A new study adds to the body of research indicating that access to legal and regulated marijuana markets served a “protective” purpose for people who vaped cannabis during a 2019 outbreak of lung injuries related to contaminated products.
Researchers at Johns Hopkins, New York University and the American Heart Association reached that conclusion in a study published in the journal PLoS ONE this month. They analyzed the prevalence of marijuana vaping, cases of e-cigarette or vaping product-use-associated lung injury (EVALI) and cannabis laws in 13 states.
While more people reported vaping marijuana in states that have legalized for medical or recreational use, that prevalence didn’t translate into a greater percentage of EVALI case burdens compared to non-legal states, according to data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) and the Centers for Disease Control and Prevention (CDC).
The research article—which looked at data from four prohibition states, seven medical cannabis states and two states that have legalized marijuana for adult-use—found that “state-level cannabis vaping prevalence was not positively associated with EVALI caseload, even after accounting for state cannabis policies.”
In fact, there was “an inverse association between state cannabis vaping prevalence and EVALI case burden.” That is, states that had higher levels of marijuana vaping, which tend to be the states that have some form of legal access, saw lower lung injury rates.
“These findings, therefore, suggest that there may not be a direct, simple link between a state’s cannabis vaping prevalence and EVALI cases, but rather the relationship is likely more nuanced, supporting the CDC’s hypothesis that the EVALI outbreak is likely reflective of access to informal sources of THC-containing e-liquids,” the study authors said.
“Although cannabis vaping prevalence was low in states with prohibitive cannabis laws, individuals from such states may more likely obtain cannabis from illegal sources, increasing their risk of using contaminated products and hence the higher prevalence of EVALI cases in such states,” it said.
In states that had legalized medical or recreational marijuana, meanwhile, people were “likely to obtain cannabis from legal sources, reducing the risk of contamination.” The research article supports findings from previous studies demonstrating that “the presence of legal markets for cannabis may have been protective against EVALI,” according to the authors of the new paper.
The EVALI crisis has dropped off significantly over the past three years as public education increased and regulators stepped up enforcement efforts against vaping manufacturers that included additives like vitamin-E-acetate into their THC cartridges that are believed to have caused the lung injuries.
However, the researchers said “continued surveillance of cannabis vaping is warranted,” and “efforts to discourage black-market sales of contaminated products should be pursued to prevent future outbreaks.”
Advocates have long maintained that cannabis legalization represents a key policy to mitigate the harms of illicit markets, and the new study seems to reinforce the public health benefits of regulations over prohibition.
“In conclusion, state-level cannabis vaping prevalence was not positively associated with EVALI prevalence,” the article says. “This suggests that the EVALI outbreak may have not necessarily been a simple reflection of state-level cannabis vaping prevalence but rather due to the use of contaminated or illicitly-sourced vaping products, which are more likely in states with restrictive cannabis laws.”
Relatedly, a study published in the journal Environmental Health Perspective last month determined that the lack of federal regulations, combined with a patchwork of state policies, “can confuse cannabis manufacturers and discourage compliance while subjecting cannabis users to a higher level of contaminant exposure in some jurisdictions.”
Another recent study that analyzed National Poison Data System (NPDS) reports found that marijuana legalization minimizes the risk of people buying and using synthetic cannabinoid products that can lead to hospitalizations or deaths.
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