Over 1,000 vape product users have been admitted to hospitals across the nation for respiratory complications — resulting in at least 18 deaths and the Center for Disease Control warning against vaping use. Outbreaks such as this are the inevitable consequence of current federal cannabis prohibitions that undermine state cannabis laws and ultimately undermine the development of an effective national program to stop adulterated and counterfeit products.

Indeed, reports indicate that the culprit behind this illness is likely adulterants found in illicit and counterfeit cannabis and e-cigarette vaporizing products.

A study in the New England Journal of Medicine reports that individuals suffering from the vaping illness, 83 percent vaped illegal-market THC products, and 17 percent vaped nicotine e-cigarette products of unknown origin. According to former FDA Commissioner Scott Gottlieb, the evidence “points to illegal products that are being cut with dangerous chemicals as a culprit” and vapes that use “oils as the emulsifying agent” or Vitamin E acetate are the problem.

This should surprise no one. Illicit procurers adulterating products and diluting their quality is nothing new. This was exactly what occurred during alcohol prohibition in the 1920s. Bootleggers making bathtub gin, or importing fine spirits consistently ignored the safety standards and purity standards we take for granted in alcohol today. This led to tens of thousands of hospitalizations and deaths because people were drinking adulterated moonshine, counterfeit or diluted “fine spirits,” and sometimes just isopropyl (wood) alcohol improperly labeled and mixed with food coloring. One cannot reasonably expect any difference between the standards of bootleg “extractors” and those of bootleg distillers. “Hot dog water” is the new bathtub gin.

It is true that three fatalities are possibly linked to cannabis vape products from legal dispensaries in Oregon and Delaware, according to Politico Pro Cannabis. However, a few outliers in nearly 1000 cases, where vaporizing products account for roughly half of the billions of times that millions of Americans use cannabis per year, highlights the need to isolate the cause and impose strict testing and purity standards with product recall, anti-counterfeiting, and track-and-trace abilities — features of a legal, not illicit, market.

Cannabis prohibition’s ill effects go beyond cavalier indifference to public safety; its effect on medical research has led to dubious medical claims, further muddying the waters. In June, a coroner in Louisiana made headlines for claiming to have recorded the first death by THC overdose. The conclusion was met with derision and skepticism from the medical community. Not only did the deceased have trace amounts of THC in her system and was admitted to the ER for a lung infection three weeks prior, but also no report has clarified whether her THC oil was tested for adulterants, or if it was obtained on the black market — which is likely, given that legally-dispensed cannabis was not actually available in the state until August.

This case may have been the first fatality of the vape-related illness outbreak. How will we ever know?

The federal prohibition in interstate trade in cannabis products must be ended swiftly to protect the millions of patients and adult-users across the United States. Prohibitionist policies both cripple the legal market of good and regulated actors, and ensure that the illicit market flourishes at its expense by cutting corners, adulterating products, and illegally shipping unsafe products across state lines. It decimates product recall and tracking abilities in the event of public health event such as this. The federal government must become a positive force in the lives of millions of cannabis consumers across the United States, and federally legalize and regulate cannabis now — before illicit products inflict more damage on unsuspecting consumers.

Randal John Meyer is the Executive Director of the Global Alliance for Cannabis Commerce (GACC) and former legislative counsel to a U.S. Senator. Jason Beck is the Vice President of the GACC and the owner of Alternative Herbal Health Services in West Hollywood; born with cerebral palsy, Mr. Beck is in the unique position of being a patient, specialist, advocate, and advisor in the fields of medicinal and adult-use of cannabis.