Vaping and Harm Reduction: Why Hampering the Sale of E-Cigarettes is Bad Policy

This week, the House Oversight and Reform Committee’s Subcommittee on Economic and Consumer Policy will hold hearings entitled, “Examining JUUL’s Role in the Youth Nicotine Epidemic.” In the hearing, the Subcommittee is expected to discuss JUUL’s marketing practices and other strategies that may have contributed to the rise in youth vaping over the past few years.

Back in August of 2018, then-Commissioner of the Food and Drug Administration (FDA) Scott Gottlieb, M.D. issued a press-release in which he pledged that the FDA would support innovations in “novel nicotine replacement drug therapies (NRTs).” He asserted that the FDA should “pave the way for products that help currently addicted smokers move away from the deadliest form of nicotine delivery:” cigarettes, by “[encouraging] innovation of potentially less harmful tobacco products for those adults who still seek to use nicotine (such as e-cigarettes).”

Unfortunately, the FDA seems to have reversed this belief, siding with sensationalist legislators seeking to regulate e-cigarettes into oblivion in the mistaken belief that doing so would magically solve the so-called youth vaping epidemic. The rise in youth vaping is certainly of concern and requires our legislative due diligence. Yet, lawmakers on both sides of the aisle risk missing the forest for the trees when it comes to regulating e-cigarettes. Put simply, e-cigarettes are the best chance of success for the 70 percent of adult smokers who wish to quit and hampering the industry under the guise of “protecting our youth” is not only misguided, but potentially damning for the 34 million Americans who smoke. The reason e-cigarettes are so important in this fight is that they present the best option for harm reduction currently available.

Harm reduction is the practice of trying to minimize the deleterious effects of licit and illicit drug use through alternative means like NRT. Rather than dissociate from reality, harm reduction accepts that societal harms like smoking are real and complicated issues that can’t be solved by a ban. Simply making heroin illegal does nothing to help a current heroin addict. Instead, harm reduction promotes a pragmatic approach, focused on individual liberty. Rather than castigate drug users and smokers, harm reduction seeks to provide alternative methods to breaking the cycle of addiction and has been quite effective in both reducing smoking rates in America and in combating the opioid epidemic.

E-cigarettes have become the forefront of harm reduction among smokers. E-cigarettes are simply the latest innovation in a long line of NRTs that the FDA champions. However, as opposed to less effective NRTs like gums and patches, studies have shown that “e-cigarettes can substitute the physical, psychological, social, cultural and identity-related dimensions that were previously enjoyed about tobacco smoking, and thus may uniquely support long-term smoking relapse prevention.”

Yet, even with a proven record of harm reduction and beneficial impact, e-cigarettes are continually being attacked under the classic guise of “protecting the youth.” This is the reason that the FDA approved a ban on selling certain flavors, naively believing that the rise in youth vaping is a result of companies targeting flavors to children. The FDA and lawmakers believe that banning fruity flavors will help stem the tide of the vaping youth, but empirics don’t support this claim.

If we look backwards to 2009, we can see that the FDA and lawmakers used the same arguments to effectively ban the sale of flavored cigarettes. Until the ban, cigarettes came in many flavors, including hazelnut, fruit, and cola. Regulators attacked such flavors, stating that “sweet-tasting flavors are particularly appealing to youth and young adults.” Yet, according to HHS data on the percentage of students smoking cigarettes, the ban on flavored cigarettes had practically no effect on the already downward trending rate of youth cigarette use. In other words, banning flavored cigarettes had practically no impact on the rates of youth smoking in America.

The same will be true for flavored e-cigarettes. Kids vape underage for the same reasons that they smoke underage; it’s rebellious and trendy. Instituting heavy regulation will not change this fact, and may have the opposite effect by creating a grey-market for the products. Instead of treating our youth as ignorant victims of some corporate scheme, it is about time that we recognize that waving a magic wand and banning certain products will not solve the problem.

Rather we should look to one of the great public health successes of the last century and educate our youth about the dangers of vaping the same way we educated them about smoking. Proper education about the dangers of these products has seen a nearly 90 percent decline of youth smoking rates since the 1980’s. It’s time for us to do the same with vaping. Only by treating our youth with intellectual respect will we be able to address the scourge of youth vaping.

As countless examples can attest, simply banning something doesn’t remove the societal problems associated with it. Rather, it is only by promoting harm reduction and education that we have been able to effectively upend our societal ills. Regulators should be treating e-cigarettes as the new champion of NRT, providing millions of Americans with the means to quit smoking. Only when regulators and legislators take a step back from the issue of youth vaping will they be able to see the forest of good that e-cigarettes can provide.