When will we learn the lesson that the government’s response to prohibit products doesn’t work? Just as alcohol prohibition provoked thousands of alcohol-related poisonings from bootleggers and the recent reductions in opioid prescriptions increased heroin overdose deaths, removing e-cigarette flavors from the regulated market, as the Food and Drug Administration (FDA) is poised to do very soon, poses a grave risk to public health.
We’ve already seen several local governments attempting to curb vaping with similar regulation. Cities throughout the nation are considering banning all e-cigarettes and vaping devices or raising the legal age for purchase to 21. And with the FDA piling on, the assault on vapes has never been so heavy.
But any of these bans would end in catastrophe.
It’s true: e-cigarettes aren’t harmless. Research shows they’re much safer than conventional cigarettes and a welcomed innovation, but it will take decades to determine the long-term consequences of e-cigarette use. And with over 27 percent of teens now reporting that they vape e-cigarettes at least once a month, local governments and the FDA are understandably concerned about their health. Almost all adult nicotine use is preceded by adolescent use, and the recent trend could re-popularize nicotine across the country after decades of a shrinking market. E-cigarette use among youth dropped in 2016, but that trend has been heavily reversed with the recent popularization of Juul e-cigarettes.
But the larger point still stands — market restrictions on popular substances frequently lead to more deaths.
The recently reported vaping-related respiratory illnesses are currently incredibly rare — there have been millions of e-cigarette users over the past decade and only 31 reported deaths. And those deaths likely have nothing to do with legal nicotine e-cigarette products. The Centers for Disease Control and Prevention reviewed 514 of the 1,299 current case patients and found that at least 76 percent of the vaping-related respiratory illnesses were caused by contaminants in black-market marijuana products. Another study published in The New England Journal of Medicine found that 84 percent of the lung-injury patients in Wisconsin and Illinois also reported vaping THC.
And if the FDA succeeds in pushing nicotine flavors to the black market, a poisoning problem currently absent of nicotine products will become chronic. The previous FDA director Scott Gottlieb acknowledged in a CNBC interview that “It’s very difficult right now because there’s different problems: there’s the teen use of e-cigarettes and there’s these acute lung injuries. And if we conflate the two and we pull the legally sold e-cigarette products off the market, it’s going to increase the market for the illegal products.”
It’s important to note, flavors aren’t the primary reason teens are vaping. Teens who vape do prefer flavors, just like adults, but the advent of safer tobacco alternatives would attract some young people, regardless of flavors. Underage tobacco use was endemic before vaping, which reveals that the failure to enforce current laws — not the existence of products — is primarily why underage use exists.
And vaping is likely why even fewer teens are smoking cigarettes. This year’s jump in teen vaping was also accompanied by a nearly 30 percent reduction in teen smoking — the largest decline in decades — and teen smoking is now at its lowest rate of all time at 5.8 percent.
The FDA is in a difficult position, but we need to make sure adult smokers have access to safer alternatives. The BMJ published a study showing that if every conventional cigarette smoker in the U.S. switched to e-cigarettes, 6.6 million fewer current smokers would die premature deaths. Banning flavors would interfere with everyone who’s attempting to quit combustible cigarettes, and would likely only reduce teen vaping as much as the ban would reduce adult vaping. Another report in The BMJ predicts that a flavor ban would reduce vaping by 11.1 percent, but would also increase conventional smoking by 8.3 percent — a terrible trade-off.
Another “solution” — increasing the minimum age to purchase e-cigarettes from 18 to 21 across the country — would largely prevent 18-year-old high school seniors from purchasing e-cigarettes for their younger classmates and also reduce youth e-cigarette use. But again, we’d then be preventing many young adults from accessing the most effective tool to quit smoking the significantly more dangerous combustible cigarettes.
Reducing teen vaping should certainly be a goal of both cities and the FDA. But prohibition of e-cigarettes is likely to increase smoking in teens and adults — and also increase black-market use and poisonings from (newly) illegal e-cigarette products. Why do it? Instead, the goal should be to teach teens not to vape. Then adults struggling with addiction can successfully quit smoking, and more lives won’t be put at risk for no real reason.