 VAPI cases per million residents. The prohibition state of Wisconsin, which doesn’t even allow medical marijuana, recorded 17.6 VAPI cases per capita. According to a CDC report on VAPI in Illinois and Wisconsin, “nearly all THC-containing products individuals reported using were … primarily acquired from informal sources such as friends, family members or illicit dealers.”
“It’s obviously a success story for the regulated market,” said Josh Wurzer, founder of the state-certified California cannabis testing lab SC Laboratories. “That’s maybe the positive takeaway from this whole thing.”
Zero confirmed VAPI cases from exclusive use of licensed products
The CDC recommends not vaping anything, but officials there put particular emphasis on avoiding any vaping products purchased on the street market. That’s because of another stunning statistic that bears repeating: Investigators have confirmed zero VAPI cases exclusively associated with the use of legal state-licensed cannabis products.
California: VAPI where legal stores are banned
The state of California—which has recorded 178 cases and four fatalities from VAPI—did turn up one self-report of licensed product use. But self-reports are notoriously unreliable, and the available data shows that VAPI cases are more common in areas of the state where legal access to cannabis is still effectively restricted by local ordinances.
Because so many local municipalities have banned state-licensed cannabis stores, many Californians cannot get their hands on legal, lab-tested products. The legal market is two years old, and the illicit market is three-to-four times bigger. With only 600 licensed cannabis retailers serving 38 million Californians, many consumers still have to travel to another county to purchase cannabis legally.
The difference in safety levels between these areas is noticeable. California’s outbreak started with seven people injured in Kings County, which prohibits legal cannabis stores. By contrast, San Francisco County—a place with abundant access to legal tested vapes—has not reported a single VAPI case.
Massachusetts: Unconfirmed reports of VAPI in licensed products
In seemingly big December news, Massachusetts officials announced six VAPI cases potentially associated with a licensed product. That sounds bad, but those six cases comprise just 7% of all VAPI cases in Massachusetts—where the main culprits are illegal brands like Dank Vapes and other notorious street products.
Further examination revealed that Massachusetts investigators haven’t actually confirmed a single VAPI case associated with exclusive use of a licensed product, according to a tweet from Massachusetts Cannabis Commissioner Shaleen Title.
Investigators have to intensely follow up on self-reports, because a certain portion of patients will lie to avoid embarrassment or self-incrimination.
New York: Hundreds of VAPI cases, none from the medical market
In the best example of how testing works, look at New York, where 205 individuals have fallen sick and one has died from VAPI. How many of those victims were associated with the state’s stringent medical cannabis system? Zero
New York’s medical marijuana regulations banned the chief culprit in VAPI—vitamin E oil used as a cutting agent—at the outset of the state’s program.
“Since the investigation into the illnesses began, there have been no reports of adverse events associated with approved products in the NYS Medical Marijuana Program related to the outbreak,” said New York Department of Health Public Information Officer Jill Montag.
“Medical marijuana products are approved by the Department and rigorously tested for contaminants, pesticides and concentration of cannabinoids, including, but not limited to THC and CBD.”