In recent months, rising numbers of vaping-related pulmonary illnesses and deaths across the country have raised alarm bells about a method of consuming marijuana and tobacco that was once assumed to be safer than smoking. Efforts to understand the root causes of these medical cases—146 in New York, as of October 22—are ongoing. The public health concern around vaping is mounting just as state politicians are gearing up to try to accomplish in 2020 what they couldn’t in 2019: Passing legislation to fully legalize marijuana for those over 21.

In the last legislative session, State Senator Liz Krueger, a primary sponsor of the Marijuana Regulation and Taxation Act, was scrambling at the 11th hour to include all the provisions her colleagues said they would need in order to support the bill. Given that several senators were still on the fence at the end of the last session, it’s unclear whether the bill would have passed had it come to a vote. Some of the concerns downstate senators raised were related to public health issues such as youth cannabis consumption or the risk of people driving while high.

But Krueger says she thinks the current concern around vaping will only increase the chances of the bill passing this time around.

“Now, you have many people in government realizing...we need to protect our people so they’re buying a product where they know what’s in it, they know that it’s not dangerous, that it’s been tested and regulated by the government,” Krueger told Gothamist this week at CannaGather, a monthly cannabis industry event.

State Senator Shelley Mayer, a Democrat representing Westchester who has yet to commit to voting to legalize marijuana, says she raised concerns last session about the need for clearer language in the bill regulating vape products. She believes recent events will make those provisions more of a priority in 2020.

“I continue to be extremely concerned and think my concerns were well placed,” said Mayer. “I look forward to talking to Senator Krueger, who’s a fantastic colleague, to ensure my concerns are met. We’re not quite there yet.”

Vaping regulations, including banning certain additives in vape cartridges, are among the measures that were discussed at a summit Governor Andrew Cuomo held last week with governors from New Jersey, Connecticut and Pennsylvania to try to coordinate marijuana legalization efforts. Krueger has emphasized the need to ban vitamin E acetate, in particular.

But some question whether there’s enough scientific evidence of what’s causing vaping-related illnesses at this point to know what regulations to put in place.

According to the state Department of Health, in nearly every one of the cases of pulmonary illness that has been linked to vaping cannabis in New York, the product has contained high levels of vitamin E acetate. The Health Department has further specified that people should be particularly wary of pre-filled vape cartridges purchased on the black market, even if they look like legitimate cannabis brands.

However, a recent study in which the Mayo Clinic examined the lungs of 17 people who died from vaping-related pulmonary illness across the country showed that their lung damage looked similar to a chemical burn. The study didn’t reveal any buildup in the lungs of vitamin E acetate or other oils sometimes used to cut the cannabis oil used in vape cartridges.

The Medical Society of the State of New York, a doctors’ association that has been lobbying against marijuana legalization for recreational use in New York on public health grounds, is using the recent spate of illnesses and deaths as fuel for its argument.

“These [public health] concerns have grown in recent weeks given the significant number of cases of pulmonary illness relating to the use of vaping devices, which have included many instances where cannabis was being vaped,” MSSNY said in a joint statement it released with the medical societies of New Jersey and Connecticut following the governors’ summit.

The statement went on to suggest that other states should follow in New York’s footsteps and focus on decriminalization for the moment, while pushing Congress and the president to change marijuana’s status under the federal Controlled Substances Act to allow for more rigorous scientific research. Indeed, vaping technology for consuming marijuana has been available commercially in the United States since 2003, but longstanding federal restrictions on cannabis research have limited the ability to study its health impacts, according to scientists and cannabis industry leaders.

Vaping aside, though, the risk of death from cannabis alone is extremely low or nonexistent, making it much safer in that sense than legal substances like alcohol, tobacco, and opioids.

For State Senator Pete Harckham, who chairs the senate committee on alcoholism and substance abuse, the issue of whether to legalize marijuana in New York should be considered completely separate from public health concerns around vaping.

“So much is unknown about the chemical solvents for vaping in general,” he said. “Some might argue that if you legalize marijuana you could regulate the purity and additives in vaping products, but we would need a lot of science in a short amount of time.”

Harckham, a Democrat representing Westchester who wasn’t ready to vote in favor of marijuana legalization last session, said Krueger did a thorough job of addressing his concerns about the bill.

“With 20 percent of [marijuana] revenue in the bill going to treatment for addiction and prevention, I was at the very end supportive of that,” said Harckham. “If we pick up at that point, I think there’s still more to do with the bill but I’m very supportive of the work [Krueger] has done.”