In 2019, the term cartdemic emerged to describe the outbreak of lung injuries caused by counterfeit tetrahydrocannabinol (THC) vape cartridges, more popularly known as carts. Many of these counterfeit carts contain dangerous chemical additives.
THC vapes gained traction due to several key factors, particularly the increase in demand for portable, discreet and potent cannabis products. However, convenience for consumers has come with the risk of encountering harmful counterfeit products. Black market THC vapes have been easily accessible since 2019, often cheaper and available without the regulatory restrictions of the legal cannabis industry, like age verification.
Counterfeit THC vape manufacturers frequently use harmful and cheap fillers like vitamin E acetate to mimic the look of pure THC oil. Vitamin E acetate is harmless when consumed orally, but when vaped, it causes severe lung damage and can even be deadly.
As of Feb. 18, 2020, THC cartridges, most of which were illicit, have caused over 2,800 cases of E-cigarette or vaping product use-associated lung injury (EVALI). According to the Centers for Disease Control and Prevention (CDC), these cases resulted in 68 deaths between 2019 and 2020. The majority of victims were less than 25 years old, and 15% of them were under 18.
The use of butane hash oil (BHO) in some THC concentrates introduces additional risks. BHO is used as a liquid solvent to extract cannabinoids such as THC, Cannabidiol (CBD) and terpenes. Although BHO is removed after the extraction process in the making of THC vapes, remaining traces can be found and can lead to lung injury.
A 2019 abstract written by Ryan Anderson and Katie Zechar featured an 18-year-old girl who came into a hospital’s emergency department complaining of persistent shortness of breath. The abstract’s authors linked her severe respiratory issues to BHO inhalation, and they diagnosed her with severe lung tissue inflammation. “This stuff [with the solvents] is the absolute worst for you,” said Bella, who works at Element 7 Dispensary in San Francisco, in an interview with The Urban Legend.
“I did have a lot more [of] a hard time breathing. And there was a really big build-up of mucus that I had,” an anonymous consumer of counterfeit carts said in an interview with The Urban Legend. “I think I had bronchitis. That is what it felt like.”
As the legal cannabis industry has expanded, many dispensaries rely on third-party manufacturers for their supply. But as both the legal and illicit THC markets grow, the influx in products has made it easier for dangerous additives to slip through the cracks, putting many consumers at risk.
In California, legal cannabis products must follow a track-and-trace system, which tracks every product from when it is planted to when it is sold. This system includes testing protocols put in place by the California Department of Cannabis Control (CDCC).
According to the CDCC, testing involves collecting uniform samples of dried cannabis flowers in various forms and combining them with a solvent for cannabinoid extraction. This extract is then analyzed by separating and quantifying cannabinoids such as THC and CBD.
All California labs are required to follow these procedural practices. Yet despite these rigorous testing methods, unsafe products still make it into dispensaries, sometimes because of falsified lab results. Emma is a dispensary manager at Mission Organics in San Francisco. “I’ve heard of stories where [counterfeit manufacturers] pay the lab to turn a blind eye or lower the numbers so it fits within safe levels. … It’s hard for us to gauge if those numbers are truthful or if they’ve been altered,” she said in an interview with The Urban Legend.
Legal and regulatory efforts have struggled to keep up with the volume of counterfeit products flooding the market. One reason for this is the difficulty of tracking illicit manufacturers and dealers. The CDCC continues to work with the California Department of Public Health to implement stricter testing regulations for legal cannabis products. Still, unlicensed dispensaries and smoke shops remain a significant problem. They often illegally sell cheaper, untaxed products that do not undergo the same rigorous testing protocols as the products for sale at licensed dispensaries.
Licensed dispensaries must provide Cannabis Certificates of Analysis (CoAs) to customers in the form of scannable QR codes on the product or upon request. These CoAs are meant to certify their products as legitimate. Counterfeit THC cartridges, on the other hand, are sold without such assurances.
During the rise of THC vapes, many brands selling new products sent dispensaries samples of their carts as a promotion. However, many of these products were unsafe for consumers. “There was just a lot of distrust. … We were getting things that were supposedly reputable, but then there were times when we would try something and they would literally catch fire. We were really the first people to be in that vape era, and it was hard to know what was safe,” Bella said.
The black market’s lack of regulatory standards makes it easy for illicit manufacturers to produce and sell large quantities of cheap, counterfeit THC vapes. “If [a black market] company is running an operation where they are [selling a] product that is not tested for or not part of the track-and-trace system, that’s where the issue starts,” Emma said.
Third-party manufacturers are in a highly profitable and legally risky industry. Honeycut Labs was a company that sold a concentrate made of vitamin E acetate, which is used as a diluting agent in counterfeit THC vapes. Honeycut Labs could buy a liter of raw vitamin E acetate for $8.50 to $42.60 before repackaging it and selling it to black-market cart manufacturers for $1,100 to $1,300 per liter. Such exchanges resulted in a 1,300% profit margin for Honeycut and an average $5000 profit for illicit dealers. Honeycut Labs’ vitamin E acetate products allowed illicit dealers to stretch their supply of pure THC oil, increase profits and pass off counterfeit cartridges as legitimate.
The emergence of delta-8 THC — a hemp-derived compound that mimics the effects of cannabis but occupies a gray area in many state regulations — has further complications. In states where delta-9 THC, the traditional cannabis compound remains illegal, manufacturers can produce and distribute delta-8 THC products, creating an opening for the illicit market.
In an interview with The Urban Legend, UCSF Professor Pamela Ling, M.D., M.P.H., said, “Delta-8 THC is another cannabinoid that has psychoactive properties, but it is typically in low levels in the grown plant. It can be extracted and synthesized from hemp products, so many of the hemp-derived products have Delta-8 THC. These products are not regulated and they are not safe.”
Bella mentioned that even regulated THC vapes with CoAs have long-term health impacts, many of which are unknown due to the newness of vaping. “[Regulated THC vapes are] not necessarily counterfeit, but [they] still … contain those chemicals in [them]. It’s just not as much,” she said. “It’s just good to know what you’re smoking and what’s in the product, like with the oils and vapes and stuff. I don’t even mess around with it too much. It is regulated, but there’s still a danger that comes with it.”