For millions upon millions of American smokers, nicotine replacement therapy products have been notoriously ineffective. Still, the data produced by various studies is often framed in much more optimistic terms. For instance, in this post on the website for the American Cancer Society, entitled “Study: Nicotine Patch Works as Well as Chantix to Help Quit Smoking,” the organization’s director of tobacco control research, Lee Westmaas, contends that the data “confirms that FDA-approved medications are effective in helping smokers quit.” But as the post itself admits, a mere 21% of participants who were treated with the nicotine patch managed to abstain from smoking for at least one year. The one-year success rates for participants who used either Chantix or a combination of the patch and nicotine lozenges were 19% and 20%, respectively. Interestingly, the researchers behind the study were decidedly less enthusiastic than the ACS post, concluding that “the results raise questions about the relative effectiveness of intense smoking pharmacotherapies.”
Admittedly, those numbers aren’t anything to sneeze at. The more we learn about addiction, the more apparent its complexities become. There are countless variables that can affect a person’s chances at breaking free from their addiction(s), including genetic and environmental factors that pose unique challenges to achieving long-term abstinence. With that in mind, a 1-in-5 success rate doesn’t sound so bad. There are around one billion active smokers in the world right now. If they all tried to quit using one of the three methods in the Wisconsin study, and if that roughly 1-in-5 success rate were to hold steady, around 200 million lives would (presumably) be saved. That’s a lot of lives, to be sure.
Nevertheless, the Wisconsin study proves that traditional methods of quitting smoking aren’t nearly as effective as many anti-smoking advocates would have us believe, and it’s certainly not the first bit of research to support that conclusion. Therefore, if the ultimate objective is to save as many lives as possible, we’re going to need more alternatives that smokers can turn to when conventional therapies fail to get the job done.
Enter electronic cigarettes, or “e-cigarettes” for short. There is a wealth of research showing that e-cigarettes are significantly less harmful than traditional tobacco cigarettes. A 2016 report from the UK’s Royal College of Physicians determined that e-cigarettes are up to 95% safer than tobacco cigarettes. A 2017 research paper published in the peer-reviewed medical journal Tobacco Control argued that e-cigarettes could save over 6 million lives over a 10-year period in the United States. And a 2017 study published in the Annals of Internal Medicine found that people who use e-cigarettes while abstaining entirely from tobacco cigarettes are exposed to “substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes.”
More recently, a comprehensive review published just this past January by the National Academies of Sciences, Engineering and Medicine found “conclusive evidence that completely substituting e-cigarettes for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes.” It also found “substantial evidence that except for nicotine, under typical conditions of use, exposure to potentially toxic substances from e-cigarettes is significantly lower compared with combustible tobacco cigarettes.”
That’s not to say that the relative safety of e-cigarettes hasn’t been overstated. To be perfectly clear, the devices themselves are far from harmless, and the same is true of the liquids they utilize. E-liquids often contain high levels of nicotine, which makes handling those liquids a risky endeavor. Nicotine poisoning from accidental ingestion of e-liquids, as well as through inadvertent skin exposure, is not unheard of, especially among young children. Additionally, the vapors e-cigarettes create, while clearly less dangerous than tobacco smoke, do still contain toxic substances, the types and levels of which vary from one flavor of e-liquid to the next.
The biggest concern regarding e-cigarettes, though, is their use among American teens, which has skyrocketed over the last several years. Surgeon General Jerome Adams declared teen vaping an epidemic this past December—“vaping” is a widely-used term used to describe the act of inhaling and exhaling the vapors that e-cigarettes produce. E-cigarette use among high school students jumped by a whopping 78% in 2018, and the blame for this eye-popping statistic has been laid primarily at the feet of a popular vaping company called Juul. Juul has quickly become the most dominant player in the e-cigarette market—the company raked in over $1 billion in revenue in 2018—but their popularity with teens has invited intense scrutiny from public health officials and put increased pressure on the industry to be more proactive in preventing its products from falling into the hands of minors.
Critics are right to be concerned about teen vaping. E-cigarettes were created specifically to help people quit smoking, not to hook a new generation of teenagers on nicotine, which is known to interfere with normal brain development in young people. A 2017 study from the University of Southern California determined that teenagers who vape e-liquids with high levels of nicotine are much more likely to smoke tobacco cigarettes on a regular basis than teens who vaped low-nicotine or nicotine-free liquids.
There are numerous potential policy solutions to teen vaping. Given the results of the USC study, limiting the amount of nicotine producers are legally permitted to put in their e-liquids might be one such solution. Last March, the FDA proposed tighter restrictions on the sales of flavored e-liquids that are alleged to appeal to young people. And Congress is considering legislation that would raise the smoking and vaping age to 21, a move that’s already been made by a long list of cities and states.
But some locales are going much further by considering comprehensive bans on e-cigarettes and other vaping devices. A first-of-its-kind e-cigarette ban was passed just last June in San Francisco, the same city that Juul calls home. While it’s only meant to be a temporary ban until the FDA takes more decisive action on e-cigarettes, it’s still a little ironic when you consider that San Francisco officials, including Mayor London Breed, have openly advocated for safe injection sites—places where addicts can use illicit drugs like heroin and opioids without being arrested, and where trained personnel might be hired to monitor users and respond to potentially fatal overdoses. The concept of safe injection sites falls under the umbrella of “harm reduction,” a philosophy which advocates for policies and strategies designed to minimize the damaging consequences of drug addiction.
Officials in Richmond, Virginia are considering following San Francisco’s lead by implementing a similar ban of their own. Livingston, New Jersey banned e-cigarette shops from their business districts last year. Several states have imposed sky-high tax rates on vaping, effectively pricing low-income individuals out of the market altogether and threatening to put e-cigarette shops out of business.
This regressive approach to e-cigarettes is troubling, to say the least. It’s an all-but-certain fact that e-cigarettes are much safer than tobacco cigarettes, which puts them squarely in the “harm reduction” category. It is true that teen vaping has become a significant issue, but that doesn’t warrant citywide bans on e-cigarettes or vaping taxes so high that working-class smokers can’t afford to make the switch from tobacco cigarettes to e-cigarettes. If San Francisco lawmakers are as concerned about the health of their citizens as they pretend, why not at least allow licensed physicians to prescribe e-cigarettes to adult patients who are trying to ditch their pack-a-day habit?
The answer may be found in new data showing that a substantial portion of the general public has been misled into believing that e-cigarettes are just as bad or worse than tobacco cigarettes. This past March, JAMA Network Open published an analysis of data from two major national surveys—the Tobacco Products and Risk Perceptions Survey and the Health Information National Trends Survey. The researchers found that “a large proportion of US adults perceived e-cigarettes as equally or more harmful than cigarettes, and this proportion has increased substantially from 2012 to 2017.” During the five-year period the researchers focused on, the percentage of respondents who correctly identified e-cigarettes as less dangerous than tobacco cigarettes fell from 50.7% to 34.5% in the HINTS survey and 39.4% to 33.9% in the TPRPS survey.
These numbers are indicative of a tidal wave of misperceptions regarding the relative safety of e-cigarettes and their efficacy as smoking cessation devices. For instance, you’d be forgiven for thinking that e-cigarettes aren’t useful cessation tools, which is a narrative that has become increasingly popular in anti-vaping circles. That narrative, however, has started to crumble under the weight of recent evidence suggesting that the opposite is true.
A study published earlier this year in the New England Journal of Medicine concluded that “e-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support.” A 2016 study conducted by researchers at the University of California, San Diego and published in Tobacco Control found that “long-term use of e-cigarettes was associated with a higher rate of quitting smoking.” And a major study published just last month in the journal Nicotine and Tobacco Research discovered that adults who used e-cigarettes on a daily basis were 77% more likely than non-users to have abstained from tobacco cigarettes over a two-year span.
Simply put, e-cigarettes could save a lot of lives, which is a big reason why medical authorities in Britain have shunned America’s approach to this issue, opting instead to encourage British smokers to switch to vaping and considering steps to increase their availability and make them more affordable. What’s more, there doesn’t appear to be a youth vaping epidemic in Britain like the one we have here in the United States, indicating that there must be ways to curb teen e-cigarette use without resorting to wholesale prohibitions on e-cigarettes and other vaping devices.
E-cigarette bans could potentially—and unnecessarily—lead to millions of premature deaths among adult tobacco users. It’s also possible that, just as we’ve seen with the war on drugs and alcohol prohibition, these bans could lead to the emergence of thriving black markets where adults and teenagers alike will be able to find what they’re looking for; vaping devices aren’t difficult to construct, and their components are easy to acquire online. And in a 2016 piece for U.S. News and World Report, Steven Nelson explains just how easy and inexpensive it is to obtain liquid nicotine and use it to create your own e-liquid. A black-market solution certainly wouldn’t be an ideal outcome to this situation, but tobacco users who haven’t found much success with nicotine patches or gum might not have any other choice if e-cigarette bans become the norm in America.