U.S. health officials were once again cautioning the public to refrain from using vaping products as related respiratory illnesses and even deaths continued to be disclosed last week.

As of Friday, officials linked at least five fatalities to e-cigarettes and electronic marijuana vaping devices.

The outbreak has some in the cannabis industry expecting at least a temporary drop in sales for products such as disposable vape cartridges and, potentially, a new round of regulations for vaporizer makers stemming from concerns over public health.

At least 450 people in 33 states had been afflicted as of Friday in addition to the five deaths, The Washington Post reported, citing federal health officials.

The states that have reported vaping-related lung illnesses to the Centers for Disease Control and Prevention (CDC) are Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Montana, Nebraska, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia and Wisconsin.

One of the latest cases, reported Tuesday in Oregon, linked a man’s death in July to “reports that the individual … had recently used an e-cigarette or vaping device containing cannabis purchased from a cannabis dispensary,” according to a statement from the Oregon Health Authority (OHA).

An OHA spokesman wrote in an email to Marijuana Business Daily that authorities do not yet know the name of the store where the suspect cannabis was purchased but confirmed that it was a legal, licensed retailer.

“What we don’t know for sure is what, exactly, caused the individual’s death – just that the individual shopped at a dispensary before falling ill,” OHA spokesman Jonathan Modie wrote.

“We believe the individual used a vaping device containing a cannabis product before getting sick.”

The symptoms of the Oregon patient were consistent with those being investigated by the CDC and resemble other newly reported deaths in Illinois, Indiana and Minnesota as well as a possible vape-related death in Los Angeles County, according to The Washington Post.

No single vaping device, liquid or ingredient has been tied to all the illnesses, officials said.

Meanwhile, a preliminary report published Friday in the New England Journal of Medicine about pulmonary illness related to e-cigarette use in Illinois and Wisconsin noted 84% of the 53 case patients analyzed “reported having used tetrahydrocannabinol (THC) products in e-cigarette devices, although a wide variety of products and devices was reported.”

At this point, there are far more questions than answers, according to all the latest statements from the CDC and other health authorities.

“We’re all wondering if this is new or just newly recognized,” Dana Meaney-Delman of the CDC told reporters Friday.

An Illinois health official, Jennifer Layden, said officials there don’t know when such illnesses first began, but she said there has been a marked increase since spring.

The Washington Post reported that an additive, vitamin E acetate, was found in a number of cannabis samples tested in New York state, but The New York Times reported that some of the 100 products used by afflicted patients tested negative for that additive, so the precise cause of the illness still remains unclear to officials.

There’s even some dissent among marijuana industry watchers as to how big an impact the issue will have for the cannabis industry, even if state-legal marijuana vaporizer products are ultimately found not responsible.

Industry: True culprit is black market

The Oregon case notwithstanding, most of the other cases appear connected to cannabis products or e-cigarettes purchased from illicit dealers or unlicensed marijuana shops, to the point that the CDC has warned consumers not to buy or use vape products “off the street.”

As a consequence, state-legal cannabis vaporizer companies and other industry observers are taking to heart that blame for the outbreak may not fall on them.

“I’ve seen this kind of media blitz for the past 10 years happen once every six months,” said Arnaud Dumas de Rauly, CEO of New York-based The Blinc Group, a vaporizer company. “It’s all over the media for two, three, four weeks.

“This might last a little bit longer because it mixes nicotine vaping and cannabis, but I think it’s just a fad. It’s going to pass and everyone is going to forget about it in two months.”

Dumas de Rauly, who also chairs the ISO Committee on Vaping Standards and CEN Vaping Standards Committee, pointed to statements by both physicians watching the outbreak and a former commissioner of the U.S. Food and Drug Administration (FDA) noting the majority of illnesses were linked to street products diluted with some new additive, perhaps such as vitamin E acetate, as The Washington Post story indicated.

Vitamin E acetate is not used in standard cannabis oil or vape cartridge production, Dumas de Rauly said, and provides more evidence the problem is coming from illegal actors and not licensed cannabis companies.

“That is never used. Vitamin E is what we call a preservative. That’s what you add into cosmetics to make sure the product does not become spoiled,” Dumas de Rauly said.

“In no case is this a product that you should be inhaling.”

“When you add products like vitamin E … when you add different kind of lipid solvents to the mix, you’re making all of that oil stickier, and that stickiness is going to create these lung illnesses we’re seeing,” he said.

“Now, why do people add vitamin E? Because it’s supposed to help with the shelf life.”

That’s in direct contrast to lab-tested marijuana vape cartridges, which have been on the market for years without drastic health impacts reported, Dumas de Rauly noted.

“All of the patients are saying they bought it off the street. They didn’t buy it in legal, regulated environments,” Dumas de Rauly said.

“This is just basic math. … We have substantial data that shows that these products and these vaping illnesses come from the black market.

“The culprit here is the black-market product. It’s not the cartridge, it’s not the hardware, it’s not the regulators. It’s the black market.”

Collateral damage?

That doesn’t mean there won’t be people who point the finger at licensed cannabis businesses, however.

Longtime industry opponent Kevin Sabet, president of Smart Approaches to Marijuana (SAM), cited the Oregon case in a Twitter post Thursday: “Pot shops kill. Close them down.”

Morgan Paxhia, the managing director of San Francisco-based Poseidon Asset Management, warned the vaping illness outbreak “definitely could throw some cold water on the (vaping) space,” perhaps depending on how many more people get sick and how long the issue lasts.

But, Paxhia said, he doesn’t expect any drastic downturn in sales for marijuana vape cartridges or cannabis in general, in part because the vast majority of users haven’t reported negative side effects and the products remain incredibly popular.

“If people are getting sick from illicit-market products, pointing the blame at the legal operators is not going to correct the (situation),” he said. “It is likely an unfair characterization of those trying to do things properly and just causes more confusion.”

“But I do think it is a risk” that legal MJ companies could get scapegoated for the epidemic, Paxhia added.

Dumas de Rauly said he believes the outbreak could lead to a short-term drop in MJ vape cartridge sales, though he noted it’s unlikely it would hit the industry’s bottom line broadly over the long term.

Jim Makoso, vice president of Lucid Lab Group in Washington state, and Dumas de Rauly emphasized that numerous studies have concluded vaping is far safer than smoking when it comes to cannabis ingestion.

Makoso said that marijuana companies dedicated to making consumer-safe products will remain fine in the long haul, even if they need to invest in additional research and development or update manufacturing processes.

“In the short term, I anticipate that vape sales will pare back somewhat as a short-term response to what’s happening out there,” he said, “but by and large, there are very few connections to these illnesses and specifically cannabis products.

“Anytime that any product in the cannabis industry could be connected to an illness … we should take it very seriously. I don’t want to jump to conclusions, because at this point it’s just conjecture.”

Regulatory backlash?

There’s already been a crackdown in Michigan on flavored e-cigarette oils by Gov. Gretchen Whitmer, who said she was issuing a ban to keep such products from appealing to teenagers.

The move was motivated at least in part by the vaping-illness epidemic as part of a broader push to protect public health.

The ban could signal an expanded regulatory backlash against the vaping industry at large, marijuana industry watchers said.

Makoso noted the vaping-illness outbreak could even motivate the FDA or Congress to get directly involved in vaping industry oversight.

According to The Washington Post, U.S. Sen. Dick Durbin, a Democrat from Illinois, was calling Friday for FDA action.

Dumas de Rauly said further regulation is exactly where he sees the situation leading.

“The most impactful points for businesses are going to be the politicians and the regulatory agencies who are going to have to bump up their policing and enforcement of current regulations, if not create even more stringent” regulations to govern the vaping industry, he said.

“The idea of people getting sick specifically because of vaping … is definitely going to have an impact in the cannabis industry. What that impact is, is yet to be determined,” Makoso said.

Makoso and Dumas de Rauly said the best way for cannabis companies to get out in front of the situation is to talk about it as much as possible and educate the public on the rigorous testing that state-legal MJ products undergo to ensure consumer safety.

“This is what the cannabis industry should be using this story for,” Dumas de Rauly said. “This should prove that people need to go buy from legal, regulated sources.”

Bart Schaneman and the Associated Press contributed to this story.

John Schroyer can be reached at [email protected]

Bart Schaneman can be reached at [email protected]