Response to Another “Epidemic” Is Likely to Generate Harmful Unintended Consequences – As Usual

After addressing the “meth epidemic” with the Combat Methamphetamine Epidemic Act of 2005 (don’t look now, but meth‐​related deaths are at historic highs, eclipsing those solely from prescription opioids), and after addressing the opioid epidemic by depriving patients of pain medication while driving nonmedical users to more dangerous drugs, it appears politicians, assisted by an eager press, are setting their sights on fixing the newest “epidemic:” the “growing epidemic of e‑cigarette use in our children.”

Secretary of Health and Human Services Alex Azar announced today that the Food and Drug Administration is considering removing all flavored e‑cigarettes from the market, with the exception of tobacco flavored one. Sales of e‑cigarettes to those under age 18 have been banned in the U.S. since 2016. Of course, as is the case with all forms of prohibition, that hasn’t prevented minors from obtaining and using them. A recent spate of hospitalizations of young vapers for lung injury associated with vaping — including 5 reported fatalities — has fueled the sense of urgency for politicians and policymakers to take action. Evidence suggests the majority of these cases were from illegal products obtained on the black market — a very common unintended consequence of underground use due to prohibition.

Commenting on the recent outbreak, former FDA Commissioner Scott Gottlieb, MD told the New York Times:

“I think this is probably going to be associated with illegal products,” Dr. Gottlieb said. “It’s not like the major manufacturers have suddenly changed their ingredients“…”It’s probably something new that has been introduced into the market by an illegal manufacturer, either a new flavor or a new way to emulsify T.H.C. that is causing these injuries.”

Meanwhile, e‑cigarettes are a proven harm reduction tool that has helped tobacco smokers, addicted to the nicotine in cigarettes, abstain from smoking tobacco. Recognizing this, the prohibitionists are proposing that flavored e‑cigarette sales, already banned to minors, be banned to adults as well, while tobacco flavored e‑cigarettes remain legal for adults to purchase.

But, as Jacob Sullum points out here, the evidence suggests that the majority of tobacco smokers who used e‑cigarettes to quit preferred the flavored form. Just 6 to 8 percent used tobacco flavored vaping. And research suggests fruit or candy flavoring of e‑cigarettes are not determinants of teen vapers moving on to tobacco use.

Even though the sale of e‑cigarettes to minors is already prohibited, policymakers seem intent on doubling down on the prohibitionist approach and, in the process, are interfering with adults’ right to enjoy the vaping experience or use vaping to reduce the harm from smoking tobacco cigarettes.

Meanwhile, teens are already accessing e‑cigarettes through the underground market. Banning flavored e‑cigarettes, their preferred form of vaping, means the only flavored e‑cigarettes they will obtain will be those made by illegal producers. They will be more likely to be tainted or laced with dangerous substances. That’s how prohibition works.

Many have expressed concerns that vaping among teens will addict them to nicotine. While nicotine creates physical dependency and generates withdrawal symptoms, and can be addictive to some people, long term nicotine use is not nearly as dangerous as long term tobacco use. Nicotine is not carcinogenic. It is a vasoconstrictor and long‐​term continued use can have negative cardiovascular effects. But the main harm from nicotine addiction derives from its presence in tobacco. The nicotine in tobacco is what makes tobacco smoking addictive, but the other components of tobacco smoke are the cause of cancer and organ damage. There are drugs that pose a much greater potential for physical harm than does nicotine.

As was the case with meth and opioids, once again policymakers look poised to generate a new cascade of unintended consequences as they impose prohibitionist policies without examining the evidence and thinking through the consequences.