THC CARTRIDGES IN MIDDLE TENNESSEE
Kara Aguilar
October 1,2019
NASHVILLE, Tenn.- Alex is a Nashville native who has been an active marijuana smoker since he was 14 years old.
For the past five years, Alex has veered away from the traditional methods of smoking and started using marijuana vape cartridges, or as he refers to them as "carts".
Carts are small, pre-filled attachments to vape pens containing cannabis concentrates such as Tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana, or cannabidiol (CBD), a non-psychoactive ingredient. When used, the cannabis oil is heated at a low temperature to produce vapor, which creates very little odor.
Alex, who asked to be referred to only by his first name, was drawn to using vape cartridges because of the public scrutiny that users receive when smoking out of pipe or a joint. In appearance, vape cartridges look like regular electronic cigarettes that contain nicotine.
“When you live in an area that is very old fashioned, if someone sees you smoking a joint on Broadway, you will probably get arrested,” said Alex regarding vaping in downtown Nashville. “But if you are hitting a pen on Broadway, you will probably be fine, like no one will say anything.”
In states like Tennessee, it is still illegal for smoke shops to sell products containing THC, which has users exploring other means of obtaining vape cartridges.
For Alex, he says that he gets his supply from people whom he believes are “reputable sources” who claim to have gotten the cartridges from dispensaries in states where they are legal to purchase.
On average, Alex says that a single cartridge containing a gram of pure concentrated cannabis oil can be sold for $40. In some cases, he says that users are paying that same price for cartridges that are only half a gram.
Alex is just one of many young adults drifting away from old school methods of smoking marijuana for electronic THC cartridges.
In Colorado, the number of marijuana concentrates sold from 2017 to 2018 skyrocketed by nearly 80 percent, according to the state’s Department of Revenue. It is predicted that the sale of cannabis concentrates, driven by vaping products, will hit $8.4 billion by 2022.
The Outbreak
Recently, the nation has seen an outbreak of young adults suffering from lung injuries associated with electronic cigarettes and vaping products. According to the U.S. Center for Disease Control, 1,080 cases have been reported from 48 states and the U.S. Virgin Islands between August and October. Those cases include 18 deaths in 15 states.
Health officials are still unaware of the source of the outbreak. The latest report released by the CDC suggests products containing THC played a role in these cases. The CDC said that about 77 percent of patients reported using THC-containing products and 36 percent reported using these products exclusively.
Dr. Tufik Assad, a Community Pulmonologist at Williamson County Medical Center in Franklin, has treated six out of the 36 cases reported by the Tennessee Department of Health.
The majority of his patients are young adults, the youngest being 19 years old and the oldest being in his/her mid-30’s. Patients have reported having respiratory symptoms, including chest pains, cough, and shortness of breath, accompanied by gastrointestinal symptoms ranging from nausea and vomiting to diarrhea and bloating.
“The health risks of [vaping] have always been unknown. But what's happened over the past couple of months has been far more prevalent than what has happened in previous times. So, something seems different. Something certainly is different compared to electronic cigarette usage years ago,” Assad said.
Electronic vaporizing products were introduced into the U.S. in 2007. Until now, there haven’t been any cases of illnesses associated with using these products.
“I would predict that something recently has changed in the chemicals or agents used, like solvents or chemicals added to the electronic cigarettes or liquids. Something has been added that is a contaminant to the lungs,” Assad said.
Some early reports from the CDC speculate that a Vitamin E additive could be the possible cause. While Vitamin E can be healthy when applied to the skin, inhalation of the product can be harmful. According to Dr. Assad, once the oil is vaporized into a liquid form and enters the body, it almost re-solidifies back into its original state, which he describes as forming a sort of film in the lungs.
“One very peculiar thing about this is that it involves all of the lungs but it spares the very edge of the lung, for whatever reason. That is not uncommon in inhalation lung injuries. And that has been consistent at least in all of the cases that I have seen and most of the cases that I have seen reported,” he added.
Across the nation, most patients have reported consuming vaping products containing THC. Of the six cases that Assad has seen, all of his patients admitted to using only THC products or both THC and nicotine electronic cigarettes.
“I think there is something about the THC supply chain that is more affected than the nicotine supply chain,” said Assad. “There might be something that is being added in the process to these vaping liquids that is going to be found to be a contaminant, that is going to be Vitamin E or some other solvent.”
Assad says that he believes the nicotine e-cigarette market is more commonly regulated and managed by companies, such as the commonly used brand Juul, than those that are manufacturing illicit THC products.
“So what is happening now is almost certainly going to be identified to be some containment in the process of manufacture or tinkering or sales or whatever,” Assad said. “It is somewhere in the supply chain, something is added or changed that has led to an inhalation contaminant. I think eventually that will be identified. I think that eventually these cases will dissipate.”
The CDC has partnered with the Food and Drug Administration to analyze over 300 samples submitted by multiple states to try and identify any compound that could be linked to these illnesses.
There is no data at this point linking THC itself or ingredients associated with THC cartridges, such as cutting agents or diluents, to the outbreak. Officials are urging users to refrain from using e-cigarette or vaping products, particularly those containing THC.
The Market
The market for underground THC vaping products has been steadily rising to meet the growing demand of consumers across the nation. This is especially true in states where marijuana is still illegal.
On social media sites like Instagram, products such as cannabis oils, vaping devices and packaging materials are offered by users without having to adhere to government regulations.
Empty cartridges and tools to create cannabis vaping products can also be found on Amazon. Consumers can purchase this equipment in large quantities for extremely low prices. Some of these products can be shipped in less than two days using an Amazon Prime account.
A Nashville resident, who asked only to be referred to as "Pat", started manufacturing his own THC cartridges from the end of 2018 to earlier this year.
Pat says that he first got the idea when he was talking with a group of friends about how easy it was to recreate the manufacturing process at home. He grew skeptical of the legitimacy of some of the cartridges purchased on the streets and the amount of THC that the brands were claiming to contain.
“I trust myself more than I trust, you know, some random source. They could tell me whatever they want,” Pat said. “I just felt like it was safer, in my opinion, to make them rather than to buy them, and obviously it was cheaper.”
He said that all the information he needed was openly available online. One of the websites that he found explained the process as five easy steps that can be done from home.
“I looked up everything on the internet. Like, that is where I found the ingredients and how I found out really how easy it was to make them,” Pat said. “It really was literally like, okay I'm going to put it in this dish and I'm going to put it in the oven and then I'm going to go sit on my couch for ten minutes and wait for the buzzer. I mean it was literally like making banana bread.”
For Pat, his focus was on making cartridges that were organically based. He said that he was able to find and replicate the process online used by anyone making them in states that allow medicinal use of THC.
“For me personally, I felt like it was kind of cool because I was always good at science and I felt kind of cool doing it, to be honest,” Pat said.“I'm just like, ‘damn,’ I was really, like, putting ingredients together and combining them to where the molecules would bind together and, like, make a vapable product. It's kind of like a science experiment in my head.”
He said that one gram of concentrated THC was enough to fill 10 cartridges. While most of his products were made for personal use, he said he was able to sell two or three to a few friends from time to time. He would charge them $30 to $40 dollars a cartridge as a way of making back some of the costs it took to produce.
“I would rather them, or I would feel comfortable, knowing that they are smoking a pen that, like, I know where it is coming from - I know everything that is in it,” he said. Later he added, “I'm not going to put anything in someone else’s body that I'm not going to put into mine, so I wasn't, like, doing it for profit.”
After three months, Pat decided to quit making his own his own THC cartridges. Today, as the number of lung injury cases continues to rise, he says that he no longer wants to have any involvement with the vaping market.
“Even if there are good people out there making them, there are still going to be negative people out there making them that it floods the market of, like, negative people doing negative things, putting negative things in there for profit. So even the people that are doing it in a good and safe way, you still have a bad [reputation] or bad name if you are doing it,” he said somberly.
Even though Pat has removed himself from the market, other manufactures are still in business to produce and sell illicit THC vaporizers. Many of them are using cutting agents and additives that could be dangerous for human consumption.
A recent study published by the CDC found that most patients in Illinois and Wisconsin reported using illicit pre-filled THC products purchased off the streets or through a friend.
Among several brands identified, a high percentage of patients reported using products from “Dank Vapes”. Dank Vapes operates through a verified Instagram account and is not registered with any regulation association.
Government Action
Multiple state and federal government officials started speaking out about vaping after media reports on the rising epidemic grabbed national attention.
Michigan became the first state to completely ban flavored e-cigarettes on Sept. 4. A couple of days later, President Donald Trump spoke out on the subject, calling for a federal ban on the sale of all non-tobacco flavored e-cigarettes.
California Gov. Gavin Newsom recently issued an executive order to crackdown on the sale of counterfeit vaping products, which is now three times the size of the state’s legalized market.
Tennessee state lawmakers have remained relatively quiet on the subject as the proposal to legalize and regulate medical marijuana in the state sits quietly waiting. The bill was abandoned in April due to lack of support.
The proposal would have allowed people with severe illnesses to legally purchase marijuana products in a variety of ways, including edibles, ointments and oils. Traditional methods of smoking would have been forbidden except for vaporizing products, which was not considered to be smoking.
Sen. Steve Dickerson, a longtime proponent for medical marijuana, plans to reintroduce the bill in 2020. In the wake of this outbreak regarding vaping cartages containing THC, the senator might face some challenges in drumming up support.
“One of the things is that the substances that they have sold as THC is black market counterfeit stuff and is not even THC,” said Dickerson. “It’s very early and I don't know what impact it might have. I don't think there will be much detrimental impact on my argument for medicinal [marijuana],” Dickerson said.
When asked about the role that legislators should take as the number of cases reported in Tennessee continue to rise, he thought it was the responsibility of local authorities.
“I think what needs to be done is law enforcement authorities need to figure out what is going on with these black market [cartridges],” Dickerson said.
The Nashville Police Department said that several illegal cartridges have been seized, but that there has not been a full-scale investigation into black market distribution.
Early efforts by lawmakers to protect citizens from vaping illnesses have been mainly centered around nicotine-based e-cigarettes. As health officials continue releasing more information, it is possible that more legislative action might be done regarding black market products containing THC.
Moving Forward
For regular users like Alex, the convenience of vape cartridges outweighs the risks that these devices might have.
Alex said that as long as he has a trustworthy source, he doesn’t think he will be affected by the outbreak. He also claims to have learned how to identify bootlegged cartridges over the years.
“You can kind of tell by the color, the smell, and the consistency of what you are looking at and it really does take a trained eye and that is something that you have to see for yourself,” Alex said.
He says that people should do their research and learn how to spot counterfeits before purchasing cartridges from just anyone off the street or online.
“Just be super cautious if you are using any type of cart,” he said with a brief hit of his vape. “Just be careful and know your stuff.”