Care Planning to Minimize Cannabis Risks

During Prohibition, “Bathtub Gin” (a spirit made at home by amateurs) caused documented instances of sickness and death among American citizens. As cannabis legalization rolls-out across America, cannabis vaping concentrates manufactured for and sold on the black market exhibit a similar public health risk.

Over the past year, users of cannabis vaping products following national news and public health concerns may have lost their spark for legalization excitement. Since September 2019, CDC-reported cases of e-cigarette, or vaping, produced use-associated lung injury (EVALI) have declined. Still, EVALI should be concerning for those who prefer the discreet method of cannabis consumption vaping allows.

As of December 2019, the CDC pinpointed a manufacturing additive–Vitamin E Acetate–as the cause of the 2019 EVALI public health crisis. Vitamin E Acetate is detectable, and IT IS POSSIBLE for users of cannabis vaping products (e.g. THC, CBD, or other cannabinoid concentrates) TO AVOID the additive.

Here are things you should know to avoid potentially dangerous additives:

  • Only buy cannabis from state-licensed retailers. This applies to CBD, THC, and other cannabis-derived products. State-licensed stores (in CA) sell products that were Phase 3 tested, meaning the products were INTENSIVELY tested and determined safe for public use.
  • Never trust cannabis from black market retailers. Experts have described using today’s black-market cannabis as a game of Russian Roulette. Be extremely careful: There’s a significantly higher chance of exposure to pesticides, etc., when using today’s black market products than before. The belief is “clean” products are now cleaner and “dirty” products are now dirtier. (Note: Stay away from the Utah black market. This statement is relative to the time when it was made, but received uniform agreement by all panel experts during a lecture at the Emerald Cup, in Santa Rosa, CA.)
  • If you live in a black market state, USE ONLY FLOWER. The flower may still be dirty, but cannabis flowers, generally, do not have as many contaminants relative to vaping concentrates.
  • Avoid breath-activated vaping devices (vs. push-button activated). In these devices, an open channel connects the concentrate to the battery compartment. Current national research HAS NOT TESTED the safety vaping breath- or battery-activated devices. Private studies indicated cannabis concentrate can enter a breath-activated device’s battery compartment prior to atomization and inhalation. Also, the metal soldering inside breath-activated machines may also pose a contamination risk. Both device risks demonstrate a plausible mechanism of injury for which any cannabis user or patient must be aware.
  • Be wary of terpine additives. Your retailer should be able to confirm the safety of additives, like terpines, added to the products it sells. Terpines, natural to the cannabis plant, are added-in to vaping concentrates for flavoring or fragrance. Terpines are available on Amazon and Alibab, in unregulated form, however. For this reason it’s important to know the origins of what you consume.

A note on nicotine vaping: Unlike cannabis concentrates, nicotine concentrates are primarily additive based. The nicotine industry does not test its products for safety and quality control the way the cannabis industry does. Thus, comparing the risks of vaping nicotine to the risks of vaping cannabis does not produce an apples-to-apples comparative analysis. The nicotine industry is behind the cannabis industry in terms of safety and quality control.

If you plan to vape a cannabis concentrate, please plan safely and according to known safety risks. Improving quality of life with less pain, depression, PTSD, etc., should not shorten your life. Be smart and buy from state-licensed facilities. If you do not live in state with legalized cannabis, avoid concentrates and choose flowers. As a healthcare worker, we don’t want you to smoke anything (including flowers). However, there is not one (yet) research article indicating a correlation between cannabis smoke and cancer or other chronic disease.

Centers for Disease Control, 2019. Outbreak of lung injury associate with the use of E-cigarette, or vaping, products. Accessed 12/23/19, from

Colorado Green Lab. Vape Pen Vivisection. Accessed 12/24/19, from:

Dixon, A., Rose, M., Sisley, S. Vaping: What are the facts and where do we go from here? Lecture at The Emerald Cup, Santa Rosa, CA. 12/14/19.

Downs, D., Howard, D., Barcott, B. Journey of a tainted vape cartridge: From China’s labs to your lungs, September 24, 2019. Accessed 12/24/19, from:


James Shannon

Nursing Leader | Quality Leader | Healthcare Attorney

View all posts by James Shannon

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