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Dan Colucci’s cigarette habit started before he was a teenager. It was part of his ritual on the way to middle school, when he would pass by a local gas station in Bloomfield Hills, Michigan. “Packs of cigarettes were sitting loose,” he tells Rolling Stone. “So, I would just go grab a Coca-Cola, a pack of gum, and then I’d grab Vantage cigarettes and they’d sell them to me. I was 12. Back then they were like 95 cents. So, I started smoking basically from that point on.”

It would be more than 30 years and one failed attempt going cold turkey before Colucci — a band manager who’s worked with groups including Tantric and Saving Abel — would finally quit. Vaping enabled him to kick smokes for good; he hasn’t had a cigarette since 2016.

Vaping is a broad term, but generally refers to using an electronic device to heat a liquid to the point of vaporization, at which point the user inhales the aerosol. Usually, the liquid includes nicotine or THC (the intoxicating cannabinoid found in marijuana) but can also have CBD or even melatonin. Though the FDA hasn’t approved it as a smoking-cessation aid, vaping nicotine first became popular as a means to quit, and recent research has backed this up: A 2019 study compared vaping with other nicotine-replacement therapies, such as nicotine gum and patches, and found that those given e-cigarettes were nearly twice as successful at quitting cigarettes. (I myself used a nicotine vape to quit cigarettes seven years ago.) That study found that e-cigarette users also coughed less and had less phlegm; another found that switching from cigarettes to vaping improves blood-vessel function within one month, which could potentially reduce the risk of heart attacks and strokes. In the U.S. alone, more than 480,000 deaths annually are attributed to cigarette smoking, according to the CDC. While there hasn’t been definitive research on the amount of people worldwide who have quit smoking by vaping to date, a 2019 study published in scientific journal Addiction estimated that in 2017, between 50,000 to 70,000 smokers quit using vapes in England.

Yet, while promising studies emerged in 2019, so did disturbing stories of vaping-related lung illnesses. Toward the end of the summer, reports began to emerge from across the country of an illness inflicting people who vaped — one that caused shortness of breath, vomiting, fever, and difficulty breathing. In rare cases, it could even lead to death. The Centers for Disease Control began to refer to it as EVALI: E-cigarette, or Vaping, Product Use-Associated Lung Injury. For months, people struggled to make sense of what was happening; vaping hadn’t been around for enough time to know what the long-term effects were, but sudden illness? Risk of death? Vapes had seemed like the discreet, responsible alternative to smoking. How could so many people have gotten it so wrong?

In November, the CDC reported that there might be something in common in the vapes that had made people sick: the additive vitamin E acetate, found in some illicit-market THC vape products. In Michigan, where cannabis is legal for all adults, regulators banned the use of vitamin E acetate in THC vaping products, temporarily halting the products’ sale for mandatory testing. Regulators removed those containing vitamin E acetate from the market, and instances of the illness began to go down. According to the CDC’s final EVALI report in February, three people died in Michigan from vaping-related lung injuries. On February 21st, the Detroit Free Press reported that a fourth person had died.

But despite the CDC specifying the correlation between EVALI and black-market THC vapes, many began to conflate them with legal vapes, and moral panic seemingly continues to rise. That same fall, Michigan’s governor Gretchen Whitmer officially banned flavored nicotine vapes, despite no evidence that EVALI was connected to that product. Other states followed Michigan’s lead, which further fueled the public’s panic around vaping and its misperceptions of what caused EVALI in the first place.

Aside from EVALI, there are real concerns about how vaping affects the body. According to researchers at Johns Hopkins, vaping nicotine can raise blood pressure, and it’s also a contributing factor to asthma and COPD. “You’re exposing yourself to all kinds of chemicals that we don’t yet understand and that are probably not safe,” said Dr. Michael Joseph Blaha.

Even some who champion vaping were confused by the deluge of information. Colucci says he heard about the illnesses, but had no idea it was connected to black-market THC vape. “[I knew] there might be some illnesses associated with it but, I mean, smoking cigarettes — there’s everything from smoking cigarettes,” he says. “Is this probably as bad or maybe worse? Who knows? But smoking cigarettes, there’s also a million different things that can go wrong.”

For nicotine vape producers, the news that vaping-related illnesses were strongly linked to black-market THC products should’ve been a relief, but the public’s lack of awareness of the differences between the two had a negative impact.

“We’ve been going for nine years strong and not a single lung illness, and then all of a sudden this — it’s obviously not nicotine vaping,” says Dan Lawitzke, founder of Mister-E-Liquid, headquartered in Grand Rapids, Michigan. “We’ve seen all of these studies — the study out of the U.K. that cited the 95-percent reduced harm switching to a non-combustible e-cigarette. And it just doesn’t make any sense. So, without [initially] digging in and trying to find the cause, nicotine vaping just got attacked.”

One consequence was Michigan’s temporary emergency ban on flavored vapes last fall. A coalition of industry stakeholders going by Defend MI Rights — which included Mister-E-Liquid — helped fund a lawsuit against Michigan, which resulted in a preliminary injunction of the ban. In December, Governor Whitmer’s motion to reinstate the ban was denied by the Michigan Supreme Court.

Proponents and opponents of the ban agree that young people should not vape. Those supporting it claim flavored vapes entice youth, but vape advocates fear adults who use flavored vape to quit smoking would return to traditional cigarettes. “We never suggest people who don’t smoke to use our products,” says Lawitzke. “That’s the last thing we want.”

When vaping first entered the U.S. market around 2007, it was a bit like the Wild West: Little was known about it, and choices were limited. Now, new research, products, and standards have been set in place. Several manufacturers do extensive testing and are preparing for PMTA (the FDA’s Premarket Tobacco Product Application), which consumers can consider when choosing products. “You should feel better about buying from a manufacturer that is taking the time to do that,” says Lawitzke, who launched Mister-E-Liquid after he quit cigarettes using nicotine vape in 2010. His company is a founding member of the American E-Liquid Manufacturing Standards Association. Established in 2013, they created e-liquid manufacturing guidelines, “basically bringing it up to almost a pharmaceutical-grade standard,” he explains. Standards include testing, sanitary guidelines, and using 100 percent United States Pharmacopeia (USP) food-grade bases with no added artificial coloring or additives.

While nicotine vapemakers grappled with the public perception, legal-THC vape producers also dealt with the undue stigma of being wrongly associated with what was coming from the black market. Headquartered in Detroit, MidKnight XPress Oil Co. CEO Sam Kaoud and his son Issam, a chemical-engineering student who works in compliance and R&D at the company, say they believe the caregiver model contributed to black-market THC arriving on some Michigan shelves, further complicating the distinction between legal and black-market products. While it’s no longer legal in Michigan, the caregiver model allowed state medical-marijuana cardholders to grow a certain number of plants at home, while also growing plants for other individuals. A caregiver could sell whatever was unused medicinally — flower or processed cannabis, like vape oil — to a licensed processor. Since no testing was required, unregulated product flooded the state.

“The consumer, the patient buying them, would need to sign a sheet of paper saying that they knew these were created for the caregiver model and that they had not received the testing required,” MKX’s Issam says. Since then, the rules have changed, and caregivers are only allowed to sell bulk flower to other producers. “Once that all changed, they recalled everything in order to retest for vitamin E acetate. That’s when we found that many vapes that were taken in through the caregiver model did indeed have vitamin E acetate.”

MKX, which makes a variety of THC and CBD products, launched in 2017 with a concentrated form of cannabis oil often used medicinally called Rick Simpson Oil, which Sam says helped his father, who had brain cancer. “It was triple-passed, pure distillate,” Sam says. “We wanted to make sure our patients had the safest possible medication.”

Issam says that some unregulated black-market THC oil producers started using vitamin E acetate in early 2019, due to its consistency. “This was a new product to cut your vapes in order to make it look like you hadn’t added anything to it, and in reality you added something to it in order to save money,” Issam explains, noting that MKX never participated in the practice as the company feared it could be harmful. “It was the same consistency as the distillate that contained the THC. So many people used that as a cost-saving measure.”

The minimum legal age to purchase nicotine or THC vape in Michigan is 21. Still, young people — as Colucci did as a preteen with cigarettes, and like so many kids do with alcohol and narcotics — found a way to get it. In the summer of 2019, Daniel Ament was enjoying the days before his junior year in high school. The Grosse Pointe, Michigan, 17-year-old was athletic, running six to eight miles a day and swimming when he could. By the second day of school in September, he wasn’t feeling well and went to the doctor, but initially they didn’t find anything wrong. “The next day I couldn’t breathe,” Ament says. He went to the emergency room. “I literally blacked out for that entire, like, basically month and a half. And then I just woke up with a transplant.”

In October, Ament became the first recipient of a double-lung transplant due to what doctors attribute to vape-related lung injury. His harrowing story lent credence to those concerned about vape usage among youth. Ament tells Rolling Stone he started vaping when he was 16, though he says it took him a while to “give in” to vaping. “I was really, like, [the] straightedge kid.” But during his sophomore year, he suffered an injury that prevented him from playing sports. “Since I couldn’t run, it kinda took me down a different path. I’d be hanging out with more people, and I just kinda got into it then.”

At first, he just dabbled with vaping nicotine and occasionally THC. “But I found one in my car once that I kept for a few weeks,” he explains. “Most of my vaping was just with friends,” He says. “I didn’t want to get addicted to it, I was conscious about that.”

Then in September, he says, “I hadn’t vaped in a while, and I got really sick the second day of school, out of nowhere.”

He says doctors told him that his lung damage was from vaping, but which product actually caused his injury has not been officially determined. “We don’t know if it was from nicotine or THC. But I only smoked THC very rarely,” he explains, noting that his friends said it had come from the legal market. “I just had friends that knew ways to get them from dispensaries. But not everyone can be trusted, so maybe it could be.”

Even if it was from a dispensary, tainted THC vape with vitamin E acetate had made it to some shelves. As recently as March, Michigan’s Marijuana Regulatory Agency recalled THC vape cartridges found at three dispensaries in the state. Before the ban, when Ament was still vaping, the caregiver model could’ve been a means for black-market vape to hit licensed shops.

Ament launched the nonprofit Fight4Wellness to educate youth and young adults about the dangers of vaping and substance abuse. “Right now we’re mainly focusing on vaping and encouraging kids to learn happier, healthier lifestyles.” He has spoken at area schools, they’re working on a school toolkit, and he also personally advises parents who reach out about their kids. He had a slate of appearances scheduled for the spring. “But now because of the coronavirus, it will probably be in the fall,” he says. “The CDC and the FDA, they’ve asked me to be featured in PSAs.”

As for adults using vaping to quit smoking cigarettes, Ament acknowledges its use. “Since I don’t really know if it is healthy or not, I think it’s better than smoking ’cause the goal is to eventually quit, and the vaping cases have been way more rare than smoking [and] lung cancer,” he says. “So I’m glad that it’s out there to help people quit, because I think cigarettes are way worse than vaping. And I think they have been controlling the vape markets better, ’cause I haven’t really seen any new illnesses popping up from it.”

“One of my thoughts is maybe have it be a prescription thing to help quit,” he adds. “That may make quitting harder for adults, but it might stop kids from being able to get it so freely.”

Since Colucci quit smoking cigarettes in 2016, he’s encouraged friends to quit via vape. He says he started with one friend whom he successfully got to switch to vaping, and others followed suit. “It was, like, all at the same time period that everybody just quit,” he says, with the exception of a couple of holdouts, like his neighbor. “I’m going to try to get him to quit smoking by the end of summer,” he says. “I’d love to be able to do that.”

Colucci’s unsure what kind of health impact vaping might bring long-term, but he says vaping’s a better alternative. “I think it’s positive because I thought I was gonna die of smoking-related death. I’d rather had vaped at a younger age than smoked cigarettes at a younger age … it was just disgusting. And I can’t believe I smoked for so long.” He does not vape nearly as much as he smoked, either. As he sees it, the benefits of vaping to quit smoking are evident. “I don’t wake up with all that gunk in my mouth,” Colucci says. Plus, he is no longer “waking up feeling like shit. You don’t think about it, but you did. Like, smoking cigarettes, you’d wake up, put a cigarette in your mouth. Now, I feel so much better.”

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