[This article was originally published by our sister paper, The Stranger—eds.]

The vape crisis that has been making headlines and scaring stoners since August, sending thousands to the hospital with lung injuries and killing at least 55 people, now appears to be subsiding. New reports of the lung injury have almost come to a standstill, according to the latest federal data, and most of the people who were hospitalized have since been released.

With the dust settling, one message appears to be emerging: the vape lung crisis is largely a creation of the black market and successful regulation can make Americans safer.

Too bad none of our lawmakers are listening.

The smart response to this crisis would be to legalize pot nationwide and start enacting meaningful regulations on e-cigarettes, which are currently wholly unregulated in America. Instead, politicians from Washington Governor Jay Inslee to President Donald Trump are choosing to make these products illegal. What these two men are doing will push consumers straight back to the black market, the very place that got people sick with vaping-related lung illness.

Inslee pushed for an emergency ban on all flavored e-cigarettes in Washington and is asking state lawmakers to make the ban permanent. Trump is promising to do something similar, but he is only banning flavored pods, like JUUL, and letting “vape juice” e-cigarette retailers sell whatever they want (this is pure Trumpian policy nonsense, as it allows the most dangerous side of the unregulated flavored e-cigarette market to persist).

Trump and Inslee are effectively deregulating these products (because prohibition is a form of deregulation), even though the data from the crisis shows the clear value of regulation.

The latest data on this deadly lung injury—which the Centers for Disease Control (CDC) is calling E-cigarette or vaping product use-associated lung injury, or EVALI for short—strongly suggests that it is a creation of the black market.

The vast majority of EVALI cases have been caused by pot vape cartridges, with 80 percent of patients reporting using THC cartridges, according to the CDC. The federal government has not released data on where consumers got these weed vape cartridges, but I haven't been able to find a single confirmed case of EVALI from a regulated, state-legal pot vape producer. And when you look at where EVALI is most concentrated per-capita, it’s clear that EVALI is hitting people hardest in states with no legal pot market.

The following CDC map, showing the number of EVALI cases per million people, shows that cases were concentrated in states like Utah, Wisconsin, Delaware, and Indiana, where consumers cannot buy legal pot. Those darker shaded states are conspicuously focused in the center of the country, where pot prohibition reigns free.


Prof. Beatriz Carlini, an associate professor at University of Washington’s School of Public Health, told The Stranger that the latest CDC data shows a clear need for legalization and regulation.

“I would say that the report clearly points for the need of regulation, based on scientific assessment of risks,” Carlini said in an e-mail.

Carlini pointed out that legalization will not be enough, given that some EVALI patients have reported using only e-cigarettes or CBD vape cartridges, two products that are legal but unregulated.

“Legalization—per se—does not protect us from another crisis like this one," Carlini said. "What can protect us is science-based regulation that is enforced. Legalization is not enough if it does not come with strict regulation to protect the public.”

None of this should be surprising.

America’s experiment with alcohol prohibition between 1920 and 1933 showed the clear value of drug regulations. During Prohibition, the government said alcohol was too much of a societal ill to be tolerated, so politicians (similar to Jay Inslee today) made it illegal. Then more people started dying, according to William J Rorabaugh, a professor emeritus of history at University of Washington who specializes in studying Prohibition.

“Black market products are often contaminated,” Rorabaugh told The Stranger in an e-mail. “During Prohibition the biggest problem was with moonshiners, many of whom were not very bright, using auto radiators as stills. They did not realize that this introduced lead into the distilled spirits, which was then deadly.”

Moonshiners weren’t the only problem. Black market alcohol dealers tried all sorts of dangerous ways to make a quick buck, according to Rorabaugh. People would try to remove poison from industrial alcohol (which the government intentionally poisoned in an attempt to prevent drinking) but would fail to get all of the poison out and then kill any subsequent drinkers. Other bootleggers would try to distill alcohol out of wood, which is naturally poisonous.

That sounds a lot like what is happened to EVALI patients. The CDC has determined that one chemical, vitamin E acetate, is associated with the vast majority of these lung injuries. Vitamin E acetate has been found in the majority of both the cartridges collected and the lung tissue samples of EVALI patients tested, including patients who died.

The cannabis website Leafly has thoroughly documented how black market producers use vitamin E acetate as a cutting agent in vape cartridges, allowing them to stretch out their supplies of THC cannabis oil and make more money. Some black market cartridges have been found to contain over 30 percent of vitamin E acetate.

Inslee is lucky that e-cigarettes are not as popular as alcohol was during the 1920s, otherwise his creation of a black market for flavored e-cigarettes could be as deadly as Prohibition.

“In one month in New York City more than 600 people died from poisoned alcohol,” Rorabaugh said. “Overall deaths from 1920-1933 from poisoned alcohol were in the thousands, perhaps even 100,000. It was embarrassing to admit that death came from an illegal substance, so MDs often falsified the death certificates to read death from heart failure.”

That negligence on the part of doctors sounds a bit like what our politicians are doing to us today. The EVALI crisis is a failure of public policy by not regulating e-cigarettes and black market pot products. Yet our governments are looking the other way. They are embarrassed that they waited for years to regulate a popular consumer product and now they're trying to bury the problem back into the black market.

There's no reason to think it will work.