With six people dead and about 450 hospitalized nationally from a mysterious lung illness associated with vaping, cautionary words from health departments and the CDC are understandable.

The New Mexico Department of Health is investigating 12 cases of the illness locally, with 11 of them associated with black market THC vape pens, and one associated with a nicotine vape pen. In response, DOH Cabinet Secretary Kathy Kunkel recently issued a warning for residents to avoid all THC vaping products. 
But nationally and locally, the majority of cases have not been connected to legally purchased medical or recreational products, and licensed legal retailers are concerned that the warnings are far too broad, could hurt their business and cause patients to panic.
“We are saying just to have an abundance of caution and just to avoid vaping THC,” says Heidi Krapfl, deputy division director for epidemiology and response at NMDOH. “Current there are no (legal) New Mexico cannabis products directly linked to those cases. However, one patient in Oregon was connected to a licensed retailer there. So we have to evaluate the evidence as it comes in.”

An Oregonian died in July after purchasing two THC vape pens from licensed dispensaries. It’s unclear if those pens were doctored or if they came straight from a licensed manufacturer in the state, but the Oregon Health Department is investigating.

So what’s really going on? Many of the black market vape pens nationally have been associated with a thickening agent called vitamin E acetate, used to manipulate the vape liquid to a certain viscosity. The substance is often used in topical products, but the US Food and Drug Administration has no bans on it being used as a vaping agent. It is not safe to inhale. 

The general theory among many in the industry is that black market sources are using it as a thickening agent because it looks like vape oil. But they stress it is not a substance that a legal, licensed retailer would consider using.
“Unfortunately there are no rules for the black market,” says Marissa Novel, a spokeswoman for Ultra Health, one of New Mexico’s largest licensed providers. “You don’t get any testing on any products in the black market. That means even your normal cannabis flower could have mold or other contaminants in it.”
Erik Briones, president and founder of Minerva dispensaries, says none of his customers have gotten sick. Legally licensed companies—especially in the medical sector—work to remove as many impurities as possible from vape oil in order to make it as safe as possible, he says.
“We are creating a medium that’s free of impurities,” Briones says. “Our standards are high. That’s not just Minerva, that’s every licensed company in New Mexico. We make our own distillate and it’s 100% cannabis derived oil that’s under very strict standards, made with very high production equipment. It’s 100% pure.”
The Department of Health has collected suspect cartridges from six of the 12 patients, and subsequently turned them over to the FDA. NMDOH is working with the FDA, and the FDA will analyze samples from across the country, Krapfl said. 
“It’s kind of a stay tuned thing,” she said. 
There are other agents in vape pens—nicotine or otherwise—that also may be cause for concern. Other thickening agents, flavoring or even heavy metals found in some cartridge components could cause toxic reactions, Krapfl said.
“It’s kind of a chemical stew there,” she said. “Heating that and vaping it, it’s similar to a chemical injury.”
Symptoms of the vaping illness include hard breathing, shortness of breath and chest pain. Lesser symptoms include fever, cough, fatigue, vomiting, weight loss and diarrhea.
“There’s inflammation, edema of the airways—there’s swelling and that’s when there’s difficulty breathing,” Krapfl said. “The lung is trying to clear it out as best it can, but it’s pretty tough.”
For New Mexico medical cannabis patients who consume their medicine with THC vape pens, the department is suggesting that they contact their physician to come up with alternative methods of delivery.
Ultra Health has been investigating some of the issues on its own, and Novel tells SFR a lot of the black market vapes look disturbingly like licensed medical products. Her company is advising anyone who purchased black market vapes from the Internet or a pop-up shop to not use them.
“If you’re going to consume cannabis with a vape cartridge, you need to buy it from a licensed retailer,” Novel said.  “There are online pop-up shops in New Mexico and other states but there’s no consistency in the products. I’d also suggest if you have any vapes purchased from the black market and you’re experiencing any symptoms, to bring them to the hospital so they can test them.”
Vapes have become increasingly popular in the cannabis market because they don’t have a strong smell, they’re easy to transport and simple to use. They make up about 30% of Minerva’s sales market, and so far his company has not seen a decline in demand, despite the scare, Briones says.
“This is not the industry standard products causing problems—it’s the black market—but now everyone’s scared,” Briones says. “The CDC, the feds, they need to figure out where this is coming from and why this is happening so the problems can be corrected. It’s unfortunate that the whole category is getting a bad reputation because of this.”