Marijuana advocates are seizing on the recent outbreak of vaping illnesses to renew calls for clear federal rules on cannabis.

Federal health officials have pointed to black market THC products as a likely culprit of a mysterious vaping illness that has sickened more than 2,000 people across the country and caused at least 39 deaths.

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Advocates argue federal marijuana regulation, including changing rules to allow more and better research, will make people safer.

“The black market can only be addressed by a viable legal market that’s regulated and can promise safety and security for consumers,” said Terry Holt, spokesman for the National Cannabis Roundtable.

According to the latest update from the Centers for Disease Control and Prevention (CDC), products containing THC, particularly from “informal sources” such as friends, family or in-person or online dealers, are linked to most of the cases and play a major role in the outbreak.

On Friday, CDC officials homed in on an e-cigarette cutting agent called vitamin E acetate. According to experts, vitamin E has been used in unregulated, illegal vaping products to dilute THC oil in order to maximize profits.

The CDC said vitamin E acetate was a “very strong culprit” for potentially causing the vaping-related injuries, but officials emphasized there could be other causes as well.

Anne Schuchat, principal deputy director of the CDC, said while most of the illnesses have been linked to illicit THC vapes, the agency can’t rule out any “infiltration” of tainted products into state-licensed marijuana dispensaries.

Marijuana is illegal at the federal level, so companies are left to navigate a patchwork of state laws for their own marketplaces. There are 11 states that have legalized marijuana for recreational use, and 33 that allow medical marijuana.

“States that have dispensaries set their own regulatory measures” in terms of documentation and ingredient testing, Schuchat said, which makes it difficult for the federal government to track them.

At least one death has reportedly been linked to oil bought legally at a dispensary in Oregon, and while Schuchat said there is anecdotal evidence about patients who bought vaping products exclusively from legal dispensaries, there are still many unknown factors.

“The data so far point to a much greater risk associated with THC-containing products from informal sources than licensed dispensaries,” Schuchat said, but added, “I don’t think we know enough yet to completely take dispensaries out of the question.”

Colton Grace, spokesman for the anti-legalization group Smart Approaches to Marijuana, said the Oregon death shows it’s not just a black-and-white issue.

“By pushing the line that legal products are safe we’ll put more people in danger,” Grace said. All vaping products should be banned until researchers figure out the main cause of the illnesses, he added.

“The answer is not regulate and test. Some states already are, and those products are injuring and killing people,” Grace said. “Use [the Food and Drug Administration’s] authorization to get these products off the shelves.”

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Holt said the government needs to take action, whether that involves better oversight of state laws or stepping in to regulate cannabis at the federal level.

“It’s a growing conclusion that whatever inequities, unsafe practices there are in the illicit market, the sunshine of being out in the open would do wonders to clean up the industry,” Holt said.

Some states that have already legalized marijuana are taking action in an attempt to keep the public safe from the vaping illness.

Massachusetts recently began requiring that manufacturers of vaporizer cartridges, marijuana extracts and concentrates publish a list of all ingredients and chemicals.

Massachusetts Gov. Charlie Baker (R) also instituted a statewide ban on all vaping products — including marijuana. A state judge subsequently ruled the marijuana portion of the ban was not enforceable, but that relief may be short-lived due to ongoing legal challenges and future regulation from the state’s marijuana regulators.

In Colorado, officials are nearing a ban on certain additives, including vitamin E acetate. The state is also exploring labeling changes to give consumers more specific information.

At the federal level, marijuana is a Schedule I controlled substance, which means it is classified in the same category as heroin and LSD. Advocates argue the restrictions make it difficult to study the safety of cannabis clinically, and even more difficult to regulate it.

The National Cannabis Industry Association has been advocating for months that the vaping illnesses are a prime example of why marijuana needs to be rescheduled and better regulated.

“The current patchwork of state regulations highlights the need for uniformity. And uniformity comes with descheduling and federal regulation,” the group wrote in an October letter to House Speaker Nancy Pelosi Nancy PelosiDemocratic senator to party: 'A little message discipline wouldn't kill us' Overnight Health Care: New wave of COVID-19 cases builds in US | Florida to lift all coronavirus restrictions on restaurants, bars | Trump stirs questions with 0 drug coupon plan Overnight Defense: Appeals court revives House lawsuit against military funding for border wall | Dems push for limits on transferring military gear to police | Lawmakers ask for IG probe into Pentagon's use of COVID-19 funds MORE (D-Calif.) and Minority Leader Kevin McCarthy Kevin Owen McCarthyHouse to vote on resolution affirming peaceful transition of power Ginsburg becomes the first woman to lie in state in the Capitol McCarthy says there will be a peaceful transition if Biden wins MORE (R-Calif.).

“If it is confirmed that Americans are being hurt because of unregulated, illicit market cannabis vape products, it is yet another reason for real, comprehensive federal cannabis reform that will allow the regulated, tested cannabis industry to displace illicit market actors,” it added.