This has been a scary time for people who vape, and for the companies that make vaping products and equipment. Every day provides more information about what’s happened, and the potential reasons behind this increasingly deadly health crisis. We still don’t have all the answers, but we know more than we did. Here’s an update.

What we knew then:

In August, news emerged that some people who had vaped had developed serious respiratory ailments. It wasn’t clear at the time if they were vaping nicotine or cannabis cartridges (carts), or if the carts contained something else altogether, such as synthetic cannabis, AKA spice. It also wasn’t clear if these were legitimate carts purchased from licensed dispensaries that are required to have their products lab-tested, or if the carts were sourced from the illicit marketplace. In short, we didn’t know much.

We did know, per the Centers for Disease Control and Prevention (CDC), that more than 200 people across 22 states had severe “vaping-related” illnesses between June 28 and August 20. (We’ve since learned the first reported case occurred in April.)

Then the CDC revealed that someone in Illinois had died from vaping.

That was just over a month ago.

What we know now:

According to the latest report from the CDC released September 26, the incidences of vaping-related hospitalizations have skyrocketed to 805 and counting, spanning 46 states, the US Virgin Islands, and Canada.

As of this writing, officials have identified 12 people who have died from vape-related illnesses, in Oregon, Illinois, Indiana, Minnesota, Missouri, Florida, Georgia, Mississippi, and two in California and Kansas. The person who died in Oregon reportedly purchased THC carts from two licensed dispensaries. Those dispensaries and the products purchased have not been identified. Two-thirds of the reported cases involve 18- to 34-year-olds, with more than half under age 25. Three-quarters are male.

What’s causing it?

There’s still no definitive answer. Many—but not all—patients reportedly used both THC and nicotene products. Officials in some states have established a connection with an added thickening agent, vitamin E acetate. However, officials at the FDA and CDC say they can’t identify a sole cause and that vitamin E acetate has not been definitively found in all the samples.

Vitamin E acetate is reportedly a common additive to black-market THC carts, but isn’t thought to be widely used in legal carts. Or, at least, we hope not. In Oregon, although we test for THC cart potency, pesticides, and solvents, we don’t test for additives such as thickening/thinning agents. One Oregon facility, Pixis Labs, has recently developed a test to identify the presence of vitamin E acetate.

The OLCC has begun asking dispensaries to review their vape carts to determine if any “undisclosed agents” have been added by the manufacturer. As OLCC Executive Director Steve Marks told the Corvallis Gazette-Times, since those additives aren’t being tested for, it’s impossible know if they are being illegally added to retail carts unless the producers come clean. Unfortunately, that appears to be the extent of what the OLCC can do at the moment.

What’s the fallout?

So far, most of the action has been around nicotene products as opposed to THC cartridges. The FDA has launched a criminal investigation into cartridge producers, making clear they aren’t going after vapers.

Three New York companies that distribute vitamin E acetate have been subpoenaed, and New York and Michigan have banned the sale of flavored nicotene pods. Walmart and its subsidiary, Sam’s Club, will cease the sale of all e-cigarette products once their current stock is exhausted. At press time, federal prosecutors just opened a criminal investigation into popular e-cigarette company Juul. Expect further regulatory action, including banning and/or testing for dangerous additives such as vitamin E acetate, new labeling requirements, and the continued elimination of some products altogether.

Your panic level should dictate that choice. Insofar as there are risks with all activities, you can reduce yours by performing some due diligence. As I’ve written before, do not purchase cartridges from anywhere but a licensed dispensary. Reach out to the cart producer and ask what they use in their products. Some producers have already taken to social media to state that they never have and never will use vitamin E acetate in their products.

Lastly, you can always vape flower in a desktop unit or a portable vaporizer. None of the aforementioned dangers are associated with doing so.