New research shows that states with legal recreational cannabis had fewer cases of lung injuries related to vaping than other states, according to a study published by JAMA Network Open on Monday. The researchers found no significant difference in the number of e-cigarette or vaping associated lung injury (EVALI) cases in states with legal medical marijuana compared to prohibition states.

To conduct the study, researchers conducted an analysis of data from the Centers for Disease Control and Prevention (CDC) on EVALI cases at the state level, including Washington, D.C. The data was evaluated in conjunction with population figures and information on the prevalence of e-cigarette use for each state.

The study revealed that states with legal recreational marijuana dispensaries had 1.7 cases of EVALI per million people while states that prohibit adult-use cannabis had 8.1 cases per million. States that have only legalized medical marijuana saw 8.8 EVALI cases per one million residents, which while higher than prohibition states was not statistically significant.

“The data suggest that EVALI cases were concentrated in states where consumers do not have legal access to recreational marijuana dispensaries,” the study’s authors wrote. “This association was not driven by state‐​level differences in e‑cigarette use, and EVALI case rates were not associated with state‐​level prevalence of e‑cigarette use. One possible inference from our results is that the presence of legal markets for marijuana has helped mitigate or may be protective against EVALI.”

Results ‘Little Surprise’ For Cannabis Activists

Erik Altieri, the executive director of the National Organization for the Reform of Marijuana Laws (NORML), said that the results of the research illustrate how consumers are protected in states that have legalized and regulated cannabis for use by adults, comparing the situation to the prohibition of alcohol in the United States in the 1920s.

“These findings come as little surprise,” he said. “In jurisdictions where cannabis is legally regulated, consumers gravitate toward the above-ground retail marketplace where they can access lab-tested products manufactured by licensed businesses.”

“Just like alcohol prohibition gave rise to the illicit production of dangerous ‘bathtub gin,’ marijuana prohibition provides bad actors, not licensed businesses, the opportunity to fulfill consumers’ demand – sometimes with tragic results,” Altieri added.

In November, the CDC announced that vitamin E acetate, a substance sometimes used to dilute cannabis extracts, was the likely cause of the vaping-induced lung injuries, leading some legal states to ban its use. In a commentary on the study released this week, three critical care specialists from the University of Utah School of Medicine wrote that regulations on cannabis produced in legal states won’t protect consumers elsewhere if the products are diverted to the unregulated market.

“If THC concentrates are transported from states where they are legal and can be relatively cheaply mass produced (like industrial ethanol stocks during Prohibition) to other states where they are illegal and must be guarded jealously as a rare and precious commodity, there may be a strong economic inducement to dilute them, thereby increasing profits,” they wrote.

News of the outbreak of lung injuries associated with vaping made headlines last summer, with cases peaking in September. In all, EVALI has resulted in the hospitalization of nearly 3,000 people in the United States and led to 68 deaths, according to the latest update on the outbreak released by the CDC in February.

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