Policy experts fear vaping backlash
Nicotine e-cigarettes remain less toxic alternative for smokers, researchers say
WASHINGTON — Only two years ago, electronic cigarettes were viewed as a small industry with big potential to improve public health by offering a path to steer millions of smokers away from deadly cigarettes.
That promise led U.S. regulators to take a hands-off approach to e-cigarette makers, including a Silicon Valley startup named Juul Labs, which was being praised for creating “the iPhone of e-cigarettes.”
Today Juul and hundreds of smaller companies are at the center of a political backlash that threatens to sweep e-cigarettes from store shelves nationwide as politicians scramble to address two separate public health crises tied to vaping: underage use among teenagers, and a mysterious and sometimes fatal lung ailment that has affected more than 1,000 people.
New restrictions at the local, state and federal levels are poised to wipe out thousands of fruit-, candyand dessert-flavored vapes that have attracted teens. But experts who study tobacco policy fear the scattershot approach of the clampdown could have damaging, unintended consequences, including driving adults who vape back to cigarette smoking, which remains the nation’s leading preventable cause of death.
“This could take us from potentially the single biggest improvement in public health in the United States toward a public health disaster in which cigarettes continue to be the dominant nicotine product,” said Jonathan Foulds, an addiction researcher and tobacco specialist at Penn State University.
Foulds and many other experts continue to view e-cigarettes as a potential “off-ramp” for smokers, allowing them to continue using nicotine — the addictive chemical in cigarettes — without inhaling all the toxic byproducts of burning tobacco.
But they warn the vaping backlash could do irreparable harm to the public perception of e-cigarettes, while ignoring the riskiest products that are most likely to blame for the recent outbreak.
Federal investigators say that nearly 80% of people who have come down with the vaping illness reported using products containing THC, the high-inducing chemical found in marijuana. They have not traced the problem to any single product or ingredient. But investigators are increasingly focused on thickeners and additives found in illegal THC cartridges sold on the black market.
On Friday, the Food and Drug Administration specifically warned the public not to vape THC or purchase any vaping products off the street.
THC vapes are separate from the legal, nicotine-filled e-cigarettes being targeted by President Donald Trump and politicians across the country.
Democratic governors in New York, Michigan, Washington, Rhode Island and Oregon have followed the president’s plan to ban flavored e-cigarettes nationally with their own state-level flavor restrictions. Massachusetts’ Republican governor has gone even further, placing a four-month moratorium on sales of vaping products of any kind.
“The problem here is we have convinced adult America that vaping is as dangerous as smoking — and nothing could be further from the truth,” said Kenneth Warner, professor emeritus at the University of Michigan’s school of public health.
E-cigarettes generally heat a flavored nicotine solution into an inhalable aerosol. There is little research on the long-term effects of inhaling the chemicals in vaping, such as vegetable glycerin. Despite those unknowns, most experts agree e-cigarettes pose a much smaller risk than cigarettes, which cause cancer, lung disease and stroke and account for some 480,000 U.S. deaths each year.
And while the flavor bans are likely to curb teen vaping, Warner and others point out that those policies won’t prohibit flavors in traditional tobacco products. That means both teens and adults could wind up switching to deadlier menthol cigarettes or flavored cigars, which come in coffee, raspberry, chocolate and hundreds of other varieties.
The policy debate underscores the challenge of finding the right regulatory scheme for e-cigarettes, products for which there is little high-quality research.
The FDA has been struggling to find the right approach since it gained authority over e-cigarettes in the U.S. in 2016.
The agency repeatedly delayed its deadline to begin reviewing e-cigarettes, a step that critics say allowed products like Juul to catch on with teenagers. At the same time, e-cigarette companies and proponents say the agency’s new review deadline of next May is too aggressive and will force most companies out of business.
Now the agency is trying to walk a tightrope between keeping e-cigarettes away from teens but preserving them for an estimated 10 million adults who use them.
Some public health advocates fear ex-smokers will simply return to cigarettes. Even with the success of Juul, e-cigarettes remain a tiny slice of the U.S. tobacco market, accounting for $8.6 billion in sales compared to $95 billion for cigarettes, according to Euromonitor.
Industry analysts point to early indicators that e-cigarette sales are beginning to flag amid the bans and negative headlines. E-cigarette sales slowed by 11% over the four weeks ended Sept. 22, according to retail data tracked by Nielsen.
The trend “could result in improved combustible cigarette” sales “as vapers potentially return” to smoking, Wells Fargo analyst Bonnie Herzog told investors in a recent note.