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Saad Metla had smoked marijuana recreationally before, but when he started vaping THC, it was initially for medicinal purposes.

The Syracuse University psychology senior has undergone over 25 major limb-lengthening surgeries due to a medical condition known as knock knees, and has been prescribed opioids for most of his life as a result. In high school, Metla developed a dependency on painkillers that had become so severe by his sophomore year of college that he decided to cut them out entirely. Still in need of medication, he turned to vaping THC in 2015.

“I had a couple friends who were dealers and they were telling me, ‘Hey check this out, it’s a concentrated form of THC … it’s powerful and the high is a little more intense,’” he recalled being told when first introduced to the then-novel e-cigarette.

Metla says he enjoys THC vapes for the extra intensity, and like many others, for its ashless, almost smokeless and mostly odorless convenience. Now, whether he’s using marijuana medicinally or recreationally, he says he prefers vaping over other forms of administration.

Vapeable marijuana products hit the market around a decade ago and represent one of the fastest growing segments of the multibillion-dollar cannabis industry. It’s also changed the way people are consuming marijuana.

A NewsHouse survey of more than 300 college students indicated that vape pens rival joints, bongs and edibles as the preferred way for students at SU and state colleges to consume marijuana.

With the health risks of vaping tobacco or other products continuing to draw attention, researchers are trying to determine connections between vaping THC and the mysterious lung illness, now known as EVALI.

As of December 2019, the Centers for Disease Control and Protection reported 2,506 cases of hospitalized EVALI across all 50 states and two U.S. territories, and 54 deaths across 27 states and the District of Columbia. While nicotine vapes and regulated THC vapes have been tied to a handful of cases, illicit THC vapes were linked to 80 percent of all EVALI cases.

Dr. Jeanna Marraffa, assistant clinical director and toxicologist at the Upstate New York Poison Center, said in November her office has treated more than 100 patients for the lung illness and that tracing vape products to their original source can be problematic.

“Even though you think you know where it’s coming from, what’s in it, we have no idea,” Marraffa said.

The federal government has poured millions of dollars into researching vapes, but marijuana’s classification as a Schedule I substance has restricted research on THC. The result is a massive knowledge gap that researchers and public health officials are rushing to fill amid the current vaping crisis. Though researchers have determined vitamin E acetate – a thickening agent added to THC vape liquids that’s been found in the lung samples of most EVALI patients – as a primary culprit, it’s unclear what else could be causing these outbreaks.

“We know that vitamin E acetate is there, but there are still other questions: Is that the only culprit? Is there something else that’s happening concurrently? Is there a chemical reaction that’s happening?” Marraffa said.

New York state, where recreational marijuana remains illegal, has been affected by the EVALI outbreak more than most other states, with 254 cases and one death related to the new illness as of March 31, according to the NYS Department of Health.

Marraffa, a co-author of one of the first EVALI patient treatment guides, said the Upstate New York Poison Center began receiving a whirlwind of cases in September when the outbreak was peaking around the nation. The Upstate toxicologist has since been collaborating with state and federal health officials on a near-daily basis but admits she didn’t expect the crisis to persist so long.

A photo illustration depicting a head surrounded by smoke.

Smoke circling around a photo illustration of a shadowed side profile.

“I thought it was going to be a week or two, and I didn’t think it was going to be so widespread,” she said of the lung illness that’s gripped the country.

Researchers remain unsure of why and how the outbreak occurred when it did. It could be that black market producers started adding vitamin E acetate to THC vape liquids as early as the spring and symptoms are just beginning to show. Another possibility is that the additive was introduced in the summer and symptoms took effect more immediately, Marraffa said.

As a vape user, Metla buys prefilled cartridges in bulk from local dealers he knows and trusts and then sends some off for testing at Pro Verde Labs – a THC analytics testing service based in Massachusetts. The lab runs product safety tests, assessing the vapes for possible toxins, like mold, E.coli, metals, and pesticides. He pays $30-$40 for the results of a few different cartridges, a low cost for his safety, he says.

Metla may be more cautious than the average vape user, but the glaring uncertainty that stands behind the machinery and what goes in them remains a cause for concern.

Sung Joon Park, a 24-year-old New York City resident, switched from smoking marijuana to vaping THC in 2018 when public belief held that vaping was a safer alternative to smoking. Since then, public health officials have stressed that the new technology, originally marketed as a solution to help adult smokers quit cigarettes, may not be any healthier.

Park stopped vaping THC after less than a year because it was starting to form a habit. The discrete nature of the vape pen made it easy for him to get high more often than when he was smoking marijuana as a flower.

“I only smoked weed pens for like a year, but I’d be smoking it a lot, like maybe a cart a week,” Park said.

Not only do vapes make it more convenient to consume marijuana but THC vapes, like nicotine vapes, are highly concentrated and can contain as much as 99 percent THC. In comparison, the most potent strains of marijuana flower hover around 30 percent, according to Leafly, a leading cannabis news database.

It had been months since Park stopped vaping THC when he started experiencing chest pains in September. He wondered if his former habit had something to do with it. He had previously been using SmartCart cartridges, one of the three most widely reported cannabis vaporizer brands associated with the outbreak, according to the CDC.

“There is a real concern that if we did imaging of the lungs [of people using these products] that there would be abnormal findings,” Marraffa says, adding that many vape users have likely been more affected than they realize.

The THC vaping crisis may have greater implications for marijuana legislation in New York than health concerns alone.

Rochester NORML executive director Mary Kruger says concerns about vaping highlight the need for regulation. New York State’s Marijuana Regulation and Taxation Act successfully decriminalized the drug in 2019 but failed to see it legalized by a slim margin.

Despite a majority of New York state voters in favor of legalization, Kruger believes a reefer madness-era mindset maintained by some state lawmakers has been one of the greatest obstacles facing legalization in New York. She says NORML is working to highlight the fact that the plant itself has played no part in the outbreak.

“It’s the things people are adding to [THC vapes] because they’re getting greedy and trying to make money in this unregulated market,” Kruger said, noting that no person has ever died from marijuana use outside of a vaping context.

Other hurdles facing legalization include regulating THC potency and chemical additives, which played a major role in the state’s inability to pass legislation in 2019. And while the coronavirus pandemic curtailed New York lawmakers from taking up legalization this year, Kruger said she feels confident that it will eventually pass.

“It will be extremely irresponsible if we do not pass legislation to legalize for adult use [because] we know that there are folks consuming unregulated cartridges right now in New York and getting sick from them,”  Kruger said. “If we aren’t even going to try to give folks an option for a regulated product, then the state is just contributing to the crisis and the problem. If people had affordable and accessible regulated cannabis that they could go to a store and buy, they would choose that over cartridges that could make them sick.”

"If we aren’t even going to try to give folks an option for a regulated product, then the state is just contributing to the crisis and the problem."
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Mary Kruger, executive director of Rochester NORML

Metla sees at least one major personal benefit in New York regulating THC vapes. Up until a ban last September, he would travel hours to Massachusetts just to buy the popular store-brand Pax Era vape cartridges because it was the closest state with recreational dispensaries. Legalization in New York would save him the trip.

But regardless of the health risks of vaping THC, getting marijuana legislation passed may just come down to dollars and cents for Metla and other consumers. THC vape cartridges can run from $25-$40 unregulated, a steep difference compared to $40-$70 for regulated ones.

“If you have the money, then go for it, go get your regulated products,” said Metla, who continues to use his vape. “But if you don’t have money or don’t care to pay a hundred dollars every time you go to a dispensary, then no, it’s not worth it, for me at least.”

An infographic outlining the vaping crisis by the numbers.
Avatar for Singdhi Sokpo

is a magazine journalism student and reporter for The NewsHouse.

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Avatar for Singdhi Sokpo

is a Multimedia, Photography and Design graduate student and contributor to The NewsHouse.