Iso Emerging Issues Perspective

By David Geller, CPCU, SCLA

EVALI: SEARCH FOR A CAUSE

A still-thriving cannabis black market may be to blame

One purported benefit of the efforts towards legalization of marijuana across the United States would be to minimize the presence of a robust black market and the potential public health issues that emanate from an unregulated supply chain. However, the fragmented approach towards efforts to legalize adult use of marijuana at the state level has apparently done little to mitigate the prevalence of illicit marijuana sales. Even California, one of the pioneering states to enact laws designed to allow the sale of marijuana for adult use, has more than triple the number of illegal marijuana distributors (2,835) than actual licensed stores (873), according to a September 2019 NBCNews.com report.

Across the United States, illegal distributors of marijuana continue to flood the market with unregulated and potentially unsafe products, including vape oils.

Perhaps what contributes to this trend in California is a caveat in Proposition 64 that allows cities to ban even legitimate sales completely or limit them as they see fit. As a result, such marijuana sales are only permissible in less than 25% of California’s cities, the NBCNews.com piece stated.

Black market cannabis products linked to vaping injuries

Across the United States, illegal distributors of marijuana continue to flood the market with unregulated and potentially unsafe products, including vape oils. The manifestation of this unfolded this past summer and autumn through a spate of lung illnesses that were so prevalent that a new term was coined for it: EVALI (e-cigarette or vaping product use associated lung injury).

As of December 2019, there were 2,561 reported cases of EVALI across all 50 states, the District of Columbia, and two U.S. territories; 55 deaths were reported. Compounding the fallout from these illnesses, which have persisted throughout the country, has been the complexity of determining the root cause. The Centers for Disease Control and Prevention (CDC) has ascertained that the presence of THC—the psychoactive component in marijuana—has been accounted for in 80% of EVALI cases that CDC has been able to study. CDC states on its website that “THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, family, or in-person or online dealers, are linked to most of the cases and play a major role in the outbreak.”

While the black market has been identified as a potential source for products that may contain the ingredients causing EVALI, diagnosing the issue on a more granular level has proved to be complicated. CDC says one roadblock is that the chemicals packed into vaping devices could change as they’re heated, meaning that chemical suspects have to be tested under a wide range of different conditions to determine how they may affect the lungs. For example, CDC and the New York Department of Health investigated numerous cases and identified vitamin E as a potential contributor to the illnesses, according to a November 2019 NBCNews.com story.

Vitamin E is generally recognized as safe for use as a dietary supplement or cream, but incorporating it into these products was reportedly a tactic for illegal sellers to cover up low-quality THC oil, a process they could implement because of a lack of oversight, according to a September 2019 Inverse.com article. When boiled, this typically safe supplement decomposes. However, as stated in a September 2019 Washington Post article, when the vapor cools and condenses in the lungs, the chemical could then return to its original state and essentially coat the inside of an individual’s lungs with oil.

While the presence of vitamin E in vaping devices has been identified as one potential cause of EVALI, further research has yielded additional possibilities that should be considered. The Mayo Clinic biopsied 17 samples of lung tissue from patients afflicted with EVALI and unearthed a pattern in the lung that resembled a chemical burn injury. According to the Clinic, the exposure resembled what “you would expect to see in an unfortunate worker in an industrial accident where a big barrel of toxic chemical spills, and that person is exposed to toxic fumes and there is a chemical burn in the airways,” according to an October 2019 New York Times article.

Short- and long-term horizons

The spike in EVALI in 2019 has highlighted the immediate dangers that vaping can pose, thus generating a significant amount of attention. But general concerns that correspond with vaping predated the EVALI crisis, specifically when contemplating what long-term effects may be on the horizon, even for regulated vaping products.

Vaping is a relatively new phenomenon, and appropriate research has reportedly not been undertaken to grasp the nature and extent of the potential harm it may cause in the long run. While some black-market products may have contributed to EVALI shortly after its use, the possibility remains that even regulated products may pose dangers that can’t be foreseen.

While black-market illegal marijuana vapes may be the culprit in these EVALI cases, the dynamics underlying the slew of EVALI illnesses could apply to future incidents beyond marijuana, including various nicotine-containing liquids in e-cigarettes.

According to CDC, use of e-cigarettes among high schoolers has surged from 1.5% in 2011 to 27.5% by 2019. This development appears to have precipitated regulatory responses, such as San Francisco’s banning of e-cigarettes this past summer. Limiting access may prove beneficial to weaning some current users off e-cigarettes, and it may mitigate the likelihood of future teenagers becoming hooked. But will lack of regulated availability compel e-cigarette users, particularly young users adept at navigating the Internet, to seek black market alternatives, potentially exposing them to similar problems that have befallen EVALI victims?

If the past is indeed prologue, this type of scenario will be worth monitoring.

The author

David Geller, CPCU, SCLA, is a senior research analyst at ISO, a Verisk business.