Pesticides, mold, bacteria — these are boogeymen that technicians at cannabis testing labs are intimately familiar with and look for daily as part of California’s rigorous requirements to legally bring THC products to market.

In the past month, they’ve increasingly been asked to look for something else: vitamin E acetate.

The synthetic form of vitamin E in black market THC vape cartridges has been linked as a possible contributor to the lung illness outbreak that has swept the nation.

Now, manufacturers in the legal market are doing everything they can to ease consumer worries, including paying higher costs for lab-verified proof that their cannabis-filled cartridges, or “carts” for short, are free of the additive.

But that hasn’t been enough for some cannabis consumers — especially when faced with the recommendation by the Centers for Disease Control and Prevention to refrain from vaping any products containing THC for now.

Some San Diego dispensaries reported a 20% dip in vape sales in the past month, with some customers switching to other delivery systems — from edibles to tinctures to pre-rolled joints — until the mysterious source of illness is revealed.

Southern California as a whole has seen the market share of cannabis vaping products contract by 20% since the vaping scare has grown in the past month — more than in other parts of the state, according to New Frontier Data, a market analysis firm.

The long-term outlook is the “billion dollar question,” said John Kagia, the firm’s chief knowledge officer.

“It is going to hinge prominently on the findings of the CDC investigation to prove — what so far is still rampant speculation — what the culprit is here,” he said.

The crisis has legal cannabis markets around the country and in California fighting to distinguish themselves even further from the unregulated illicit market, which so far appears to be culpable for the outbreak.

“When something happens like this, and it comes out it’s illicit market carts making people sick, it affects everyone, even those of us following the rules to a T,” said Vera Levitt, chief operating officer of Mankind, a licensed dispensary in Miramar.

“No one’s taking it lightly,” she added.

The process to turn leafy cannabis into a vaping oil involves an extraction process stripping away everything else but the THC, creating a potent waxy, peanut-buttery substance. Manufacturers will then add back in terpenes — organic material from the plant that provides aroma and flavor and acts as a natural thinning agent — resulting in an oil that is ready for a vape cartridge.

“Our product only carries state-tested cannabis oil and terpenes,” said George Sadler, founder of Platinum Vape in San Diego. “There’s nothing else in there.”

But some black market sellers have been using vitamin E acetate and other oily additives as a short cut, either to achieve the right viscosity or to stretch their cannabis supply longer for higher profits.

Vitamin E acetate, also known as tocopheryl acetate, is often used in skin care products. It is the synthetic form of vitamin E, which naturally occurs in plants and some foods, from sunflowers to nuts. Inhaling it is believed to damage the lungs by coating them in oil and causing inflammation.

The oil has been found in 47% of samples of THC-containing products tested by the U.S. Food and Drug Administration thus far, according to data released Friday. In the first 37 confirmed samples, the range of concentration of vitamin E acetate stretches from 28% to as high as 88 percent.

What also makes vitamin E acetate suspect is the timing. It became widely used in the cannabis vaping market only within the past year or so, according to Leafly, an online cannabis news site that has been investigating the outbreak.

About six months ago, David Marelius, the chief operating officer of Infinite Chemical Analysis Labs in Miramar, was asked to test the makeup of a mystery thickening compound that was being sold in Los Angeles.

“It was vitamin E acetate, or something similar,” Marelius determined.

In California, it is not illegal to put vitamin E acetate in cannabis vaping cartridges, and state law does not require a test for the substance for commercial sales.

But many manufacturers and retailers say such additives are not widely used on the legal market. None of the licensed dispensaries in San Diego contacted by the Union-Tribune said they sold any vaping products containing vitamin E acetate. Most, if not all, manufacturers have been testing for the substance to prove that it is not present.

The problem is, the role that vitamin E acetate is playing in this crisis is no more than an educated guess at this point. The CDC continues to stress — several weeks into the investigation — that it has been unable to pin the outbreak on any single substance.

Scientists from around the country who have been independently examining vaping illnesses have hypothesized that various additives, including synthetic flavoring, may not be harmful individually, but when combined and then heated are creating a new unknown poison.

Other researchers have noticed links to toxic metals.

Colorado Green Lab used data from 53 vaping patients in Wisconsin and Illinois and found they developed a similar disease suffered by welders and other such workers called Metal Plume Fever. The lab blamed the illness on cadmium-containing silver solder, a way to bind together different metals. The method is used to manufacture cheap vaping pens in China.

Another culprit could be pesticides used to grow black-market cannabis. While pesticides have always been a concern over the decades, the problem is compounded when concentrated into an oil for vaping, a delivery method that has only recently exploded in popularity.

NBC News recently had tested 10 vaping cartridges obtained from illicit dispensaries in California and all contained the fungicide myclobutanil. When burned, the toxin can turn into hydrogen cyanide, according to researchers.

Myclobutanil is allowed in cannabis under California law, but only in trace amounts. NBC did not report the myclobutanil levels found in its illicit samples.

Thirteen illicit cartridges also tested positive for vitamin E acetate.

“I think we really have the feeling right now, that there may be a lot of different nasty things in e-cigarette or vaping products,” Dr. Anne Schuchat, the CDC’s principle deputy director, said in a recent news conference. “And they may cause different harms in the lung.”

As of Tuesday, the CDC has logged 1,299 vaping-related cases nationwide since March, including 26 deaths, three of them in California. The vast majority of patients experienced respiratory distress and many also suffered from gastrointestinal symptoms such as nausea and diarrhea, according to the CDC.

Of the 573 patients interviewed for information on their vaping habits, 76% reported using THC-containing products both with and without nicotine.

Most products appear to have been obtained from illicit or unknown sources, the CDC confirmed, although officials linked one vaping death in Oregon to an item bought from a legal dispensary.

“The CDC recommends you do not use e-cigarette or vaping products containing THC,” said Schuchat said Friday.

The FDA has received or collected more than 725 product samples from 23 states to be tested at its forensic facility in Cincinnati.

Many of the samples have little to no liquid in the samples, which puts an extreme limit on the type and number of tests researchers are able to perform, said Mitch Zeller, the FDA’s director of the Center for Tobacco Products.

“This is a complex investigation unlike any we’ve seen,” warned Dr. Judy McMeekin, a deputy associate commissioner at the FDA.

At March and Ash, a licensed cannabis dispensary in Mission Valley, new signage posted in the store encourages customers to educate themselves about the unfolding situation and learn how to best protect themselves.

“We see this as an opportunity for public awareness and education,” said Spencer Andrews, the store’s public affairs director.

Customers can ask for a particular product’s certificate of analysis, or COA, on file at the shop to evaluate test results, including those for vitamin E acetate. If customers are still uncomfortable buying a vape cartridge, store employees have been helping explore other options.

“Our main seller always has been flower, and that continues to be a good alternative if someone maybe wants hold off on vape products,” said Andrews.

In fact, as the vape market has contracted, customers have reallocated their spending mostly toward flower — both loose buds and pre-rolled joints, according to analysis by New Frontier Data. It makes sense, said Kagia: most cannabis users started with flower and are familiar with it, and there is also a sense of it being traditional and safer.

At Mankind, customers are invited to turn in their illicit market vapes and receive a 35% discount off any state-tested brand.

The Bureau of Cannabis Control, the state’s regulatory arm, is prioritizing complaints about black market vaping manufacturers in light of the illnesses and are sending seizures of cartridges to the state Department of Public Health for testing, according to officials.

Shutting down brick-and-mortar illicit dispensaries in the city of San Diego has largely been successful, although many have shuffled to other parts of the county. The county is also inundated with illegal delivery services.

“We have a stack of known delivery services operating, but if we get actual complaints from citizens, it becomes a priority,” said police Sgt. Jose Chavez, who oversees the marijuana team.

In August, an illicit delivery service based on El Cajon Boulevard in Rolando was shut down. The same operators were running an illegal dispensary in the city of El Cajon, Chavez said.

David Dallal, managing director of Torrey Holistics, a Sorrento Valley licensed dispensary, said the outbreak should be a wake-up call pushing authorities toward federal legalization and uniform regulation. Cannabis is legal in some form or other in 33 states.

“As many as 50,000 people died from drinking tainted alcohol during the era of alcohol prohibition,” he said. “Let’s not let history repeat itself.”

The hardest part for cannabis users, industry professionals and regulators is the wait for answers. But experts urge patience.

“I know it’s hard to just wait for the science,” Marelius of Infinite labs said, “but sometimes we need to slow down and wait for the science and be 100% sure.”


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