If all the recent news about vape-related deaths and illnesses has you casting suspicious glances at your cartridges and concentrates, you aren’t alone. Reports of hospitalizations due to vaping are surging around the United States, with 450 cases currently under investigation. Yet health officials have yet to pinpoint an exact cause of the illnesses and deaths. They also haven’t been able to link the illnesses to any specific product, as reports involve both cannabis and nicotine vapes. But we aren’t completely in the dark, either. So as this story continues to develop, here’s everything we know so far about the recent vape-linked deaths and illnesses.

Here’s What “Vape Lung” is Like, According to One Patient

Hopefully, you don’t know anyone and are not yourself someone who has experienced severe lung distress due to vaping cannabis or anything else. The experience is a miserable and long-lasting one. Just ask Jackie Gomez, a resident of Los Angeles who spent days in the hospital after developing what doctors diagnosed as necrotizing pneumonia. Gomez told High Times she thinks the DANK vape cartridges she had been consuming may be to blame.

Gomez says it started as a tickle in her throat. That tickle soon became irritation. Then the muscle soreness started, the loss of appetite, the coughing and the vomiting. When Gomez noticed her phlegm was dark brown and tasted putrid, she knew something was up and checked herself into an urgent care center. After a chest X-ray, Gomez ended up in the emergency room.

That was the start of a weeks-long stay in the hospital. Doctors tested Gomez for everything from TB to HIV to bacterial and viral infections. But even after a test of her lung tissue, doctors couldn’t come up with a conclusive result. In the end, it took Gomez a month of IV antibiotic treatments to fully recover from the lung infection. Her doctors still don’t know what could have caused such a severe illness.

Gomez says doctors and specialists regularly asked her about her smoking habits. But she says they never asked what she was smoking or how. The doctors seemed to assume it was a tobacco product, Gomez said. They never asked her directly about cannabis consumption.

Gomez’ experience was terrible. And she isn’t alone. But as in her case, health specialists are struggling to come up with answers for those suffering from vape-related illnesses.

Vape-Linked Lung Problems Hit the Midwest in August

Reports of vape-linked health issues began surfacing about a month ago, when 22 midwesterners were hospitalized for breathing problems linked to vaping. The incidents impacted vape consumers across Minnesota, Wisconsin and Illinois. But despite identifying patterns common to all the cases, doctors were unable to determine an exact reason or cause of the patients’ lung distress.

Many of the patients were young, and some were vaping both nicotine e-cigarettes and THC cartridges. One person, 26-year-old Dylan Nelson, was so sick after consuming an illicit THC cartridge that doctors placed him in a medically-induced coma.

Vape-Related Hospitalizations Surge in California, New York

Just days after the outbreak of vape-related lung illnesses in the midwest, California health officials issued a public warning after seven people fell ill with pneumonia-like symptoms after vaping. Some of the patients became so ill that they were placed in intensive care units and placed on breathing machines. Patients suffered from shallow and rapid breathing, low blood oxygen levels, low blood pressure, confusion and tiredness. And all seven of them had recently vaped THC and CBD oil cartridges obtained from unlicensed retailers.

Meanwhile, New York health officials began warning health care providers to be on the lookout for vape-linked pulmonary illness. At the time, the New York Department of Health was investigating 11 cases of lung problems linked to vape consumption. And it was those investigations that finally provided the first possible answer to the mysterious vape-linked illnesses.

New York Health Department Identifies Vitamin E Acetate as Potential Cause of Vaping Illnesses

On September 5, the New York Department of Health announced that it believed the vape-related illnesses across the state could be the result of people vaping vitamin E acetate. Lab analysis of the vape products that landed 11 New Yorkers in the hospital showed that nearly all contained very high levels of vitamin E acetate.

The discovery completely altered the focus of other ongoing investigations, shifting the spotlight to cannabis products, not e-cigarettes. “It is really starting to look like this is a cannabis vaping issue and that it may not have anything to do with e-cigarettes,” Boston University professor of public health Michael Siegel told USA Today. Those findings were then backed by the Food and Drug Administration.

“Vape-Lung” Fears Spread to Canada

In just a matter of weeks, more than 350 cases of “vape lung” had been reported across the United States. And it became increasingly clear that the handful of vape-linked deaths were likely caused by cannabis vaping products. The problem, however, was that no one could determine which products were causing the harm.

Most of the cases across the U.S. stemmed from THC vape cartridges obtained on the illicit market. This led many to assume that counterfeit or unregulated concentrates were to blame. But after officials in Oregon linked the death of one vape consumer to a cartridge purchased in a licensed dispensary, those assumptions went out the window. “At this point, we don’t really know what is safe,” said Dr. Ann Thomas, a pediatrician and public health physician in charge of Oregon’s incident management team.

In light of the rapidly spreading epidemic of cannabis vape-related illnesses, and the uncertainty over its cause, federal health officials in Canada issued a health advisory against vaping of any kind.

As of Today, Six U.S. Deaths Linked to Vaping Cannabis, Nicotine

By early September, the CDC-confirmed death toll from vaping had climbed to five people. The death in Oregon, however, has so far been the only fatality linked to a cannabis vape product. Still, all of the deaths resulted from severe lung illnesses and breathing difficulties likely caused by vaping. In each case, symptoms mirrored serious respiratory diseases like pneumonia. But experts still aren’t sure what the root cause is. It could be contaminants in illicit products, common ingredients, the concentrate or the device or cartridge itself.

Then, on September 10, the vaping-related death toll rose to six, with the passing of a resident of Kansas. Like the other cases, the Kansas death resulted from an unknown respiratory illness linked to vaping. We don’t know much about the patient who died in Kansas, except that the individual was over 50 years of age and had a history of health issues, according to a hospital statement. The day before, the American Medical Association issued a warning urging Americans to stop using any kind of vaping device or e-cigarette. It’s so far unclear what kind of product the patient in Kansas had consumed.

Also this week, a Texas high school student collapsed after hitting a vape pen containing cannabis. According to reports, the student passed out immediately after hitting the vape and was unresponsive. Emergency responders transported the Texas teenager to a local children’s hospital. Across the country, cases of vape-linked illnesses had surged to more than 450.

Regulators Aren’t Equipped to Handle Changing Concentrate Formulas

Prior to the popularization of vaping, cannabis had a track record of causing not one overdose death. On its own, cannabis is very safe. But now, cannabis products have claimed at least one life, even if THC isn’t to blame. Clearly, there’s something in the vape cartridges causing serious lung illnesses. And currently, experts’ best guess is that that something is vitamin E acetate.

Vitamin E acetate isn’t just in illicit vape cartridges, either. You’ll find it in certified cannabis products that have passed the tests regulators require. State agencies, like the Oregon Liquor Control Commission, have cleared vape products with vitamin E acetate for sale in licensed retail shops. Vitamin E acetate is a common additive in vaping liquids.

Furthermore, extract manufacturers regularly experiment with new concentrate formulas, trying out different diluents and thickeners. Regulators can barely keep up. There are even different versions of vitamin E acetate, and state agencies don’t really require testing for them. As a result, completely untested varieties of vitamin E acetate are ending up in cartridges on cannabis store shelves.

The Cannabis Industry Responds to Rash of Vape-Linked Illnesses and Deaths

Amid these growing fears that dangerous and deadly vape products are everywhere, some in the cannabis industry are taking action. In Portland, for example, Connoisseur Concentrates has stopped the sale of its signature “Clear Cut” line of concentrate diluent. Clear Cut, which dilutes viscous cannabis oils, contains vitamin E acetate, according to company owner Andrew Jones.

In Michigan, one cannabis business is following the governor’s lead in getting e-cigarette products out of consumers’ hands. Last week, Gov. Gretchen Whitmer authorized a ban on all flavored e-cigarette products. But for those who had already purchased e-cigarette products, two cannabis companies came together to offer a potentially life-saving deal.

Greenhouse, a medical marijuana provisioning center in Walled Lake, and Platinum Vape, partnered to give away $50,000 in cannabis products. For five-days running from September 11 to 15, Greenhouse is running a promotion where people can bring in any nicotine vape product—even if it’s empty—and exchange it for CBD or THC products at no cost. Greenhouse only sells state-licensed and lab-tested cannabis products, including its THC vape pens. Michiganders without medical cannabis cards can also participate in the promotion. They’ll get CBD products for their nicotine trade-ins. “I think vaping THC or CBD is way better for you than nicotine,” said Greenhouse owner Jerry Millen.

Still No Definite Cause to Vape-Linked Lung Illnesses

Public health officials are getting closer, but right now there’s no definite cause to the increasing number of vape-linked illnesses. That’s why health experts across the United States and Canada are urging people to refrain from vaping, especially unregulated, untested products, until scientists can provide an answer.

For cannabis consumers like you, the best thing to do is make sure you know what you’re inhaling when you vape. Buy from licensed sellers who can show you verified lab test results of vaping products. Make sure you can tell what’s inside your vape pen. Avoid products with vitamin E acetate. As the tragic death in Oregon shows, this isn’t foolproof, but it will increase your chances of avoiding a trip to the hospital or worse.

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