It’s frightening when people are dying and doctors don’t know why. Over the past few months, 26 deaths and some 1,300 injuries have been attributed to vaping. We shake our heads in disbelief at X-ray images of lung damage and findings of vape-borne chemicals that turn to cyanide when heated.
Doctors and public health officials are appropriately sounding alarms. Lawmakers are responding predictably, and unfortunately, with calls for outright bans on vaping and vape products.
As a scientist, clinician and parent, my instinct and duty are to protect the public, especially children, from harm. But outright bans could worsen our current crisis and have unintended negative consequences for adults and children alike.
So, what to do instead? First, we must acknowledge that nicotine, the chemical that has fueled the rise of vaping, is highly addictive and can lead to lifelong physical dependence. We also know nicotine affects brain development, interfering with the establishment of networks that support memory, attention and impulse control in young minds.
I’m the mother of a 3-year-old I hope will never develop an addiction to nicotine. However, instead of telling her to “just say no,” which research shows is ineffective, I am giving her the most current scientific information to help her make safer choices as she grows up.
That’s what her father — a rehabilitation neuropsychologist and former pack-a-day smoker — did: He carefully considered the scientific evidence and switched to vaping to protect his health and his family.
In contrast, politicians feel pressured to act quickly and unequivocally. Bans are easier to defend, even if they are contraindicated by scientific data and history’s lessons.
What scientific data? The vast majority of people who vape do so without injury. Public-health officials are finding common threads among the products involved in the recent vaping deaths and injuries, and tracing them to black-market producers and disreputable merchants.
Further, nicotine, addictive as it is, is not at fault for these deaths and lung injuries. Many, if not all, of the products implicated in the current epidemic were e-liquids delivering THC, the psychoactive ingredient in marijuana.
Cigarettes, which kill 8 million a year, are legally produced and ironically not banned. Smokers who switch to vaping — which delivers nicotine but without as many other chemicals in cigarette smoke — dramatically reduce their exposure to toxins. Initial studies, including research from our center, have shown that providing vaping equipment during stop-smoking interventions improves treatment outcomes. Research participants describe vaping as a more attractive stop-smoking aid than pharmaceuticals. Part of this appeal is the range of flavor options: Flavorants attract not only teens; they are used by 70% of adults who vape.
What’s the history lesson? Bans and other sudden edicts to squeeze the supply of drugs have had disastrous, unanticipated effects. Alcohol prohibition in the 1920s, the 1970s-launched War on Drugs, and the opioid crisis each has led to costly and deadly outcomes without putting a lasting dent in the prevalence of substance-use disorder. In this last instance, the sudden restriction of opioid prescriptions pushed pain patients to the illicit drug market, which dramatically increased the incidence of opioid overdose and blood-borne illness.
Extrapolating from this history, bans on vaping and related products will almost certainly drive people who vape to use lower-quality, illicitly produced products — or to resume smoking. These are the most dangerous and deadly possible outcomes for the general public, including our children.
Instead, we need transparent and factual public-safety announcements about the relative risks of nicotine products so consumers can make safer choices. For example, while no nicotine use is “safe,” smokeless chewing tobacco is safer than smoking, vaping is safer than chew, and nicotine-replacement therapy is safer than both of those. Purchasing nicotine and vape products from reputable companies is a safer choice than purchasing them on the illicit market.
We also need stricter regulation of nicotine products. This includes setting a high legal age to purchase any non-pharmaceutical nicotine product, regulating advertising, limiting sales venues, and prosecuting individuals and companies that provide nicotine to minors.
In spring 2020, the Food and Drug Administration will start regulating the vaping industry. State regulation will be helpful, too, as long as it is informed by the state of the science and not the politics of the moment.
If well-regulated, vaping might one day be harnessed by clinicians as a stop-smoking aid that is more affordable and attractive to smokers than pharmaceuticals. Look to England, where the Royal College of Physicians and Public Health England recommend physicians advise patients to switch from smoking to vaping. In the U.S., more research and regulation on vaping is needed to maximize its safety and public-health impact. But this ideal cannot be reached in the context of prohibition.