EVALI and Illegal Vapes

A few months ago, headlines across the world exploded with news that people who were using vaporizer pens, or vaping, were being hospitalized and some were actually dying. So many cases were being reported that the Center for Disease Control (CDC) ,in Atlanta, stepped into the fray. Headlines were vague and no officials could find the reason why so many people were getting sick so quick. As of Nov. 14th 2019 there were 2,172 cases of EVALI or E-cigarette/Vape Associated Lung Injury.

A total of forty two people in twenty four states have died from these injuries. There are a number of factors that may have had an impact on this wave of vaping injuries.

Vaping is essentially using a battery powered device to heat liquids contained in a cartridge to their evaporation point, think of the steam in your shower. One of the first historical instances of inhaling vapors comes from Egypt when humans would place essential oils on a heated stone and the heat from the stone would release vapor into the air, much like a sauna. Today there are many shapes and sizes of vaporizers but the cartridges and the “oil” they contain is where the controversy lies.

The liquid in a nicotine vape contains nicotine, a cutting agent, usually propylene glycol, polyethylene glycol or vegetable glycerin, flavorings and other chemicals. The cutting agent is important because otherwise the oil would be too thick to vaporize. In the early days of the recreational cannabis industry, the vaporizer pens also needed a cutting agent, but after five years, technology has caught up and increased the efficacy of cartridges and batteries so that cutting agents are no longer necessary. Many cannabis cartridges are pure cannabis oil with no fillers or cutting agents. With nicotine vapes, there will always be a need for fillers because just sixty milligrams of nicotine will kill a one hundred and fifty pound human and therefore cannot be safely vaped without a cutting agent. The safety and long term effects of these cutting agents and added flavors has yet to be properly studied and understood.

Vapes, vaporizers, vape pens, hookah pens, electronic cigarettes (or e-cigs) and e-pipes are some of the terms used to describe electronic nicotine delivery systems or ENDS. The FDA regulates the manufacture, import, packaging, labeling, advertising, sale and distribution of ENDS. The process to get a tobacco product through the FDA is extensive and expensive.

In Oregon’s first year of recreational cannabis, they did not inform the cannabis growers on what pesticides were allowed in cannabis cultivation, including chemicals linked to public health risks. A newspaper in Oregon, the “Oregonian”, shopped at dispensaries and purchased products that had passed pesticide tests. They then sent these products to an independent lab for retesting. A total of fourteen chemicals were found in eight of the samples, including six the federal government has classified as having potential links to cancer. Oregon has long since changed and tightened many of their rules, but this is a good example of the need for more oversight and regulation. In the case of recreational and medical cannabis, most states initial research is fair and more often than not changes are usually made to conform fairly quickly.

As far as EVALI goes, most cases are from illegal THC vapes and Nicotine vapes. None of the cases of lung illness were from regulated tobacco vape shops or legal cannabis shops. There are a few cutting agents that were found in these illicit vape carts from Vitamin E acetate, a synthetic form of vitamin E and diacetyl, harmful if boiled or heated.

Another possible health issue found in California was cheaply made cartridges from other countries contained lead that was being released into the oil of a cartridge. Yet another issue is a fungicide called myclobutanil that some growers use in the cultivation of cannabis.

If an illegal cannabis grower gets fungus on their crops, myclobutanil is one of the best fungicides and is safe when used in small amounts. However, it is banned from use in all legal recreational states for a good reason. When heated or burned myclobutanil transforms into hydrogen cyanide, sometimes called prussic acid. It is a colorless, extremely poisonous and flammable liquid that boils and evaporates slightly above room temperature. This fungicide can be used in any illegal grow and there is no way to get test results or regulated products from the black market.

It is already very dangerous when myclobutanil is used on a cannabis plant’s flower, however it takes a large amount of flower concentrated to make a single vape cartridge. That means the harmful pesticides and fungicides are also concentrated making this illegal product even more dangerous.

Ingredients like these pose a major health risk to people and on November 8th the CDC tested fluid found in the lungs of twenty nine patients from ten different states and found Vitamin E acetate in all samples. While it appears that vitamin E acetate is associated with EVALI, evidence is not sufficient to rule out the potential contribution of other chemicals.


Since 2009, High Country Healing has dedicated their time and energy to creating the best and most effective medicine possible. These stores feature a live grow, visible to patients, where one can directly observe the cultivation of cannabis by hand. This transparency allows patients to see the love and care that goes into their medicine. Visit highcountryhealing.com for more information or call (970) 468-7858 to talk to a professional.