In a recent House Oversight Committee hearing, U.S. Food and Drug Administration Commissioner Robert Califf was pressed on the influx of foreign-produced disposable e-cigarettes, with one lawmaker noting that such “vapes” have been found to contain fentanyl. That fentanyl might be found in nicotine vapor products has stirred fear in some circles, fueled by the rise of fentanyl overdoses and the perennial concern over youth vaping. However, not all fears are justified. In this case, fears that nicotine e-cigarettes are being adulterated with fentanyl are completely baseless and potentially dangerous.
First, let’s address the lack of evidence. While fentanyl has allegedly been detected in illicit cannabis vapes in a handful of cases and is present in “fentanyl vapes” designed for and used explicitly for opioid use, there is no evidence of a nicotine e-cigarette testing positive for fentanyl. Moreover, while there might be an economic incentive to substitute or dilute illicit opioids with cheaper and more potent fentanyl, the same does not extend to nicotine e-cigarettes, all the ingredients of which are legal and cheaper compared to fentanyl.
Nearly every news item or report referring to fentanyl in “vapes” makes it clear that the vapes in question are not e-cigarettes but illicit and unregulated vape cartridges, used intentionally to consume opioids or other controlled substances, like cannabis. Rather than revealing some hidden dangers associated with nicotine vaping, these stories highlight the well-known hazards of illicit drug markets created by prohibition. Lawmakers should keep this in mind as they discuss e-cigarette regulation, lest they unintentionally manifest the outcome they fear.
At best, raising questions about fentanyl in e-cigarettes is a waste of Califf’s time. At worst, it publicly conflated two distinct policy areas, illicit drug markets, and the nicotine vaping market, increasing public confusion and diverting attention from effective policy approaches to both arenas. If anything, stories regarding fentanyl in illicit drug markets ought to prompt lawmakers and regulators to resist fear-mongering over e-cigarettes, lest they succumb to the same type of sensationalism that led to the prohibitionist drug policies that contributed to the fentanyl crisis.
Despite youth vaping hitting a 10-year low, the moral panic surrounding youth use of e-cigarettes continues to dominate the discourse over tobacco harm reduction. That panic led to the adoption of heavy-handed restrictions on e-cigarettes, some bordering on outright bans, with little discussion of the effect on adult smokers or other unintended consequences. As a result of those restrictions and the FDA’s heavy-handed regulations, nearly all e-cigarette products produced in the U.S. have been removed from the market, creating a vacuum quickly filled with a flood of disposable e-cigarettes, largely produced in China. While fentanyl hasn’t yet made its way into the illicit e-cigarette market, the likelihood of this type of contamination only increases the closer we get to e-cigarette prohibition, driving more consumers and demand into the illicit market and toward products of unknown origin and quality.
Public health policies should be based on evidence, whether regarding illicit substances or legal adult products, like e-cigarettes. Demonizing nicotine vapor products by linking them to problems within illicit drug markets does nothing to address real public health issues or the rampant misperceptions the public has about e-cigarettes. Numerous high-quality studies have demonstrated the role e-cigarettes can play in smoking cessation and their enormous potential as a harm reduction tool, something even the head of the FDA Center for Tobacco Products, Brian King, admits to. Yet a growing portion of the public mistakenly believes that e-cigarettes are as or more dangerous than smoking, potentially deterring smokers who cannot quit from switching to something far less harmful to their health.
If anything, the unfounded fear of fentanyl in e-cigarettes provides the FDA with an opportunity to educate the public about the relative risks of e-cigarettes compared to smoking and to reaffirm the agency’s commitment to modernize its approach to tobacco and nicotine around harm-reduction principles. If lawmakers and regulators wish to avert creating a large illicit e-cigarette market and similar hazards observed in illicit drug markets, they should ignore the sensationalism and focus on fixing the FDA’s broken approval process so that consumers can have access to approved and regulated products rather than turning to the black market.