The recent outbreak of vaping illnesses is the result of letting the black market decide how marijuana should be regulated and sold.

To prove how overwhelmingly positive cannabis can be as a wellness supplement, medicinal force, and recreational pastime, advocates and stoners alike will often reference a simple fact — you can’t overdose on cannabis. Unlike opioids, alcohol, and cigarettes, marijuana can’t kill you. Other contrarian-minded folk would take it one step further: If you really want to be a healthy canna-consumer, put down the joint and vape instead.

I’m guilty of this line of thinking as much as anyone. But the cannabis community and country writ large must also reckon with a different set of facts. According to the Centers for Disease Control and Prevention (CDC), as many as 450 different people have contracted illnesses due to vaping products. At least four people have died. These cases involve common symptoms of fever, shortness of breath, coughing, nausea, and diarrhea, among others, reports a preliminary paper published in the New England Journal of Medicine. Most striking, the paper reports 84% of patients hospitalized by vaping-related illnesses admitted what they were vaping included THC, the psychoactive cannabinoid in marijuana.

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Plenty of marijuana users, in states legal or otherwise, have expressed concern and confusion. Very reasonably, these people don’t want to die. Their questions in response to this news multiply infinitely. Five years after Washington and Colorado created recreational markets, why the death and illness now? Is vaping still safe? What even is in vaping fluids? If I buy products someone says is from California, does that mean I’ll be okay? Is this somehow Trump’s fault?

Believe it or not, all those queries are related. Early analysis from the Food and Drug Administration (FDA) found presence of vitamin E acetate in vaping products used by those who fell ill. A spokeswoman from the New York State Department of Health confirmed high levels of vitamin E acetate in all New York cases. “As a result, vitamin E acetate is now a key focus of the Department’s investigation of potential causes of vaping-associated pulmonary illnesses,” read the state’s release.

Vitamin E, while used as a topical skin treatment or ingested as a health supplement, isn’t dangerous. But its molecular structure, reports The Washington Post, could be hazardous when smoked into the lungs. However, unlike the New York Health Department, the FDA isn’t even positive that vitamin E acetate is the deadly culprit.

“No one substance, including Vitamin E acetate, has been identified in all of the samples tested,” FDA spokesman Michael Felberbaum told the Post. “Importantly, identifying any compounds that are present in the samples will be one piece of the puzzle but will not necessarily answer questions about causality.”

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While various health agencies analyze what role vitamin E acetate plays in these illnesses, the FDA advises “it is prudent to avoid inhaling this substance.”

One way to avoid contracting these illnesses is to avoid purchasing THC cartridges on the streets. By the way, that doesn’t mean purchasing cartridges from legal states like Oregon or California means you’re in the clear. In the wake of legalization and the explosion of ancillary cannabis products in dispensaries—including edibles, tinctures, and vape cartridges—the black market has responded with equal sophistication.

Brands like Dank Vapes and Chronic Carts may seem legitimate, due to colorful packaging and marketing prowess. But they also aren’t real producers or businesses. Instead, a brand like Dank Vapes acts as a shadow company for counterfeit producers to mask the illegal and unregulated nature of their products. Grow illegal marijuana, produce illicit vape oil, and stuff it in a seductive-looking box, and suddenly unwitting buyers assume you’re a real, state-approved retailer. Inverse reported that at one point you could buy empty Dank Vape boxes on Amazon, in case you wanted free Prime shipping while harming cannabis users. If you’re smoking Dank Vapes, know that it isn’t laboratory tested, it doesn’t come from legal retailers, and it might kill you.

Some have suggested this outbreak will impede the growing momentum toward legalizing cannabis nationwide. It’s possible. But this vaping illness also demonstrates how problematic the federal government’s inaction on cannabis has become. Donald Trump promoted noted prohibitionist Jeff Sessions to Attorney General and empowered Senate Majority Leader Mitch McConnell, who “has shown zero interest in doing anything to make it easier for marijuana companies to do business,” writes POLITICO. By avoiding regulation and progressive legislation, the federal government instead let the market decide how, where, when, and why cannabis products will reach consumers.

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Letting the market decide, though, indirectly led to these vaping illnesses. Consumers want vaping products—they’re discreet, portable, and easier to dose your usage. A 2019 report from Arcview, the cannabis research analytics firm, announced that concentrates rose from 10% of the cannabis market in 2014 all the way to 27% in 2019. That’s just what we can track from legal sales. Prohibitive taxes and competitive pricing pushed producers and consumers alike in California to the black market. At the beginning of 2019, the Associated Press reported up to 80% of all marijuana sales in California still happen “under the table.”

The truth is the moment we’re in has been brewing for years. All the factors listed above—consumer demand, unregulated black markets, government leniency—have been pointing this direction. Rolling Stone columnist Amanda Chicago-Lewis identified this possibility a couple years back, but no one really listened. Heads were stuck in sand and everyone was happy to make a quick buck. That countercultural, screw-the-government streak present amongst many cannabis veterans only added fuel to the fire. But when people land in hospitals with the possibility of death, it’s time for a change. We need institutional oversight, we need laboratory testing, we need scientists examining these products, we need consumer awareness around cannabis safety. Currently we have none of that. The only way to achieve any necessary change, of course, is simple—legalize marijuana. That would be the first step to solving a lot of this country’s problems.