to be cut that much." some cannabis laboratories began making arrangements in september 2019 to provide testing services for vitamin e. regulations in legal markets for cannabis use allow the use of many additives such as tocopherols (various forms of vitamin e). however, regulators may be considering banning such substances in the near future, as of september 2019. as of december 2019, washington state has now banned vape products containing vitamin e acetate, thought to be linked to illness. although the substance is not banned in the united states and has not been officially declared as a deadly substance, many states are making advances to ban the use of the chemical in vape products. states like massachusetts are considering a ban on flavored tobacco and vape products, and in new york, manhattan is expected to become the largest city to ban all vaping flavors except tobacco. other states that have already banned the use of vitamin e acetate in vape products include colorado and ohio. legal proceedings subpoenas in september 2019, new york governor andrew cuomo instructed the state health department to issue subpoenas against three sellers of thickening agents used in illicit vaping products. the subpoenas are being served against honey cut labs in santa monica, california, for its honey cut product; floraplex terpenes in ypsilanti, michigan, for its uber thick product; and mass terpenes in amherst, massachusetts, for its product. all three firms sell a product used as a thickener in vape liquids. the thickeners from all three firms were found to contain mostly vitamin e acetate, according to test results from the wadsworth center. criminal cases on 5 september 2019, tyler huffhines and jacob huffhines were arrested. search warrants were served on a house at their place of residence and at a leased condominium. in september 2019, an investigation in kenosha county, wisconsin, is underway to determine whether a major operation ran by the huffhines brothers for purportedly making illicit thc vape cartridges, which were packed in containers to resemble candy and were thought to have been marketed to youth, could be related to a series of vaping-induced lung illness and deaths in the us. the purportedly candy-themed containers used names such as sour patch. in january 2018, tyler huffhines purportedly began the operation. the vape cartridges purportedly contained as high as 1,000 milligrams of thc, when the packaging stated it was just 5 milligrams. roughly $1.5 million worth of thc products were seized during the raid. 57 mason jars containing thc oil were also seized during the raid. each jar was worth about $6,000. an initial appearance in kenosha county court was held for both brothers on 16 september 2019. tyler huffhines is facing multiple drug-related charges including possession with intent to deliver thc. jacob huffhines is facing charges including being a felon in possession of a firearm and possession of thc. bond for tyler huffhines was set $500,000. bond for jacob huffhines was set at $50,000. both are scheduled to return to court on 26 september 2019. the huffhines brothers pleaded not guilty on 23 october 2019. courtney huffhines, the mother of jacob and tyler huffhines, was charged with assisting her sons run the illegal thc vape operation. a woman was arrested in connection with the thc vape operation. on 3 october 2019, hannah curty was charged with making thc, as a party to an offense against the law. she is scheduled to return to court on 11 october 2019. courtney huffhines and hannah curty were in court on 11 october 2019. both women are due to return to court on 23 october 2019. courtney huffhines and hannah curty pleaded not guilty on 23 october 2019. on 17 october 2019, 22-year-old jordan lynam was charged with making thc vape cartridges in relation to the huffhines's purportedly illicit vaping operation. daniel graumenz, wesley webb, and tarail king are facing charges in relation to the illicit vaping operation. civil lawsuits on 23 september 2019, a product liability lawsuit, charles wilcoxson v. canna brand solutions llc et al., was filed in superior court of pierce county, washington, against makers of thc vape cartridges. wilcoxson, a peace officer, had used thc vape products between january 2018 and september 2019. he bought cannabis products that included conscious cannabis, rainbows aloft, leafwerx, mfused, and jane's garden, and a canna brand solutions vaporizer, all of which were cited as defendants. the plaintiff was hospitalized for three days in september 2019 with wheezing and lipoid pneumonia as a result of his vaping, according to the complaint. in september 2019, 35-year-old erin gilbert from virgin islands filed a lawsuit against just cbd in a broward county, florida court, contending that her sickness was the result of a cbd vape oil containing mango flavor that she had purchased from a merchant in saint croix. after just a few days of using the vape oil, she had severe respiratory problems, multiple organ failure, and deficient supply of oxygen, resulting in necrosis of her legs, both of which had to be amputated. in may 2019, a 21-year-old was hospitalized for more than two weeks due to fluid in his lungs and was in a medically induced coma for 8 days. he had purportedly developed an addiction to juul mint pods, which he had been using since age 19. in october, the patient sued juul, complaining the company did not disclose the dangers of its pod system and deceptively advertised its products as being safer than combustible cigarettes. the suit also claimed juul aimed to intentionally entice underage individuals and young adults with their product, as well as individuals who had never been smokers in the firm place. in september 2019, a lawsuit was brought on behalf of an 18-year-old from illinois who had been hospitalized with lung damage from vaping. the plaintiff charged juul with targeting teens with false marketing of a dangerous product, and a gas station for allowing him to buy vaping products as a minor. on 29 october 2019, the los angeles unified school district, the second largest district in the nation filed a class action suit against juul for creating an epidemic of youth vaping that impedes student learning and endangers the health and safety of more than 600,000 students in the los angeles school district. as of january 2020, a total of 10 california school districts have filed a lawsuit against juul labs, inc. the suit seeks injunctive relief and abatement remedy to fight against the vaping epidemic in california school districts. responses e-cigarette industry the e-cigarette industry is placing the blame on illicit vaping liquids for the lung injuries. "each day of this crisis brings more evidence that street vapes containing thc or other illegal drugs are responsible for these illnesses, not nicotine vaping products," said gregory conley of the american vaping association, in august 2019. "like any health-related events reportedly associated with the use of vapor products, we are monitoring these reports," juul labs stated to reuters in august 2019. the company also stated that some news agencies report that several cases of lung illness are associated with vaping thc, found in cannabis, "a schedule 1 controlled substance that we do not sell." however recent research using commercially sourced juul nicotine vape products has documented harms from these devices. a february 2022 research article on vape aerosol from juul products showed "profound pathological changes to upper airway, lung tissue architecture, and cellular structure," of mice exposed for as little as 9 weeks. "this vaping-induced pulmonary injury model demonstrates mechanistic underpinnings of vaping-related pathologic injury." < united states the cdc recommends that people should not use e-cigarette, or vaping, products that contain thc, particularly from informal sources like friends, or family, or in-person or online dealers. until the relationship of vitamin e acetate and lung health is better understood, vitamin e acetate should not be added to e-cigarette, or vaping, products. in addition, people should not add any substance to e-cigarette or vaping products that are not intended by the manufacturer, including products purchased through retail establishments. cdc also recommends that people should not modify or add any substances such as vitamin e acetate to e-cigarette, or vaping, products that are not intended by the manufacturer, including products purchased through retail establishments. according to the cdc, if you are an adult using e-cigarettes, or vaping, products, to quit smoking, do not return to smoking cigarettes. adults addicted to nicotine using e-cigarettes should weigh all risks and benefits, and consider utilizing fda-approved nicotine replacement therapies. the us fda considers it prudent to avoid inhaling vitamin e acetate. on 6 september 2019, the us fda stated that because consumers cannot be sure whether any thc vaping products may contain vitamin e acetate, consumers are urged to avoid buying vaping products on the street, and to refrain from using thc oil or modifying/adding any substances to products purchased in stores. on 4 october 2019, the us fda strengthened its warning to consumers to stop using vaping products containing thc amid more than 1,000 reports of lung injuries—including some resulting in deaths—following the use of vaping products. "the legal vapes have been actively regulated by fda since aug 2017. fda has conducted thousands of inspections of manufacturers and vape stores, published manufacturing guidance, sought product removals etc. these tragedies point to illegal vapes and thc," former fda commissioner scott gottlieb tweeted in august 2019. during an interviewed on cnbc's squawk box on 9 september 2019, gottlieb said that "the current belief is the illnesses are linked to illegal vapes containing vitamin e oil." he also stated that cannabis products in the us should be regulated. "the e-cigarette-related lung illnesses currently sweeping across the country reaffirm our belief that the use of e-cigarettes and vaping is an urgent public health epidemic that must be addressed. we must not stand by while e-cigarettes continue to go unregulated. we urge the u.s. food and drug administration (fda) to speed up the regulation of e-cigarettes and remove all unregulated products from the market. we also call on the fda to immediately ban flavors, as well as marketing practices, that enhance the appeal of e-cigarette products to youth," patrice a. harris, the president of the american medical association, stated on 9 september 2019. on 19 november 2019, the american medical association urged for a complete ban on all types of vaping products that are not approved by the us fda as quitting smoking aids. various states have banned vitamin e acetate in vaping products, including colorado, ohio, and washington. the governor of massachusetts declared a public health emergency on 24 september 2019, and ordered a 4-month moratorium on the sale of all vaping products, both for nicotine and thc. after courts determined it had sole jurisdiction over thc products, the massachusetts cannabis control commission quarantine all thc vape products until they could be screened for vitamin e acetate and other chemicals. a massachusetts testing lab offering tests to consumers found vitamin e acetate was widespread in unlicensed products but not in licensed products. the nicotine vaping ban was also challenged and ended early, but prompted the state legislature to ban flavored nicotine products to reduce underage vaping, among other new measures. the federal government has been criticized for instituting bans on flavored products rather than passing caps on nicotine concentrations and establishing accountability measures for negligent marketing. canada health canada, the responsible government agency, responded to the us cases of potentially deadly lung illness by issuing a warning on 4 september 2019. they advise that canadians consider not using vaping products, monitor for symptoms, get a medical attention quickly if they have concerns, tell their doctor if and what they vape or have vaped, avoid the illegal and unregulated markets, avoid modifying vaping products, report adverse reactions, and monitor their advisory for updates. they also stated for those who are vaping to watch for symptoms such as cough, shortness of breath, or chest pain. on 11 october 2019, chief public health officer of canada recommended to canadians to consider holding back from vaping. health canada started a $766,000 advertisement campaign to curb underage vaping in part in response to the us and canadian outbreak. europe "what little we know of recent reports from the u.s. is that the devices used appear to be linked to 'home brews' of