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This hinders extrapolation of US-based results to other countries

[24] In late February 2020, a CDC-authored article in the NEJM stated that the VAPI outbreak was "driven by the use of THC-containing products from informal and illicit sources." [25] [24] However, the CDC also stated, "Evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC or non-THC products, in some of the reported EVALI cases." [26] In 2021, analysis of the aerosols from popular vape brands such as Juul and Vuse found "nearly 2,000 chemicals, the vast majority of which are unidentified." [27] [28] The CDC has stated that the THC cutting agent vitamin E acetate is very strongly implicated in VAPI, [29] but evidence was not sufficient to rule out a contribution from other chemicals of concern to VAPI as of January 2020

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