As of Friday, Sept. 6, the CDC has reported up to 450 cases in 33 states of severe acute respiratory distress syndrome possibly associated with a recently inhaled drug aerosol (commonly known as vaping). Three patients may have died from the condition. The deaths occurred in Illinois, Oregon, and Indiana. Here’s what you need to know.

Should I Stop Vaping?

  • If you own illicit vape cartridges, throw them away immediately. The CDC, FDA, and HHS advised consumers Thursday to avoid buying cannabis vapes or using products off the street[1]. They are unregulated, untested, and could be contaminated.
  • If you purchase an illicit market disposable vaporizer cartridge—either THC or nicotine—and it’s filled with the wrong additive at the wrong amount[2], using it carries the risk of immediately injuring your lungs. Three patients may have died as a result of tainted cartridges.

What Is the Suspected Diagnosis?

  • In many cases, symptoms and treatment mirror a condition called lipoid pneumonia, previously found in patients who inhaled mineral oil.

What’s Causing It?

  • We don’t know for certain, but New York health authorities have confirmed that vitamin E oil[3] (tocopheryl-acetate) is tainting most seized vape carts in that state. Pen makers report using it because it’s a cheap thickener[4]. The FDA is now specifically looking[5] at vitamin E oil.
  • The FDA has received about 120 samples for testing. So far, they’ve found vitamin E acetate in 10 of the 18 THC samples. The FDA is testing seized carts for THC, nicotine, cutting agents called diluents, additives, pesticides, opioids, poisons, and toxins.
  • Health officials have confirmed that among the tainted carts are ones with the brand names Chronic Carts, Dank Vapes, and West Coast Carts, but the condition is linked to multiple illicit market brands across multiple states.

Why Vitamin E Oil?

  • As Leafly reported last week, a new diluent known as Honey Cut entered the illicit vape cart market in late 2018. The product, which dilutes THC oil without thinning the viscosity, is manufactured by an unknown company operating only with a web site. Officials at the terpene manufacturer True Terpenes, based in Portland, OR, told Leafly they tested Honey Cut earlier this year and found it to contain Vitamin E oil, aka tocopheryl-acetate. We’ve seen evidence that other brands have also been selling tocopheryl-acetate into the vape cart market.

What Are the Symptoms?

  • Any who has vaped a black market cart in recent days or weeks and subsequently developed shortness of breath, dizziness, nausea, weakness, and tiredness should see a physician. Bring the cart.

What Are the Latest Numbers?

  • This outbreak is akin to bathtub gin under alcohol prohibition. It is generally a creature of unlicensed markets where consumers have no legal alternative. It’s akin to recent Spice/K2 poisonings, as well as unregulated CBD market poisonings. The first reports came out of the prohibition state of Wisconsin[6], which has 34 cases, and Kings County, CA[7], which has banned legal access to tested cannabis, alongside 60% of local cities and counties. California has 49 potential cases[8]. Wisconsin has 34 cases as of Friday. Illinois has 53. New York also reports 34 cases. By contrast, Oregon has one suspected death. Colorado has two suspected cases. Washington has none.

Why Is This Happening Now?

  • Leafly has reported that a new ingredient—next-generation cutting agents (thickeners)[9]—are being misused in THC vape carts. Legal chemical thickener makers said they do not approve of use in vape carts. Chemical thickener makers also do not approve of dilutions greater than 10%. However, their web sites are unclear about the products’ approved and unapproved uses. The chemical makers have no information on what inhaling thickener aerosol does to your lungs, especially if it is heated or burned.

How Can I Protect Myself?

  • Only buy tested, regulated adult use and medical cannabis products in legal stores like California, Washington, Oregon, and Colorado. Street traffickers are filling carts with harmful chemicals, and they go straight into your lungs.
  • Cheap illicit market vape carts also routinely malfunction. Malfunctioning carts can get very hot, and burn additives and thickeners, releasing an unknown noxious gas. Run them at low, controlled temperatures.
  • If you’re concerned about additives in your cannabis, stick to tested flowers from licensed adult use stores. In terms of extracts, additive-free extract is called “rosin”, and it also comes in vape carts in mature adult use markets. There’s also tinctures, sublinguals, edibles, topicals, and transdermals, for those who want to avoid all cannabinoid inhalation products.


  1. ^ avoid buying cannabis vapes or using products off the street (
  2. ^ wrong additive at the wrong amount (
  3. ^ confirmed that vitamin E oil (
  4. ^ cheap thickener (
  5. ^ specifically looking (
  6. ^ Wisconsin (
  7. ^ Kings County, CA (
  8. ^ 49 potential cases (
  9. ^ next-generation cutting agents (thickeners) (

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