(An updated edition of this report can be found here.)

This has been a scary time for people who vape, and for the companies that make vaping products and equipment. Although I reported on the situation a couple of weeks ago, every day since has provided more information about what’s happened, and the potential reasons behind this increasingly deadly health crisis. We still don’t have all the answers, but we know more than we did. Here's an update.

What we knew then: In August, news emerged that some people who had vaped were developing serious respiratory ailments. It wasn’t clear at the time if they were vaping nicotine or cannabis cartridges (carts), or if the carts contained something else altogether, such as synthetic cannabis, AKA Spice. It also wasn't clear if these were even legitimate carts purchased from a licensed dispensary that is required to have its products lab-tested, or if the carts were sourced from the illicit marketplace. In short, we really didn’t know much.

We did know that nearly 200 people were hospitalized across 22 states per the Center for Disease Control and Prevention (CDC) for severe “vaping related” illnesses between June 28 and August 20.

In one city in Northern California, seven people who had been hospitalized revealed they had purchased and used THC carts purchased at illegal “pop-up" dispensaries, as they were cheaper than the ones available through licensed channels.

Then the CDC revealed that someone in Illinois had died from vaping.

That was less than three weeks ago.

What we know now: The incidences of vaping-related hospitalizations skyrocketed to 450 [UPDATE the CDC has now adjusted this number to 380] across 33 states and the US Virgin Islands. Yesterday (Wednesday, September 11), Washington State reported its first known case of a vaping related hospitalization.

As of this writing, officials have identified six people who have died from vape-related illnesses, in California, Illinois, Indiana, Minnesoota, Kansas, and Oregon. The person who died in Oregon reportedly purchased THC carts from two licensed dispensaries. Those dispensaries and the products purchased have not been identified.

What’s causing it? That isn’t yet known. Officials in several states, including New York, have established a connection with an added thickening agent. Per CNN: “New York health officials said last week that extremely high levels of the chemical vitamin E acetate were found in nearly all cannabis-containing vaping products that were analyzed as part of the investigation. At least one vape product containing this chemical has been linked to each person who fell ill and submitted a product for testing in the state.”

Vitamin E acetate is reportedly a common additive to black-market THC carts, but isn’t thought to be widely used in legal THC carts. Well, we hope not. In Oregon, although we test for THC cart potency, pesticides, and solvents, we don’t test for additives such as thickening/thinning agents.

Instead, the OLCC has begun asking dispensaries to review their vape carts to determine if any ”undisclosed agents” have been added by makers and manufacturers to the carts. Yesterday, OLCC Executive Director Steve Marks told the Corvallis Gazette-Times that because these kinds of additives aren’t being tested for right now, “regulators can't know if it's being added illicitly by some manufacturers.”

“Any company that has added an 'undisclosed agent' to its vape cartridges should tell regulators immediately or face legal complications and probably additional liabilities," he said.

"My worry is that some of these folks may have gone around and put vitamin E in their products that we are unaware of," Marks said. "If it's in our products, it's out there and we don't have a clear way to know which ones it may or may not be in."

That’s the extent of what the OLCC can do at the moment, save for requesting that dispensaries post signs about the potential dangers about vaping. As Marks told the Gazette-Times, the agency can't ban vaping devices or any specific ingredients in them until more is known about what is causing the health problems. "The public safety agency has to tell us there's a public health concern for us to act," Marks said. "They have not done so yet. With the lack of specificity, that's about the level of action we can take at this point."

What’s next? Expect some regulatory action, including banning and/or testing for dangerous additives such as Vitamin E acetate, new labeling requirements, and, on the nicotine side, possible elimination of some products altogether. Yesterday Trump announced that the federal government may take action to recall or ban nicotine carts with "flavorings,” which sucks if you have a Pineapple Menthol Blueberry Punch vape juice monkey on your back, but is a great thing for anyone who has to stand in your vicinity while you emit clouds of your foul "Satan's Sweat" concoction.

Should I keep vaping? Your panic level should dictate that choice. Insofar as there are risks with all activities, you can reduce yours by performing some due diligence. As I've written about, do not purchase carts from anywhere but a licensed dispensary. Reach out to the cart producer and ask what they use in their products. Some producers have already taken to social media to state that they don't use the suspected additive to their products, and never have.

Lastly, you can always vape flower, in a desktop unit or a portable vaporizer. There are zero dangers associated with doing so.