Five out of eight Hawaii medical marijuana dispensaries that had been warned by health officials to stop selling vaping products made with outside ingredients say they are now in compliance with state law.

Cure Oahu, Aloha Green Apothecary and Noa Botanicals in Honolulu, Big Island Grown and Pono Life Maui were ordered last week to remove all cartridges made with any compounds from outside sources amid a growing outbreak of lung illnesses nationwide. Hawaii law prohibits pot shops from selling anything not manufactured by the dispensaries, which could face penalties including fines or suspension or revocation of their licenses.

“State-licensed dispensaries take public health very seriously as evidenced by the safety of their products designed specifically for medical use, ” said Pedro Haro, executive director of the Hawaii Educational Association for Licensed Therapeutic Healthcare, or HEALTH, representing the state’s eight licensed dispensaries. Haro said a study published earlier this week found 92% of patients who have become ill after vaping reported vaping tetrahydrocannabinol, or THC, the psychoactive compound in pakalolo, acquired from the black market or online dealers.

“This is a moonshine problem caused by uncontrolled illicit activity,” Haro said. “The real story here is that vaporization products purchased outside of a state-licensed dispensary are unregulated, illegal and potentially life-threatening.”

It is against the law to sell vaping cartridges that contain nicotine, tobacco or any other non-cannabis-derived product, including organic compounds known as terpenes. Dispensaries may only sell cartridges filled with cannabis, cannabis oils or cannabis extracts manufactured in-house, which is substantially more expensive.

“Our products are safe, undergo stringent lab testing and are effective,” said Brian Goldstein, CEO of Noa Botanicals. “We agree with the DOH that patient safety is most important and will continue to provide quality medicinal cannabis so patients can get the relief they need. Limiting the use of natural, lab-tested plant derived terpenes does not increase product or public safety, but instead decreases the available product options and increases costs that will eventually be passed on to patients.”

While the DOH’s ban on all third-party ingredients is limiting, it does “protect the public from potential harm,” said Claire Hill, spokeswoman for Pono Life Maui.

Health officials said they would “strictly enforce” the law and ensure future compliance with regular examination of ingredients and on-site inspections. Earlier this month the DOH urged local residents to stop vaping regardless of substance or source as they investigate a second possible case of serious lung illness. Nationwide, more than 1,600 cases of lung injuries and 34 deaths have been associated with electronic cigarettes in all states except Alaska.

“Every product dispensed in the state through a licensed dispensary is heavily scrutinized and must pass a very strict and robust set of testing standards including testing for pesticides such as myclobutanil, which has been found in several black-market vape products currently being investigated nationally,” said Jaclyn Moore, spokeswoman for Big Island Grown, adding that the ban has affected sales of distillate cartridges. “While we understand the importance of regulating in the interest of patient safety, the decision to not allow the use of lab-tested, naturally derived, externally-sourced terpenes ultimately increases the price for patients while minimizing the selection of products.”

Meanwhile, Aloha Green said it has removed and destroyed one line of products called Smooth Aloha, a value-­priced product created with a lower THC potency to reduce the cost of medicine for patients, said Aaron Whyne, the company’s patient outreach coordinator. The product contained terpenes found in cannabis but derived by licensed labs from other plants such as pine trees, he said.

“We have received no complaints from any patients since this line of product was introduced earlier this year as all ingredients are listed on our products and patients are made aware of any additives,” he said. “These terpenes are not the same as the artificial flavorings found in e-cigarette juice. These terpenes have not been identified as a potential cause for vape illness.”

The company said it hopes to bring back the line in the future when regulators determine the cause of the vaping illnesses.

Cure Oahu said it also is in compliance and acts “accordingly to every interpretation, guidance or request made by the department regardless of what it may be.”