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Indiana University researchers find prohibition a factor in last year’s vaping epidemic

Apr 28, 2020

Earlier this month, the Journal of the American Medical Association Network Open published a cross-sectional study seeking to determine the effects of the so-called “vaping epidemic” known as EVALI that swept through the United States last year. The epidemic, which was cause for numerous panicked headlines throughout 2019, was ultimately deemed to be caused by third-party vape cartridges sold on the illicit market.

According to the study, cannabis consumers who lived in legalized states were less likely to be affected by EVALI than those who lived in states where cannabis was still illegal, bolstering claims that the illicit market caused the epidemic.

Over nine months, nearly 3000 people were stricken with EVALI, including at least 60 who died, with the epidemic causing widespread panic among cannabis consumers and the public-at-large. The sale of vape products dropped significantly, and a myriad of consumer products was caught in the crosshairs of public ire, as nicotine vape products and flavored vape products were in danger of facing a federal ban.

The JAMA study was led by Indiana University researcher Coady Wing, who looked to past eras of prohibition for inspiration.

“We thought about some of the things that often happen in black markets for illegal drugs. For instance, during the alcohol prohibition era, bootleg alcohol producers often made and sold alcohol products that were not that safe to drink,” Wing told Cannabis Newswire. “In more recent years, there are cases where black market sellers of illegal drugs like heroin try to increase profit margins by diluting drugs with other substances, which can be harmful.”

Researchers from the O’Neill School of Public and Environmental Affairs at Indiana University, Bloomington reviewed state-level CDC data, e-cigarette consumption data from the Behavioral Risk Factor Surveillance System, and population data, according to Cannabis Newswire. Their findings led them to conclude that the “data suggest that EVALI cases were concentrated in states where consumers do not have legal access to recreational marijuana dispensaries.” 

In the end, after much confusion, it turned out that the tainted vape cartridges in question contained Vitamin E Acetate, a chemical designed to thicken cannabis oil. Though Vitamin E Acetate was not definitively linked to EVALI, it was determined to be closely associated with the epidemic.

“It is clear that the outbreak represented a new phenomenon,” said Anne Schuchat, principal deputy director of the CDC, during a press conference last year. “It’s not a recognition of a common syndrome that had evaded our attention.”

The vaping crisis caused panic among all sorts of constituencies, from cannabis users to nicotine users and more. Perhaps no company caught the brunt of the nation’s anger over the vaping crisis as much as Juul, the maker of electronic cigarettes that had become popular among high school students. In fact, one true thing was that not every EVALI patient had claimed to use THC products. 

“This does not mean there are not other substances in e-cigarettes or vaping products that have or are capable of causing lung injury,” said Schuchat last year.

The researchers at Indiana University, however, did note that prohibition played a significant role in the EVALI epidemic. 

“While these types of laws are designed to reduce the use of specific drugs, one effect is that some consumers will be pushed into the black market, which is unregulated and thus inherently riskier,” researcher Ashley Bradford told Cannabis Newswire.

She continued: “While we can’t speak to whether marijuana legalization is a net positive for society, what we can say is that allowing consumers to legally purchase THC products is associated with fewer EVALI cases. These results, while simply cross-sectional, do shed some light on the spill-over effects of prohibition policies.”

Chart from JAMA Network Open, "Association of State Marijuana Legalization Policies for Medical and Recreational Use With Vaping-Associated Lung Disease"

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