Known cases of e-cigarette or vaping product use associated lung injury (EVALI) are proliferating around the country. Even Hawaii has been affected, with two new cases reported just last week. Understandably, many of the state’s 26,448 registered medical cannabis patients are deeply concerned.

But they needn’t be — as long as they are using pre-filled and sealed containers purchased directly from one of the state’s licensed medical cannabis dispensaries.

The islands’ medical cannabis program requires every product to pass laboratory testing using some of the nation’s most stringent standards for purity and safety. In fact Hawaii law, HRS §329D-10 (8) expressly forbids the use of additives in products intended for safe pulmonary administration:

“Pre-filled and sealed containers used to aerosolize and deliver cannabis orally … shall be filled with cannabis, cannabis oils, or cannabis extracts manufactured by the licensed dispensary; shall not contain nicotine, tobacco-related products, or any other non-cannabis-derived products; and shall be designed to be used with devices used to provide safe pulmonary administration of manufactured cannabis products.”

The U.S. Centers for Disease Control’s (CDC) principal deputy director, Anne Schuchat, cited additives such as vitamin E acetate, used in illicit THC-containing vaporizing products, and the increased availability of “do-it yourself” online videos for the growing number of lung illnesses. Based on the CDC’s October data, about 85% of those sickened reported using vaporizable THC products obtained from illegal sources.

The CDC has identified vitamin E acetate as a “chemical of concern” among those diagnosed with EVALI. Lab tests of lung fluid samples collected from 29 EVALI patients revealed vitamin E acetate in all of the samples. While it appears that vitamin E acetate is the primary culprit, there is insufficient evidence to rule out other chemicals still under investigation.

Rigorous state Department of Health (DOH) oversight ensures that Hawaii has a safe, effective and high-quality program designed to help those suffering from any of the 11 approved serious medical conditions.

However, these safety assurances do not apply to cannabis products obtained outside of state-regulated dispensaries.

Cannabis users are strongly advised to steer clear of any vaporizable product obtained from unregulated sources such as family, friends, online or retail stores, street dealers and anyone making THC-containing products at home. This includes vaporizing products that may appear to be professionally manufactured.

Please be clear: Illicit THC products intended for vaporization are potentially lethal.

Enforcement of existing drug laws is crucial when illicit activity threatens public health, but we all share responsiblity for protecting our community’s health, especially the health of our youth, by avoiding those who profit from illegal, black market activity without regard for the harm they cause others.