Originally published in our sister paper The Stranger.

America’s vape crisis may be coming to a close.

The vape-inflicted lung injury that has swept the nation since the summer, sending thousands of vape users to the hospital and killing 52 people, appears to be subsiding, according to the most recent report from the Centers for Disease Control (CDC).

“Data suggest the outbreak might have peaked in mid-September," the CDC said in an update last week. "However, states continue to report new cases, including deaths, to CDC on a weekly basis."

The CDC said there has been a "steady decline" in patients hospitalized with vaping-related lung injuries since the outbreak peaked on September 15. The CDC reported no new patients in the first week of December and said that only 30 percent of patients remained in the hospital by Dec. 3.

Health experts have been hampered in their response to this lung injury outbreak, which is being called EVALI (E-cigarette or vaping associated lung injury), because the vast majority of vaping products in the U.S. are entirely unregulated.

There are two types of common vaping devices: e-cigarette, or nicotine vapes, and THC, or cannabis vapes. The federal government does not provide any regulation for either category. Cannabis vaporizers are regulated in states where pot is legal, but there is a multi-million-dollar black market for cannabis vapes in states without legal weed.

The CDC reported on Friday that “most EVALI patients reported use of THC-containing products, in particular use of counterfeit branded products such as Dank Vapes.” The CDC said that black market vape cartridges labeled as “Dank Vapes” were used by 56 percent of hospitalized EVALI patients nationwide.

The CDC has also found that one common black market vape additive, Vitamin E Acetate, is associated with the majority of the injuries. The CDC tested lung samples from 29 injured patients and found vitamin E in all of them.

“Although it appears that vitamin E acetate is associated with EVALI, many substances and product sources are being investigated, and there might be more than one cause,” the CDC said on Friday.

Kristen Maki, a spokesperson for the Washington Department of Health (DOH), said the state has seen 21 cases of EVALI since the summer with no new confirmed cases since mid-November, although she said the DOH is still investing new suspected cases.

Unlike the national trend, most of Washington’s cases involved at least some e-cigarette use. Only three of Washington’s confirmed cases vaped exclusively THC, while nine vaped only nicotine. Six vaped both. One case vaped something else entirely and two cases vaped unknown substances.

This vape outbreak has sent shockwaves through Washington’s legal pot vape market, which is tightly regulated by the state and has grown increasingly large in recent years. Pot vape cartridges grew from 12 percent of the legal market in January of 2019 to 19 percent in June of 2019, according to Seattle analytics firm Headset. But the vape market dropped to 16 percent of the legal week market by September, after the health crisis hit.

Customers are clearly worried about whether Washington’s legal weed vapes are safe, but there has yet to be a confirmed case caused by one of Washington’s regulated pot vape cartridges. Maki said five of the state’s EVALI patients said they had purchased at least some of their pot vape cartridges from legal sources, but she said the patients were only able to give “vague” descriptions of the products, like “THC concentrates” or “such and such” crop.”

Maki said DOH has sent seven different confiscated vape cartridges to the FDA and CDC, but she was not aware if those products were legally purchased.

The Liquor and Cannabis Board, which regulates cannabis in Washington, required all legal vape manufacturers to submit entire product lists to the state by Dec. 1 of this month. An LCB spokesperson confirmed to The Stranger that Vitamin E Acetate was not included in any product descriptions.

A police officer in Puyallup made headlines in September, at the peak of the EVALI crisis, when he sued five of Washington’s legal pot companies and accused them of giving him EVALI. The cop did not provide any evidence that those cartridges specifically caused him harm, other than saying he fell ill with EVALI and those were the products he had used. Mark Lindquist, the cop’s attorney, said they have yet to get test results back from the cartridges.

“Results not back yet for cartridges,” Lindquist said in an e-mail. “Given recent news, we will be asking specifically about Vitamin E Acetate.”