E-cigarette companies have been peddling their products as a healthier, safer alternative to smoking actual tobacco cigarettes for just over a decade now. But the truth is, nobody really knows what these things are doing to the inside of people’s lungs. 

Case and point: earlier this month, a teen by the name of Chance Ammirata, had to undergo emergency surgery after his left lung collapsed. When the doctors got a look inside of the 18-year-old’s lungs, they noticed a constellation of black dots that they’d never seen before.

When they did the actual major surgery to re-inflate my lungs, the surgeon said, ‘whatever you’ve been smoking has been leaving these black dots on your lungs,’” Ammirata told the Dailymail.

The doctors say those dots came from vaping nicotine. But the American Vaping Association (AVA) disagrees. They say that cannabis is more likely the culprit — in Ammirata’s case and in other’s like it.   

Ammirata said that he’d been vaping for about a year and a half when he first felt the pain in his left side. It was mild at first, like a cramp or a tweaked muscle. But by the next day, he was doubled over in pain, could hardly breathe and knew that something was seriously wrong.

So he and a friend went to the hospital, and Ammirata was subsequently rushed into emergency surgery. His left lung had completely collapsed inside his chest. Doctors were forced to insert a tube into his lung through Ammirata’s ribs in order to re-inflate it.

Ammirata’s case certainly isn’t an isolated event, either. Nearly three dozen other young people across the US were hospitalized just in recent weeks for vape-related health problems. And in Denver, there have even been cases of young people having seizures from vaping too heavily, or too frequently.

However, the AVA is adamant: the blame for these hospitalizations, cannot be placed on e-cigarettes alone. In response to a Good Morning America segment on the dangers of vaping, the president of the AVA board, Gregory Conley, posted to Twitter:

Maybe he’s right. Maybe these vape-hospitalizations are the result of people using cannabis vape cartridges, not e-liquid. Maybe vape companies like Juul really are just blameless victims, and it’s cannabis vaping we should crack down on.

Or, maybe it’s the toxins that are commonly found in e-liquid nicotine cartridges that are the problem. Harvard researchers found that 80 percent of e-liquid cartridges on the market contain traces of glucan, and one in three contained traces of endotoxin — both of which can cause asthma, reduced lung function and inflammation. On top of that, heavy metals like nickel, tin and lead are also commonly found in e-liquid.

And don't get me wrong: I use Juul's and cannabis vape pens like most people my age and I enjoy them. I'm not against them. I just also don't have a financial incentive to tell people they're harmless. I am under no illusions  when I vape, be it cannabis or nicotine, I know it isn't good for me. Just like when I smoke a cigarette, puff a joint or hit a jeffery I know it isn't good for me. It's just a matter of moderation, as it is for any drug

Ammirata says he was smoking about one Juul pod every few days when his lung collapsed. Which is not excessive. Some vapers burn through as many as four cartridges in a single day, the equivalent of smoking 80 cigarettes. (Which is about the point where people reportedly start seizing out.)

As time passes and habitual vapers keep on vaping, more and more of these cases are going to start popping up. The literature will grow. The unforeseen health effects of vaping will manifest in the public and that will not be good news for vape businesses. Until now, they’ve been leaning heavily on the “safe to use” and ”healthier than tobacco” marketing schemes. And people have lapped it up — in part because it’s such a trendy habit; but also, because companies like Juul have pushed these things on young people, touting them as harmless and cool.  

This isn’t to say that cannabis vapes don’t also pose health risks. If e-liquid contains toxins and heavy metals, you can bet that marijuana cartridges do too. But people aren’t huffing marijuana cartridges at the same rate they’re sucking through e-liquid. Maybe cannabis vapes are contributing to the problem, but they certainly aren’t driving it.

"You thought Juuls were safe. So did I.” Ammirata wrote in a post on social media after his lung was successfully re-inflated, and his life was returning slowly to normal. "The black dots on my lungs are reminiscence of juuling [sic] … I've been doing it for a year and a half and can never do it again – you really shouldn't either … I know how hard it is to change anyone's mind who's addicted because I was too … And I don't think anyone could have said anything to make me stop. But your lungs most likely look like this too if you've been smoking … Don't let it get worse – please stop – like really please. It's so fucking scary.”