Promoting a new position paper titled “WHO Position on Tobacco Control and Harm Reduction,” Director General Dr. Tedros Adhanom Ghebreyesus claims e-cigarettes aren’t promoting harm reduction, via transitioning smokers to a safer source of nicotine, but are instead encouraging a new wave of addiction among young people.  

Instead of switching to e-cigarettes or nicotine pouches, the WHO recommends smokers make use of quit helplines and nicotine replacement therapies. But both these methods have notoriously low success rates and are not readily available or affordable in low- and middle-income countries (LMIC) where the majority of smokers live. LMICs often lack the public health infrastructure of countries like the United Kingdom or New Zealand, which have independently and successfully embraced products like e-cigarettes for tobacco harm reduction. LMICs are often more reliant on bodies such as the WHO for health and regulatory advice, placing a great responsibility on these organizations to provide sound, evidence-based guidance.   

In 2019, the WHO congratulated India, where there are more than 250 million tobacco users and around one million tobacco-related deaths per year, for its ban on e-cigarettes. In 2024, the WHO honored Brazil’s National Health Surveillance Agency with an award for reaffirming a ban on e-cigarettes. E-cigarettes are also banned in Argentina, Thailand, Brazil, Vietnam, and Mexico, where more than 70 million tobacco users live. Cigarettes, which are by far the most dangerous way of consuming nicotine, remain legal in all these countries. 

The WHO paper doesn’t provide any evidence that e-cigarettes or nicotine pouches are, in fact, just as or more harmful than smoking. The safer profile of these products is not just some self-serving claim from the tobacco industry trying to sell these alternatives. That vaping is safer than smoking is acknowledged by some of the WHO’s largest funders, such as the United States, the United Kingdom, and Canada. These countries have different regulatory regimes for nicotine products, but all of their leading health agencies, the Food and Drug Administration, the Office for Health Improvement and Disparities, and Health Canada, agree that e-cigarettes are safer than cigarettes. The gold standard for evidence-based medicine, the Cochrane Review, consistently finds e-cigarettes to be more effective than nicotine replacement therapies for smoking cessation. 

The UK’s National Health Service (NHS) and Cancer Research UK consistently promote e-cigarettes to smokers, regularly debunking the myths that these products are just as or more dangerous than cigarettes. The NHS even offers some smokers free vape kits as part of its “swap to stop” initiative. 

These efforts are bearing fruit. Smoking rates in the UK have declined significantly since the rise of e-cigarettes. In November 2025, the number of vapers in the UK surpassed the number of smokers for the first time. The spread of e-cigarettes, nicotine pouches, and heated tobacco products has given tens of millions of smokers who want to quit— but have failed through other methods—an alternative. Sweden has the lowest smoking and lung cancer rate in Europe because those who wish to use nicotine typically choose snus, an oral nicotine product that doesn’t involve combustion or inhaling smoke. 

There is also a wide-ranging body of evidence demonstrating that the kinds of restrictions Tedros is calling for, whether in the form of higher taxes or bans on e-cigarette flavors consumers prefer, result in more smoking of traditional cigarettes. That’s not a prescription for better public health.

Despite the overwhelming evidence that vaping is dramatically safer than smoking, the WHO persists in its demands that if countries don’t ban e-cigarettes outright, they should be subject to the same taxes and regulations as cigarettes. It should be commonsensical that products presenting vastly different risks should be regulated differently. But the WHO’s advice to put vapes, nicotine pouches, and other nicotine alternatives on a level playing field with cigarettes, if implemented in more countries, will only prolong and sustain death and disease among smokers who want to quit but don’t have the right options that might help them succeed. 

The post Why the World Health Organization’s anti-nicotine policy could keep millions smoking appeared first on Reason Foundation.

But if the Trump administration is serious about reducing the harms of smoking and sticking to its campaign promises, this pilot program should be immediately expanded to include other non-combustible nicotine products, like e-cigarettes.

Currently, the expedited review for premarket tobacco applications (PMTAs) appears open only to nicotine pouches made by four companies, three of which are legacy tobacco firms. This comes as a gut-punch to e-cigarette makers, consumers, and advocates who have pleaded for a similar streamlined process for e-cigarettes since the FDA began regulating them in 2016. The agency’s failure to provide one has been catastrophic.

When Congress granted the FDA authority to regulate tobacco in 2009, the requirement to obtain premarket authorization applied only to new tobacco products. Legacy tobacco products—those marketed in the U.S. prior to 2007—were exempt from premarket authorization. This effectively shielded entrenched cigarette brands from newer, safer competitors, leading some to dub the law the “Marlboro Protection Act.”

This scenario became truly perverse in 2016. When the FDA deemed e-cigarettes subject to its oversight, all vaping products on the market were classified as “new” because there were no e-cigarettes on the U.S. market before 2007. Suddenly, every e-cigarette was forced into a prohibitively expensive and opaque PMTA process, while tobacco companies could continue introducing new cigarettes that were merely “substantially similar” to their legacy products. As many experts and some lawmakers warned, it made no sense to hold safer alternatives to a higher standard than the combustible products they were designed to displace. But the FDA ignored these warnings.

The result was a predictable public health disaster. The FDA’s unworkable approval process eliminated nearly every e-cigarette product available in 2016. Today’s e-cig market is a dystopian mix of the few Big Tobacco brands to receive FDA authorization and a flood of unauthorized e-cigarettes that poured into the U.S. market to fill the vacuum created by the FDA. Few of the independent companies that once existed could afford the $20 to $100 million cost of preparing a PMTA, nor wait the years it might take the FDA to make a decision. Those that tried were squeezed out of the market anyway. They could no longer legally compete with the legacy tobacco brands that received FDA authorization early or the unauthorized products still available in a range of flavors.

The story of Juul, once the dominant e-cigarette brand that was seen as an existential threat to cigarette sales, is just one particularly egregious example of how the FDA’s regulatory failure functionally handed the legal e-cigarette market to Big Tobacco.

In 2018, Juul was the undeniable leader in the e-cig market, representing nearly 70 percent of all e-cigarette sales. Its nearest competitor, British American Tobacco’s Vuse, captured just 13 percent. That year, Juul submitted its PMTA to FDA, reportedly spending over $100 million to prepare the 125,000-page document. But, while the FDA was statutorily required to make a decision within 180 days, it took five years. Juul only received authorization for its tobacco and menthol products this past July.

In the interim, Juul faced massive litigation, nearly went bankrupt, and fell behind its competitors. Vuse, which was authorized by the FDA in 2021, is now the market leader among authorized products, with 35% of sales. Juul is a distant third with 19%, earning fewer sales than even GeekVape—an authorized Chinese import. The technology has also advanced, making the now-approved first-generation Juul outdated before it was authorized. The company’s next generation product, which features built-in age-verification technology, has been available in the U.K. since 2022. But at the FDA’s current glacial approval pace, it will take the agency until 2030 to authorize its sale in the U.S., if it ever does.

The rise of nicotine pouches, arguably accelerated by the FDA’s destruction of the e-cigarette market, is a positive development. Like e-cigarettes, they have no combustion and do not even involve inhalation. As such, nicotine pouches are considered among the least-harmful of the safer smoking alternatives. Speeding up access to these products will undoubtedly benefit public health by giving adult smokers more options to reduce smoking-related risks. But pouches will not work for every smoker, especially those accustomed to the hand-to-mouth ritual of smoking. And it remains unclear if pouches are as effective for smoking cessation as e-cigarettes have proven to be.

The new pilot program is a quiet admission that the PMTA process is broken. It is a small step in the right direction. But, to truly fulfill its public health mission, the FDA must expand this accelerated pathway to include e-cigarettes. Doing so would give adult smokers a full range of life-saving options and allow legal U.S. companies to outcompete the growing illicit market. Streamlining the PMTA process for e-cigarettes is not just sound policy, it is a long overdue correction to a harmful regulatory failure.

The post The FDA’s plan to fast-track nicotine pouches is long overdue. But why aren’t vapes included? appeared first on Reason Foundation.

The latest National Youth Tobacco Survey found that 5.9 percent of middle and high school students were using e-cigarettes in 2024, down from 7.7 percent in 2023 and the lowest level of youth use recorded in a decade, and nothing close to what could reasonably be described as an epidemic. Rather than using the notion of a “child vaping epidemic” to justify tighter restrictions, Makary should focus on the 28.8 million adult smokers who face the most significant health risks and expand the number of FDA-authorized alternatives that can help them transition from combustible cigarettes to far less harmful products. 

Why weren’t the needs of adult smokers mentioned in this interview? Makary’s one-sided treatment of the issue contrasts sharply with Health and Human Services Secretary Robert F. Kennedy Jr., who, speaking only days before Makary, made clear that while shrinking the illicit vape market and protecting youth is a top priority, nicotine itself is not a carcinogen and products like e-cigarettes and nicotine pouches are “infinitely preferable to smoking.” 

As Makary’s own agency acknowledges, nicotine products exist on a continuum of risk, and not all carry the same level of harm. Combustible cigarettes remain the most dangerous form of nicotine use, while other products present far fewer health risks and can play a valuable role in helping adults quit smoking. Alternatives such as e-cigarettes are not risk-free, but they are significantly less harmful than smoking and help those who are not able to quit with nicotine replacement therapies like gums, lozenges, or patches. Supporting these options is a step toward better health outcomes, especially when the alternative is continuing a behavior that causes severe and preventable disease.

Many adult smokers remain unaware that switching completely to e-cigarettes can substantially reduce their exposure to harmful chemicals. A recent survey found that only about one in five U.S. smokers believes e-cigarettes contain fewer toxic chemicals than cigarettes, and even fewer recognize them as less dangerous. This knowledge gap persists despite endorsements from respected medical journals and conclusive evidence that complete substitution lowers toxicant exposure. If Makary is serious about reducing smoking-related deaths, part of his focus should be on correcting these misperceptions through targeted, evidence-based public education for adult smokers. 

The National Institutes of Health and Cochrane Review have found ample evidence through systematic reviews of randomized controlled trials illustrating that those who use e-cigarettes are more likely to stop smoking for at least six months when compared to those who use traditional nicotine replacement therapies. Despite strong evidence and endorsements from some of the most respected medical journals, U.S. policy continues to heavily restrict e-cigarettes through product bans, flavor prohibitions, and limited market authorizations. This stubbornness on e-cigarettes often ends up causing an uptick in tobacco sales. 

On The Conversation, Makary focused particularly on the problem of illicit disposable products imported from China and framed the issue primarily around youth use, which, as noted, is at an all-time low. The problem with focusing on the illicit market is that this problem itself stems from federal policy choices that limit the legal market. When FDA authorizations exclude the products that adult users prefer, such as certain flavors, device types, and nicotine strengths, consumers are more likely to turn to the unregulated market.

Economic and policy research shows that restrictive measures often fail to reduce use as intended. A Yale School of Public Health study found that local flavor bans reduced e-cigarette sales but increased cigarette purchases, calculating that for each 0.7 ml of e-liquid sales suppressed, an additional 15 cigarettes were sold. In areas with flavor restrictions for more than a year, adult-preferred cigarette brand sales rose 10 percent, and brands popular with underage users rose 20 percent.

The policy takeaway is clear: To reduce the spread of illicit products and improve public health outcomes, the FDA should authorize a broader range of regulated, appealing alternatives. When adult smokers have access to legal options that match their preferences, the economic incentives for illicit trade diminish. 

Efforts that focus only on cracking down on illegal supply while limiting lawful access will continue to drive consumers toward unregulated products, undermining both safety and public health goals. Mackary’s call for collaboration and evidence-based regulation should fully extend to vaping policy, replacing fear-driven narratives with strategies grounded in public health evidence and economic insight.

The post Evidence, not fear, should guide the FDA’s vaping policies appeared first on Reason Foundation.

It’s an idea that, if implemented carefully, could improve inmate health, reduce contraband tobacco markets in prisons, and lower prisons’ healthcare expenses without increasing risk to the public. For those of us who have spent years advocating for pragmatic, science-based policies to reduce the harms associated with tobacco use, this proposal checks nearly every box. Importantly, it also centers discussion on a population too often ignored by both the tobacco harm reduction and tobacco control movements. For that reason alone, it deserves careful consideration by all experts in the field, regardless of their ideological camp.  

Smoking among incarcerated people is staggeringly high, with estimates ranging from 70 to 80 percent. That’s roughly seven times the national average, even though tobacco has been banned in federal prisons since 2014 and removed from commissaries since 2006. Most state-run prisons prohibit smoking inside prison facilities, many extending that ban to include possession or use of any tobacco product anywhere on prison grounds.  

But like every form of prohibition, these prison tobacco bans haven’t eliminated tobacco use. Instead, illicit tobacco markets thrive in prisons, with inmates obtaining contraband cigarettes through smuggling or bribery. Some turn to improvised tobacco products—made by inmates who collect used tobacco chew spit out by guards—with some reportedly turning to more hazardous alternatives, like “spice” (synthetic cannabinoids), to mimic the experience of smoking.  

The public health rationale underlying “smoke-free prison” policies is the idea that non-smoking prisoners and guards should be protected from second-hand smoke, as well as a belief that forcing smoking inmates to break their nicotine dependence while in prison will improve their health and lead to long-term smoking cessation after release. Even if those goals justified such coercive and cruel tactics—like using solitary confinement to punish inmates caught with contraband cigarettes—the fact is that prison tobacco bans do not work. The vast majority of inmates who quit smoking while incarcerated typically relapse upon release—around 98% by some estimates. Many incarcerated people, in fact, only begin smoking while they are incarcerated.  

In his Filter article, Kirkpatrick—who is currently incarcerated in Washington Corrections Center in Shelton, Washington—argues that allowing the sale of nicotine vapes in prison commissaries could accomplish what tobacco bans have not: reduce smoking among inmates and keep them smoke-free after release. A significant amount of evidence suggests he is right.  

Numerous studies indicate that smokers who switch from cigarettes to vapes see rapid health improvements. For prisoners, that could translate into fewer smoking-related illnesses, doctors’ visits, and health emergencies. Smokers who switch to harm reduction products are also less likely to relapse—with high-quality evidence for e-cigarettes, in particular—indicating that they are even more effective for smoking cessation than traditional nicotine replacement therapies, such as the nicotine patch or gum. This could lower the rate of smoking among inmates after release, reducing healthcare costs both during and after incarceration.  

E-cigarettes, unlike other tobacco harm reduction products, might raise concerns within the context of prisons as they can pose a fire hazard or potentially be used in improvised weapons. However, prisons can opt to purchase specially designed vapes, with soft plastic casings and low-voltage, non-rechargeable batteries—like those already offered in Kentucky and Pennsylvania prison commissaries.   

And, unlike most policy proposals involving e-cigarettes, this one sidesteps the two biggest political landmines: youth use and taxpayer cost. Youth access to e-cigarettes or other tobacco harm reduction products is a non-issue in adult prisons. And there’d be no cost to taxpayers so long as prisons marked up commissary prices just enough to cover costs. But to truly succeed, this policy proposal requires careful implementation.  

Prices that commissaries charge for tobacco harm reduction products are a pivotal factor in whether this policy would succeed or fail. Kirkpatrick, in presenting his idea, reasonably points out that commissary sales of tobacco harm reduction products might generate modest revenue for prisons, which he suggests they direct toward prison maintenance and programming. However, while this potential for cost-offsetting might enhance the policy’s political appeal, any discussion about “revenue generation” from imprisoned people should justifiably raise alarm bells.  

Too many prison systems already engage in financial exploitation of inmates—charging exorbitant fees to make phone calls and send emails, inflating commissary prices, and taking hefty cuts out of low- or non-existent prison wages. Reports suggest that prisons that already sell vapes in commissaries impose markups exceeding 700% over cost. In addition to being exploitative, these sky-high prices undermine the goal of giving inmates safer alternatives to smoking.  If smoking inmates cannot afford commissary prices for tobacco harm reduction products, they will continue to smoke or turn to the contraband market, reinforcing harmful behaviors rather than replacing them. Worse, the policy could become just another revenue stream wrung out of a captive population.  

To work as intended, the safer products at prison commissaries must be attractive, affordable, and accessible, and they must be competitive with combustible cigarettes in both cost and appeal. That means avoiding price gouging, ensuring product quality, and offering inmates real choices. Offering choices to inmates might be among the harder parts of implementing this policy, particularly if prisons are limited to purchasing only those products that have received authorization by the U.S. Food and Drug Administration. Thus far, the FDA has approved only a handful of e-cigarettes, heated tobacco products, nicotine pouches, and smokeless tobacco products. Yet, affordable access to even some of these products would give inmates a chance to switch from smoking to safer alternatives and represent an improvement on the status quo.   

At its core, allowing prison commissaries to sell safer alternatives to smoking isn’t just about reducing tobacco-related disease or helping prisons save money on healthcare. It is about giving incarcerated adults some sliver of control over their own lives and health—it acknowledges their agency in a system built to deny it. That alone is reason to take the proposal seriously.  

For those working in tobacco policy, it is also a chance to put marginalized nicotine users at the center of our advocacy—an imperative too often neglected. Putting safer alternatives to smoking in prison commissaries won’t fix everything, but it is a humane place to begin that might move our criminal justice system ever-so-slightly toward human dignity.  

The post Prisons selling vapes? Smart public health policy and a step toward autonomy behind bars appeared first on Reason Foundation.

Berg’s piece cleverly presents technically true claims that lack critical context, creating a distorted picture of e-cigarettes’ role in public health. This obscuration ignores the reality that e-cigarettes are a vital tool for adult smokers seeking to quit traditional combustible cigarettes. Consider some specific claims from the AMA’s interview to highlight the gaps between their narrative and the evidence:

Claim 1: “E-cigarettes, once marketed as a safer alternative to smoking, have found a stronghold among teens and adults alike.”

This opening statement implies that e-cigarettes are no longer considered a safer alternative to smoking, but it stops short of making that claim explicitly—it’s a subtle inference designed to mislead. The truth is, e-cigarettes are still widely recognized as safer than smoking. Back in 2015, Public Health England published a landmark review that concluded e-cigarettes are approximately 95% less harmful than combustible cigarettes. Recently, King’s College London reaffirmed this observation, arguing that “vaping products rather than smoking leads to a substantial reduction in exposure to toxicants that promote cancer, lung disease and cardiovascular disease.” By omitting this context, the AMA avoids an outright lie while ignoring inconvenient facts.

The claim of a “stronghold among teens and adults alike” is equally misleading. First, youth nicotine use is at an all-time low, as evidenced by the 2024 National Youth Tobacco Survey (NYTS), which reported a decline in e-cigarette use among high school students from 10% in 2023 to 7.8% in 2024. Second, while e-cigarette use among adults has risen, overall adult nicotine use has remained stable since 2017, according to a CDC review of the National Health Interview Survey (NHIS). Meanwhile, cigarette smoking among adults fell to a record low of 11% in 2024, which suggests that adult smokers are switching to e-cigarettes without a significant increase in new nicotine users—a public health victory the AMA fails to acknowledge.

Claim 2: “While vape use went down between 2023 and 2024, for the 11th year in a row, e-cigarettes have been the most commonly used tobacco product among middle- and high-school students…”

The AMA highlights the decline in youth vaping between 2023 and 2024 but omits the broader trend: youth e-cigarette use has dropped nearly every year since 2019. By focusing on e-cigarettes as the “most commonly used tobacco product” among youth, the AMA distracts from the fact that overall youth nicotine use is at a historic low. The 2024 NYTS reported that only 10.1% of high school and 5.9% of middle school students currently used any tobacco products in 2024, a significant decline from previous years that should be celebrated. Indeed, current cigarette smoking among many youth demographics, such as black high school students, is now so low that it’s statistically indistinguishable from zero.

Claim 3: “Vaping not shown to help you quit… No e-cigarettes or vapes have been found to be safe and effective by the Food and Drug Administration (FDA) in helping smokers quit…”

It’s true that the FDA has not approved any e-cigarette as a safe and effective smoking cessation tool—but this is a regulatory failure, not a reflection of the science. The science is clear: E-cigarettes do help smokers quit. An ongoing review by Cochrane Library that was updated this year found that nicotine e-cigarettes are much more effective than all of the traditional nicotine replacement therapies that are FDA-approved, like patches or gums. Such observations motivated a 2024 editorial in The New England Journal of Medicine, which urged the medical community to “add e-cigarettes to the smoking-cessation toolkit,” highlighting the overwhelming scientific evidence that they can save lives.

The burdensome regulations that the FDA has arbitrarily produced have made it nearly impossible for e-cigarette manufacturers to make cessation claims, as none have yet to successfully navigate the process. The FDA has barely approved any e-cigarettes to be legally sold (PMTA), and none to be advertised as modified risk products (MRTP). This regulatory framework prevents e-cigarette manufacturers from disclosing truthful information about their products, which prevents smokers from knowing that they can switch to a less harmful alternative—a consequence the AMA fails to address. Some legal scholars and I argue that these laws violate free speech protections under the First Amendment.

Claim 4: “Using any other tobacco product or any other product that contains nicotine is not actually quitting.”

Dr. Bangash’s assertion that vaping isn’t “quitting” because it involves nicotine misses the point of harm reduction. The goal of switching to e-cigarettes isn’t necessarily to end nicotine use but to reduce health risks. While long-term data on e-cigarette use is still emerging, early studies are promising. A 2017 study in the Annals of Internal Medicine found that former smokers who switched to e-cigarettes had significantly lower levels of carcinogens in their saliva and urine compared to current smokers. And a 2018 study published by the AMA itself noted that within a year of switching to e-cigarettes, former smokers’ blood carcinogen levels were nearly indistinguishable from those of never-smokers.

The benefits are particularly striking for vulnerable populations, such as pregnant women. Smoking during pregnancy is well-known to cause adverse outcomes like low birth weight and miscarriage. However, a 2019 presentation published by the American Journal of Obstetrics & Gynecology found that babies born to mothers who exclusively used e-cigarettes during pregnancy were nearly indistinguishable in health outcomes from those born to nonsmokers. Leading publications, including The Lancet’s EClinicalMedicine, have replicated these results multiple times. By dismissing vaping as “not quitting,” the AMA overlooks significant harm-reduction benefits for both adults and children.

A call for nuance and honesty

Perhaps most troubling is the AMA’s failure to encourage adult smokers to switch to vaping. In 2023, the CDC reported that 24.3 million U.S. adults still smoked combustible cigarettes, contributing to approximately 447,000 smoking-related deaths that year. Such circumstances have motivated The New England Journal of Medicine to issue an editorial calling on clinicians to recommend e-cigarettes to smokers in appropriate situations, emphasizing the potential to save lives through harm reduction. Yet the AMA’s focus on youth vaping—despite declining rates—overshadows this urgent need, perpetuating a narrative of fear rather than opportunity.

The AMA should be a beacon of scientific integrity, not a purveyor of misleading narratives. Instead of obscuring reality, the AMA should foster a nuanced discussion about the competing interests of promoting e-cigarette use among adult smokers while minimizing youth exposure to nicotine. E-cigarettes are not risk-free, but they are a proven tool for reducing the harm caused by smoking—a fact supported by decades of research. By ignoring this reality, the AMA undermines public health and misses a critical opportunity to save lives.

The post The AMA’s misleading narrative on vaping harms public health appeared first on Reason Foundation.

Data from Massachusetts’ Multi-Agency Illegal Tobacco Task Force shows a surge in illegal vape seizures from 71,746 in 2022 to 308,100 in 2024. The number of cigarette packs seized during that time declined significantly from 18,483 to 5,029, and cigar seizures stood at 152,075, more than in 2023 but less than in 2022. The task force says it is seizing so many illegal products that it’s having difficulty storing and destroying them, with smugglers becoming ever more sophisticated in avoiding their investigations.

When Massachusetts banned flavored tobacco in June 2020, the move was paired with a 75 percent wholesale tax on e-cigarettes and hailed as a triumph for public health. 

“The Massachusetts law sets a tremendous example that other states and the entire nation should follow in order to stop the tobacco industry’s predatory targeting of kids and communities of color once and for all,” said the then-head of the Campaign for Tobacco-Free Kids, Matthew Myers, in a press release. 

Following the latest task force report, some of the ban’s most vigorous opponents highlighted that the predictions they made when the ban passed are coming to fruition. 

“These numbers are absolutely staggering and prove what NECSEMA [the New England Convenience Store & Energy Marketers Association] has warned from the start—Massachusetts has created the perfect environment for illegal smuggling,” said Peter Brennan, executive director of NECSEMA. 

So far, only California has followed Massachusetts’s example, and it’s easy to see why.

Compare tobacco use in Massachusetts to a state without a flavor ban like Michigan. Since 2020, smoking in Massachusetts has fallen by just 1.3 percentage points, whereas in Michigan, it fell by 4.8 percentage points. Youth vaping,  a significant motivation for the Massachusetts ban, has fallen substantially. However, the decline of youth vaping since 2019 was a nationwide trend not unique to Massachusetts, with some non-flavor ban states like neighboring New Hampshire experiencing equally impressive declines.

Whatever the intentions of the flavor ban, it’s clear that the alleged benefits were overstated, and Massachusetts is bearing a significant cost in lost revenue and increased criminality. Tobacco excise taxes in the Bay State fell from $526.6 million in 2020 to $354.3 million in 2024.

The report catalogs a series of investigations, searches, and prosecutions to clamp down on the illicit market but points out that the Commonwealth’s high tax rates on tobacco products remain a strong incentive for smugglers to import products from low-tax states. In 2019, Massachusetts was ranked 12th in the nation for inbound cigarette smuggling, but by 2022, it jumped to fourth. According to the Tax Foundation, around 40 percent of cigarettes sold in Massachusetts are smuggled in from out of state.

To help crack down on the illicit trade, the task force recommends, among other changes, the creation of new criminal provisions to punish people who sell tobacco products without a license. Because enforcement funding is unlikely to be increased significantly, and Massachusetts borders states with lower tobacco taxes or no flavor bans, it’s doubtful these new measures would significantly impact the illicit market.

Though legislators have little appetite to repeal the flavor ban, some of its worst effects could be ameliorated by exempting safer alternatives to cigarettes that have received authorization for sale from the Food and Drug Administration. These products include e-cigarettes, nicotine pouches, and heated tobacco in flavors other than tobacco that the agency has deemed to be “appropriate for the protection of public health,” meaning the benefits they present to adult smokers trying to switch to a safer product outweigh the risks of youth using them. 

Giving smokers legal options for safer nicotine alternatives could make some dent in the illicit market and would be a win for health. Other states considering flavored tobacco prohibitions should closely examine Massachusetts and see if it’s a situation they’re sure they want to replicate.

The post The failure of Massachusetts’ tobacco flavor ban appeared first on Reason Foundation.

The latest findings of the Cochrane Review—a gold-standard library of evidence to inform healthcare decision-making—could help steer the agency toward a smoking cessation approach that prioritizes equipping individuals with evidence-based solutions. Measures like capping nicotine in cigarettes, proposed by the Biden administration, create more problems than they solve, while harm-reduction tools like vaping are already proving effective in helping people quit smoking at higher rates.

For millions of Americans, vaping has succeeded where traditional smoking cessation methods have failed—offering an accessible, satisfying alternative that works. The Cochrane Review finds that nicotine e-cigarettes increase quit rates by 59% compared to nicotine replacement therapy (NRT) and 96% compared to behavioral support alone. Yet, instead of embracing this public health victory, e-cigarettes have been vilified, overtaxed, and regulated. By prioritizing abstinence-only messaging and waging war on vaping, we ignore real-world benefits and push people toward a far worse alternative—cigarettes.

Analysis from the National Health Interview Survey (NIHS), including data from 1990 to 2022, reveals that as e-cigarette use increased, smoking rates declined faster than expected—especially among younger adults. The groups most likely to vape—ages 18 to 34—saw the steepest drops in cigarette smoking, while those who didn’t take up vaping saw no significant acceleration towards quitting. This means that e-cigarettes are not keeping people hooked on smoking; they’re replacing it. 

Other countries are leveraging vaping and seeing its positive effects firsthand. The U.K.’s National Health Service (NHS) Better Health Report acknowledges vaping as “one of the most effective tools for quitting smoking.” They have the numbers to support their claims—with nearly three million people having quit smoking with a vape in the last five years. 

Why does vaping work so well as a cessation tool? It mimics the smoking experience, maintaining the hand-to-mouth motion and inhalation experience—unlike traditional patches and gums. Vaping also provides flexible nicotine control, allowing smokers to start at a higher nicotine concentration and gradually reduce their intake over time—tailoring the quitting process to their individual needs. It also reduces exposure to toxic chemicals. Regular tobacco smoke contains 7,000 chemicals, including tar and carbon monoxide, which cause cancer, lung disease, and heart disease. 

Despite the compelling data, the United States takes an extremely aggressive stance against e-cigarettes. The FDA has rejected countless vaping products and failed to adequately inform the public that vaping is a safer alternative to smoking. These actions give people zero incentive to switch, leaving many using traditional cigarettes or turning to unregulated black-market vape products. History has shown that these prohibitive effects are disastrous. 

With a new FDA head soon to take the helm, the agency has the chance to rethink its approach and offer a method to bridge the gap between traditional cessation aids and total abstinence. Instead of demonizing e-cigarettes, we should recognize them as a resource for public health. Not all nicotine products are created equal, so we shouldn’t regulate them like they are. 

As the Cochrane Review has demonstrated, nicotine e-cigarettes offer a significant advantage over traditional NRT, and public messaging must be clear and evidence-based: Vaping is significantly less harmful than smoking and is a viable smoking cessation tool. Will the FDA course correct? One can hope this new administration will bring policy decisions that reflect the best available evidence—rather than outdated fears.

The post Will Martin Makary’s FDA listen to the evidence on e-cigarettes? appeared first on Reason Foundation.

Flavored tobacco is allegedly responsible for a litany of harms, including an ”epidemic” of youth use. Advocates claim banning these products will have few to no negative consequences. But since then-Mayor Michael Hancock vetoed the last ban in 2021, the picture of tobacco use in Colorado and across the country has changed dramatically, and a ban now makes even less sense.

According to the Healthy Kids Colorado Survey (HKCS), vaping among high schoolers fell 46 percent from 16.1 percent in 2021 to 8.7 percent in 2023. Youth smoking remains low at 3.1 percent. Even among the minority of youth who vape, only one in five say they do so because they’re available in flavors, whereas 52 percent do so because a friend or family member used them. Among those who smoke cigarettes, a minority of 30 percent use menthol cigarettes. 

For context, 12 percent of Colorado high schoolers binge drink at least once a month, and 13 percent use marijuana, according to HKCS. However, proposals to ban pineapple-flavored hard seltzers or blackberry banana kush have not been forthcoming from the Denver City Council. According to the 2024 National Youth Tobacco Survey, youth tobacco use nationwide is at a 25-year low, an achievement won within the framework of a legal and regulated marketplace.  

Because youth tobacco use is plummeting, it’s worth noting that bans on flavored products may backfire and increase smoking. Bans on all flavored tobacco products, including flavored e-cigarettes, actually increase the number of cigarettes purchased. According to a 2023 study by researchers at Yale, Georgetown, and the University of Missouri, for every flavored e-cigarette pod not sold because of a flavor ban, 12 additional cigarettes are sold. Since e-cigarettes are significantly safer than combustible cigarettes, as the Food and Drug Administration (FDA) acknowledges, and are the most popular method for quitting smoking, flavor bans represent a significant threat to public health. 

“There’s unintended negative effects that are really important to think about,” said Michael Pesko, who co-authored the research, commenting on a similar proposal in Kansas City, Missouri. The Kansas City Council decided to hold the ban for further study.

Flavored tobacco bans can also come at a hefty financial price. When Massachusetts became the first state to ban flavored tobacco products in 2020, it lost $125 million in cigarette and smokeless tobacco revenue in the first fiscal year, as purchases of cigarettes and other tobacco products soared in neighboring New Hampshire and Rhode Island. Some small businesses, such as hookah lounges, face the threat of closure because almost all hookah is flavored.

Perhaps the most troubling aspect of Denver’s flavor ban is that it would deny residents access to products the FDA has authorized as “appropriate for the protection of public health.” The FDA has authorized 34 e-cigarette products for sale, some menthol-flavored, as well as several smokeless tobacco products and heated tobacco products in a variety of flavors. The agency authorized these products because, after an extensive review, they found that they were beneficial to public health because they are safer than cigarettes, help smokers quit, and do not have any significant appeal to youth.

Prohibitions always have a superficial appeal but are often not evidence-based policies. Instead, “evidence” is mustered to support a preordained conclusion. Betting on prohibition to deliver a safer, healthier future for kids has a poor record. The Denver City Council should avoid making a costly mistake and reject a tobacco flavor ban.     

The post Denver should reject a flavored tobacco ban appeared first on Reason Foundation.

Each state varies in its approach to smoking cessation programs. But there is a nearly universal strong anti-vaping stance across states that considers e-cigarettes to be just as undesirable as traditional cigarettes. It’s atypical for a national health organization or individual cessation program to include vapes in their official guidelines. Still, many have endorsed them as a valid option for those looking to quit.

Contrary to widespread belief, there is substantial proof that e-cigarettes are a viable and successful cessation tool. The Cochrane Review, a well-regarded research institution that prides itself on evidence-based healthcare guidance, concluded that those who used nicotine-containing e-cigarettes in their quitting attempts were 60% more likely to succeed than those who use standard nicotine replacement. Another bout of misinformation would also lead most to believe that vaping and smoking are comparable in the harm they inflict on the individuals who use them. The Institute of Psychiatry, Psychology, and Neuroscience (IoPPN) at King’s College London finds vaping to be at least 95 percent less harmful than cigarette smoking. 

The United Kingdom’s National Health Service (NHS) recognizes vaping as a successful smoking cessation strategy and has included e-cigarettes in its official guidelines. However, it emphasizes that quitting smoking entirely provides the most health benefits. This strategy balances educating and respecting individuals who smoke by providing them with the most current information possible. 

The New England Journal of Medicine (NEJM) has also taken a significant step toward changing the present social paradigm, publishing an editorial urging American healthcare professionals to reassess their negative opinions of e-cigarettes as a harm reduction tool. Providing holistic and current data is the only way to ensure that we are putting our best foot forward in public health efforts.

Traditional cessation programs based on abstinence principles and behavioral intervention have been found ineffective for many smokers, yielding a mere 7-16% success rate. States need a shift in program design and approach. By incorporating e-cigarettes as a smoking cessation option, programs will be more inclusive of those who are unable or unwilling to quit via nicotine replacement therapy, total abstinence, or other means. A complicated problem involving individuals with varying degrees of addiction needs a broader range of treatment options and equitable access to more effective quitting aids.

To better achieve their smoking reduction goals, state health departments should update their smoking cessation guidelines to reflect the latest research and consider new tools or strategies that can be used in their programs. This culture shift would be so different from the present messaging that specialists leading these programs must be appropriately informed on the value of e-cigarettes as a quitting strategy for adult smokers. 

While state smoking cessation programs are beneficial, they must shift from an abstinence-based definition of success to one that includes harm reduction techniques as well. Substantial evidence supports the inclusion of e-cigarettes in treatment programs and recommendations. Including these harm reduction measures in our toolkit will provide a thorough and successful path to quitting, lowering overall death and disease rates. 

The post Why smoking cessation programs should embrace vaping appeared first on Reason Foundation.

The last U.S. surgeon general’s report on nicotine was issued in 1988 when cigarettes were one of the only options for nicotine consumers, and around 32% of adults smoked.

Today, consumers have access to a broader range of products, including many that the scientific evidence indicates pose significantly lower risks compared to smoking, such as e-cigarettes, snus, heated tobacco, and modern oral tobacco. A fresh review from the surgeon general could cut through growing public confusion surrounding these products, ensuring that public health messaging keeps pace with scientific advancements. 

E-cigarettes, in particular, have risen in popularity, and nearly two decades of evidence shows that smokers who switch to vaping drastically reduce their health risks. Despite these advancements in science and technology, public misperceptions about nicotine and confusion over e-cigarettes have only grown.  

Nicotine has been vilified due to its association with combustible tobacco products. Cigarettes are undeniably harmful and are a leading cause of lung cancer, heart disease, and other serious conditions. However, while nicotine plays a role in smoking’s habit-forming nature, researchers have long been aware that the health risks associated with smoking are due not to nicotine but rather the nicotine delivery method cigarettes employ: combustion. Without the smoke and tar created by lighting tobacco and paper on fire, nicotine use is not linked to the diseases associated with smoking. For example, nicotine replacement therapies, like the nicotine patch or gums, are generally regarded as safe for most users, for long-term use, and even for pregnant smokers who cannot otherwise quit.  

Nearly two decades of research on e-cigarettes has repeatedly vindicated e-cigarettes as a lower-risk alternative to combustible smoking. E-cigarettes have also been tacitly endorsed as a method of tobacco harm reduction by various representatives of the Food and Drug Administration (FDA)—the agency responsible for regulating tobacco products and communicating the relevant health information about such products to the public. Brian King, the current director of the FDA’s Center for Tobacco Products (CTP), has noted that adults who switch completely from smoking to vaping can improve their health, a view echoed by other FDA representatives, including former FDA Commissioner Scott Gottlieb and former CTP Director Mitch Zeller. King, however, cautions that while vaping is generally safer than smoking, some vaping products are “more risky” than others.  

Despite the acknowledgment that there is a spectrum of risk when it comes to tobacco products and e-cigarettes, neither King nor anyone else at the FDA has clearly specified which products or types of e-cigarettes might be on the safer or riskier side of that spectrum. Nor has the FDA meaningfully updated its public messaging strategies to reflect this shift in understanding. As a result of the FDA’s failure, public knowledge about nicotine and the lower risks associated with e-cigarettes has only grown more muddled, even as the science on these issues has become clearer.  

In 2012, when the science of e-cigarettes was still developing, only about 13% of adults incorrectly believed that e-cigarettes were as harmful as or more harmful than smoking. Yet, as research increasingly demonstrated that e-cigarettes are a lower-risk alternative, this public misperception grew. By 2020, nearly 65% of adults held this mistaken belief.  

Alarmingly, the falsehood is even more prevalent among smokers—the very people who could benefit most from accurate information about nicotine products—with 88% of adult smokers believing as of 2023 that e-cigarettes are no safer than smoking. Physicians might be able to correct these myths, but even they are confused about nicotine. A 2021 study revealed that a shocking 80% of U.S. physicians mistakenly believe that nicotine is the cause of tobacco-related cancers. On the contrary, there is a broad scientific consensus that while smoking exposes smokers to numerous carcinogens, nicotine is not one of them. Without the knowledge that e-cigarettes offer a safer alternative to smoking, fewer smokers will switch, more will continue to smoke, and more will die as a result.  

The FDA has been aware of the growing public misinformation since at least 2017, when then-Commissioner Scott Gottlieb unveiled the agency’s new approach to tackling tobacco-related harm. The ambitious plan centered on taking a more sober and scientific perspective on the role nicotine plays in addiction and disease, with a key component aimed at educating the public about the relative risks of different nicotine-consumption methods. However, apart from informal acknowledgments from staff and a single page on its website, the FDA has done little to correct public confusion. The FDA’s failure to address a problem it has acknowledged—and, in some ways, contributed to—underscores the need for other health authorities to intervene. 

The surgeon general should initiate a comprehensive review of the evidence on nicotine e-cigarettes, summarizing what the evidence says about their risks and benefits and comparing those risks to other forms of nicotine use. Such a report could provide much-needed clarity on e-cigarettes, cutting through sensationalistic news reporting and FDA rigidity to provide the public, providers, and policymakers with the clear and actionable information they need to make science-based health decisions.  

Recent statements from the FDA suggest a willingness to embrace harm reduction more fully. However, this shift must be accompanied by robust public education efforts, which must be grounded in evidence. An updated surgeon general’s report could serve as a cornerstone of those efforts, helping to reshape public understanding and policy in a way that truly promotes health. Such a report could correct longstanding myths, correct misperceptions, and support regulatory strategies that differentiate between the harms of smoking and the far lesser risks associated with noncombustible nicotine products like e-cigarettes.  

With an updated report from the surgeon general, we can better align public health policy with scientific evidence about e-cigarettes and provide individuals with the information they need to make better health choices. 

The post The case for a surgeon general’s report on e-cigarettes  appeared first on Reason Foundation.

Youth vaping was declared an “epidemic” by former U.S. Surgeon General Jerome Addams in 2018. Six years later, it’s clear the language of epidemics no longer accurately describes patterns of youth vaping, if it ever did.

Two questions arise from the rapid decline of youth vaping. First, what caused such a substantial fall in the number of kids experimenting with vaping? Second, how should policymakers, regulators, and commentators respond to this trend?

There’s no single answer as to why kids no longer find vaping as attractive as they once did. Critics of vaping are quick to point to the number of e-cigarettes the Food and Drug Administration (FDA) has purged from the legal market and decisions in some states to ban flavored e-cigarettes outright. 

These answers are hardly convincing. Since a handful of states and the FDA started cracking down on flavored e-cigarettes, a wave of single-use flavored vapes flooded in from China to replace products that were previously legal. Disposable flavored vapes, mostly sold in the gray and black market, now account for around 60 percent of all e-cigarette sales. The influx invited hearings in Congress and raised concerns about fly-by-night companies skirting FDA regulation.

But even as flavored vapes remain ubiquitous in most of the country, youth vaping continues to decline. A more likely explanation for the lack of youth interest in e-cigarettes is a combination of an increase in the tobacco age to 21, greater engagement among parents and educators to prevent their kids from vaping, and the reality that some teen trends fall out of fashion as quickly as they rise.

The youth vaping epidemic may be over, but smoking still causes hundreds of thousands of preventable deaths, and while youth tobacco use should always be a concern for policymakers, when the facts change, policy should follow. In 2017, Georgetown University Medical Center estimated that 6.6 million premature deaths could be avoided if smokers switched to vaping. Seven years later, both federal and state governments have failed to maximize the public health gains that vaping offers. 

Companies trying to get their vaping products authorized by the FDA and into the hands of adult smokers who want to quit face regulatory barriers so high that more than 99 percent of product applications submitted to the FDA have been rejected. Because of unclear public health messaging, most adults incorrectly believe vaping nicotine is just or more dangerous than smoking, despite overwhelming evidence to the contrary.

Legislators and the FDA should shift their focus from out-of-date narratives and misbegotten policy responses. Banning flavored e-cigarettes hands the market to bad actors, and higher e-cigarette taxes remove the incentive for adult smokers to switch to a safer product.

The FDA has belatedly recognized the problem of misperceptions of e-cigarettes and is currently investing resources to discover how best to communicate to adult smokers that not all nicotine products carry the same level of risk. But the slow pace of change and lack of interest in reforming the FDA’s regulatory processes means that many of more than 30 million adult smokers in the U.S. will continue to do so for longer than they otherwise would.

Youth vaping has declined at a steady clip since 2019. Still, many lawmakers, anti-vaping campaigners, and media outlets continue to frame vaping as a dangerous epidemic threatening America’s children, ignoring the benefits these products present to adult smokers trying to quit. The continuing panic over youth vaping is not cost-free. 

The post The youth ‘vaping epidemic’ is over appeared first on Reason Foundation.

Members of Congress vented frustration at the FDA over the chaotic U.S. vape market at a Senate Judiciary hearing on June 12. Spearheaded by Sen. Dick Durbin (D-Ill.), the hearing was titled “Combatting the Youth Vaping Epidemic by Enhancing Enforcement Against Illegal Cigarettes.” Officials from the FDA, the U.S. Department of Justice, anti-tobacco groups, and the e-cigarette industry all appeared to present testimony.

Senators showed Dr. Brian King, the FDA’s chief tobacco regulator, pictures of illegal vapes being sold less than a mile from the FDA’s headquarters with no apparent consequences. King insisted that the FDA needs more resources to tackle the illicit market, pointing to a new multi-agency task force established two days before the hearing that would crack down on illegal vapes. Senators worried that such a large, unregulated market was targeting kids and could threaten public health and were bewildered as to how the market has gotten so out of the FDA’s control. 

While claims of widespread youth vaping are disputable—youth vaping has dropped more than 60 percent since 2019—the issue of illegal e-cigarettes is a real one. Because the FDA fails to authorize them, almost all e-cigarettes sold today in the United States are illegal. The rise of flavored disposable vapes flooding the market from China was particularly concerning to the committee. These vapes have become increasingly prevalent since 2019 and could make up as much as 50 percent of the total e-cigarette market.  

But why are so many vapes illegal in the first place, given that they’re substantially safer than cigarettes? The answer lies in what Sen. John Cornyn (R-Texas) described during the hearing as the FDA’s “Kafkaesque” regulatory process for authorizing e-cigarettes on the U.S. market. Every model and flavor of e-cigarette must have its own application submitted to the FDA at enormous expense. Each product must demonstrate it is appropriate for the protection of public health in that the benefits for adult smokers will outweigh the risk of youth using the product.

None have met this threshold so far, according to the FDA. Exactly how a non-tobacco-flavored e-cigarette can surpass this barrier remains unclear. Earlier this year, the U.S. Court of Appeals for the 5th Circuit concluded that the agency had instituted a de facto ban on vape flavors via these regulatory hurdles.

Legitimate companies find it almost impossible to comply with the current regulatory regime. However,  companies less willing to stick to the rules have stepped into the breach to satisfy consumer demand, resulting in a huge gray and black market.

“Look, if we’re going to establish a byzantine labyrinth of regulations to do this stuff, then for heaven’s sake, at least make the regime work,” Sen. Mike Lee (R-Utah) told King. “The worst thing you can do is set those up so as to choke out U.S. producers that are trying to comply with the law and then open the floodgates so that the illegal Chinese products can move in and be sold unabated.”

The only legal vapes on the market today are sold in tobacco flavors, and few people use them. There remains a backlog of e-cigarette product applications, including applications from the former market leader, Juul. To compare, new cigarettes are authorized regularly. 

Durbin and fellow Democrats criticized the FDA for not cracking down on the supply of illegal vapes and demanded that all flavored e-cigarettes be immediately removed from the market. However, as Sen. Thom Tillis (R-N.C.) pointed out, even if the FDA leveraged the enforcement options available to the agency, it still isn’t enough to create a functioning legal market. 

Early in the hearing, Durbin claimed that tobacco companies invented e-cigarettes to hook a new generation of kids to nicotine and reverse the steady decline in cigarette sales. In reality, the e-cigarette market as we know it today was started by a Chinese chemist named Hon Lik, himself a heavy smoker, as a way of trying to quit. His initial invention birthed an industry that continuously innovates to improve standards and consumer satisfaction and has become the most popular and effective method for smokers to quit cigarettes.

Efforts to further restrict e-cigarettes will not just prove ineffective, but they may have unintended consequences. Two papers released the same week as the hearing suggest bans on flavored e-cigarettes may increase smoking among teens and adults below the age of 25.

Despite the contentious hearing, it’s unlikely the FDA will make any substantive changes that allow for more legal adult options in e-cigarettes. However, these decisions, in some form or another, may be taken out of the FDA’s hands. The Supreme Court is set to decide on June 20 whether to take on a case challenging the FDA’s current regulatory regime of e-cigarettes, which could fundamentally alter the regulatory landscape for nicotine products. 

The post Congress spotlights the FDA’s “Kafkaesque” vaping regulation appeared first on Reason Foundation.

The main point of contention surrounds the WHO’s position on e-cigarettes. In the weeks before this year’s WNTD, WHO released a report titled “Hooking the next generation: How the tobacco industry captures young customers.” The document contains recommendations and calls to action that would strike most people as unobjectionable, such as ensuring tobacco products aren’t sold or marketed to kids. 

But the report also frames e-cigarettes, nicotine pouches, and heated tobacco products as threats to public health without any recognition that they are safer than smoking or that they have helped tens of millions of smokers across the world kick cigarettes for good. The report compares claims that e-cigarettes are less harmful than combustible cigarettes with the tobacco industry’s past messaging about low-tar cigarettes being less dangerous and says that there’s insufficient evidence to conclude these alternatives are effective in helping smokers quit.

Shortly after the report’s publication, Dr. Sarah Jackson, the principal research fellow for the Tobacco and Alcohol Research Group at University College London, challenged WHO’s negative take on e-cigarettes. “Large evidence reviews, conducted independent of industry, consistently conclude that while vaping is not risk-free, it poses only a small fraction of the risks of smoking tobacco,” Jackson told the Science Media Research Center. Jackson also referenced the Cochrane Review, which concluded that vaping is more effective than nicotine replacement therapies, such as gums or patches, for smoking cessation.

WHO’s report is of a piece with its wider messaging on safer nicotine alternatives. WHO’s explainer on e-cigarettes erroneously links nicotine vapes to incidents of lung damage and death that were found to be caused by tainted illicit marijuana cartridges. The most basic question of whether e-cigarettes are safer than cigarettes is not answered on WHO’s website. WHO also claims e-cigarettes haven’t been shown to be effective for smoking cessation at the population level and that there is “alarming evidence” on the negative health effects of vaping.

For policy recommendations, if e-cigarettes aren’t banned outright, WHO recommends banning all flavors other than tobacco, raising taxes, and “limiting the concentration and quality of nicotine.” In a series of articles published at Medium, veteran journalist Marc Gunther highlighted brazen examples of misinformation from the WHO. In April 2024, the WHO tweeted that vaping increases your risk of seizures, typically within 24 hours. The study was based on a small sample of self-reports with no evidence of causality. Neal Benowitz, a professor of medicine at the University of California, San Francisco, who specializes in nicotine, wrote in 2020 that the study shouldn’t discourage smokers from switching to vaping.

Another WHO tweet in March 2024 claimed it’s a myth that e-cigarettes and heated tobacco products are safer alternatives to cigarettes. Even regulators that have been hostile to e-cigarettes, such as the U.S. Food and Drug Administration, concede that the basic science demonstrates e-cigarettes to be safer than cigarettes.

Referring to WHO’s social media messaging and website content, Gunther told the YouTube show RegulatorWatch, “They have both spread unwarranted fear about the risks of e-cigarettes, and they discourage people from using e-cigarettes as a way of quitting smoking even though there’s really strong independent evidence that for many, many people e-cigarettes have become the best way to quit smoking.”

Gunther fears the WHO’s messaging will have the biggest impact on low- and middle-income countries that lack a well-developed public infrastructure and rely on the WHO for accurate information and sound policy recommendations. His fears are not without cause. In 2021, Dr. Harsh Vardhan, India’s health and welfare minister at the time, was awarded the WHO Director-General’s Special Recognition Award for driving forward legislation banning all e-cigarettes and heated tobacco products in India.

“Fundamentally, in the advice they give to other countries, they’re terrible on e-cigarettes,” Gunther said “Then, in their public communications, they’ve consistently spread fear and minimized the benefits of e-cigarettes.” According to polling from Ipsos conducted for the We Are Innovation think tank, three-quarters of smokers globally incorrectly believe vaping is just as harmful or more harmful than smoking.

If the WHO continues to promote messaging that is out of sync with the best scientific evidence and guidance, it should be discounted as a credible source of information for governments trying to give their citizens the best options to improve their health.

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First, let’s address the lack of evidence. While fentanyl has allegedly been detected in illicit cannabis vapes in a handful of cases and is present in “fentanyl vapes” designed for and used explicitly for opioid use, there is no evidence of a nicotine e-cigarette testing positive for fentanyl. Moreover, while there might be an economic incentive to substitute or dilute illicit opioids with cheaper and more potent fentanyl, the same does not extend to nicotine e-cigarettes, all the ingredients of which are legal and cheaper compared to fentanyl.  

Nearly every news item or report referring to fentanyl in “vapes” makes it clear that the vapes in question are not e-cigarettes but illicit and unregulated vape cartridges, used intentionally to consume opioids or other controlled substances, like cannabis. Rather than revealing some hidden dangers associated with nicotine vaping, these stories highlight the well-known hazards of illicit drug markets created by prohibition. Lawmakers should keep this in mind as they discuss e-cigarette regulation, lest they unintentionally manifest the outcome they fear. 

At best, raising questions about fentanyl in e-cigarettes is a waste of Califf’s time. At worst, it publicly conflated two distinct policy areas, illicit drug markets, and the nicotine vaping market, increasing public confusion and diverting attention from effective policy approaches to both arenas. If anything, stories regarding fentanyl in illicit drug markets ought to prompt lawmakers and regulators to resist fear-mongering over e-cigarettes, lest they succumb to the same type of sensationalism that led to the prohibitionist drug policies that contributed to the fentanyl crisis. 

Despite youth vaping hitting a 10-year low, the moral panic surrounding youth use of e-cigarettes continues to dominate the discourse over tobacco harm reduction. That panic led to the adoption of heavy-handed restrictions on e-cigarettes, some bordering on outright bans, with little discussion of the effect on adult smokers or other unintended consequences. As a result of those restrictions and the FDA’s heavy-handed regulations, nearly all e-cigarette products produced in the U.S. have been removed from the market, creating a vacuum quickly filled with a flood of disposable e-cigarettes, largely produced in China. While fentanyl hasn’t yet made its way into the illicit e-cigarette market, the likelihood of this type of contamination only increases the closer we get to e-cigarette prohibition, driving more consumers and demand into the illicit market and toward products of unknown origin and quality.  

Public health policies should be based on evidence, whether regarding illicit substances or legal adult products, like e-cigarettes. Demonizing nicotine vapor products by linking them to problems within illicit drug markets does nothing to address real public health issues or the rampant misperceptions the public has about e-cigarettes. Numerous high-quality studies have demonstrated the role e-cigarettes can play in smoking cessation and their enormous potential as a harm reduction tool, something even the head of the FDA Center for Tobacco Products, Brian King, admits to. Yet a growing portion of the public mistakenly believes that e-cigarettes are as or more dangerous than smoking, potentially deterring smokers who cannot quit from switching to something far less harmful to their health.  

If anything, the unfounded fear of fentanyl in e-cigarettes provides the FDA with an opportunity to educate the public about the relative risks of e-cigarettes compared to smoking and to reaffirm the agency’s commitment to modernize its approach to tobacco and nicotine around harm-reduction principles. If lawmakers and regulators wish to avert creating a large illicit e-cigarette market and similar hazards observed in illicit drug markets, they should ignore the sensationalism and focus on fixing the FDA’s broken approval process so that consumers can have access to approved and regulated products rather than turning to the black market. 

The post Fentanyl in e-cigarettes: The making of a myth  appeared first on Reason Foundation.

Cigarette tax advocates use many popular arguments to make their case, arguing that taxes deter people from smoking, encourage people to quit, and cover the costs of smoking-related diseases in the healthcare system. However, any benefits must be weighed against the regressive nature of these taxes as most smokers have lower incomes, and higher taxes could cause an increase in illicit sales.

In Rhode Island, one in five cigarette packs sold is from out of state. 

Taxes on e-cigarettes can be even more detrimental. Many people misunderstand the potential benefits of e-cigarettes, believing they are just as or more harmful than cigarettes. However, e-cigarettes are safer than traditional cigarettes and help smokers quit, as acknowledged by the Food and Drug Administration and health agencies in countries from the United Kingdom to Canada. The prestigious Cochrane Review concludes e-cigarettes are more effective than traditional nicotine replacement therapies in helping smokers quit cigarettes.

Because e-cigarettes are substitutes for traditional cigarettes, policies that make e-cigarettes more expensive incentivize people to continue smoking cigarettes instead of switching to a safer alternative. 

A growing body of evidence shows how harmful e-cigarette taxes can be on public health. An analysis of Minnesota’s 95 percent e-cigarette tax found 32,400 more smokers than there would have been without the tax.

A separate study focusing on young adults aged 18-25 found e-cigarette taxes were associated with reduced vaping but were similarly associated with increases in smoking. These effects are also seen in youth aged 18 or younger, with the authors concluding that “the unintended effects of… taxation may considerably undercut or even outweigh any public health gains.”

Just as revealing as the empirical literature is how financial analysts reacted when the United Kingdom announced a new vape tax in March, with experts at Citibank believing higher taxes on vapes are good news for the bottom line of two big tobacco companies. The higher the e-cigarette tax, the higher the likelihood that people will smoke traditional cigarettes. 

Rhode Island already suffers from an illicit vape market thanks to its prohibition of flavors other than tobacco, which is also set to be codified in the budget. However, implementing such a high vape tax would supercharge the illicit market, especially as it is set to be higher than taxes in New Hampshire, New York, Massachusetts, and Connecticut. Rhode Island’s legitimate vape retailers who are helping people quit smoking and providing employment opportunities while doing so would be severely impacted. When Pennsylvania introduced a 40 percent vape tax in 2016, 110 vape shops shut their doors within one year. 

Around 1,800 Rhode Islanders die every year from smoking-related diseases. Many smokers wish to quit cigarettes but find products like nicotine patches and gums, which have a 90 percent failure rate, unsatisfying and therefore fail. E-cigarettes are a critical tool for reducing the harm associated with smoking. A fundamental principle of tobacco tax policy should be that less dangerous products are taxed significantly lower than the most dangerous products. If these taxes aim to improve public health, the vape tax should be substantially lowered or scrapped altogether. Rhode Island does not need to raise revenue off the backs of people trying to quit smoking.

The post Rhode Island Gov. McKee’s proposed e-cigarette tax is a bad approach to public health appeared first on Reason Foundation.

From a public health perspective, the news is good. The latest National Youth Tobacco Survey (NYTS), an annual CDC-administered survey of middle and high school students, reveals that only 10 percent of high schoolers and just 4.6 percent of middle schoolers reported any e-cigarette use in the previous month. It signifies a 20 percent decline in youth vaping from the previous year and an impressive 60 percent drop since its peak in 2019. The survey also highlights a broader positive trend, with diminished youth interest in all forms of tobacco, particularly traditional cigarettes, as a mere 1.6 percent of youth reported current smoking. 

The youth vaping epidemic, declared by the Food and Drug Administration (FDA) in 2018, appears now to have been more of a teenage fad—one possibly partially fueled by media attention on the issue. But, while the vaping fad may be subsiding, the hysteria surrounding it continues unabated. Anti-vaping campaigns and legislation continue to sweep across the country, often swaying towards outright bans, leaving little room for a nuanced discussion of the varying risk profiles of noncombustible nicotine products, the benefits lower-risk nicotine products may provide adult smokers, or the potential unintended consequences of youth-centric policy proposals. 

Even nations with minimal youth vaping rates but high smoking prevalence began to criminalize e-cigarettes. In the U.S., lawmakers implemented a barrage of regulations, from online sales bans, restrictions on shipping, exorbitant taxes, bans on flavors, and prohibition of all sales. Regrettably, these policies meant to make e-cigarettes and other noncombustible sources of nicotine less attractive to youth have a similar effect on adults, discouraging adult smokers from potentially life-saving alternatives to cigarettes.

The reality obscured throughout the panic over youth vaping is that nicotine without combustion poses minimal risk of harm. While nicotine use carries a risk of dependency, dependency itself is not necessarily harmful. Dependency can quickly lead to harm, however, when public policy prioritizes abstinence above all other considerations, including the well-being of those who continue to use that substance. Take caffeine, for example, a different habit-forming substance that over 80 percent of Americans use daily. Caffeine addiction, though not completely without risk, is a relatively widespread dependency with few individual or social harms. Were caffeine treated like nicotine and caffeine abstinence the main focus of public policy, harms would almost certainly emerge as caffeine consumers turn—as e-cigarette consumers have done—to illicit alternatives, products of questionable quality, and non-legal sources to feed their habit, raising a host of additional risks beyond those inherent to caffeine use.

Increasingly, policymakers have embraced this reality when it comes to illicit drug use, ditching punitive anti-drug initiatives in favor of harm reduction, which prioritizes minimizing the hazards of drug use rather than seeking total abstinence. Initiatives like supervised injection sites, clean needle exchange programs, opioid replacement therapy, and overdose reversal medications are effective ways to reduce the risks drugs pose both to users and communities while maintaining respect for the autonomy and dignity of those who use drugs. Yet, when it comes to nicotine, the approach is turned on its head, embracing bans that push those who wish to use nicotine toward the most hazardous forms of nicotine use. 

Traditional combustible cigarettes are the most dangerous way to consume nicotine. Around half of all smokers are expected to die as a result of their habit. Evidence suggests that smokers who quit by the age of 40 practically eliminate their risk of future smoking-related diseases, most of which typically manifest after middle age. However, not all smokers can quit, even with the aid of smoking cessation therapies. Luckily, more than 15 years of research have demonstrated that smokers who cannot or will not quit can greatly reduce exposure to harmful toxins and significantly lower their risk of disease by switching to noncombustible sources of nicotine, like e-cigarettes, snus, or heated tobacco. E-cigarettes, in particular, have proved effective at helping smokers make this transition, more so even than traditional nicotine replacement therapies.

Nations that have embraced noncombustible nicotine products and tobacco harm reduction are already reaping the public health benefits, such as the United Kingdom, which provides no-cost e-cigarettes as part of their quit-smoking initiative that has led to 50,000 smokers quitting in a single year. Similarly, Japan, which legalized the sale of heated tobacco in 2014, has seen a 50 percent decline in cigarette sales since. Sweden, where snus—a moist tobacco snuff—is the preferred nicotine source, has virtually no smokers and enjoys the lowest rates of lung cancer in the European Union. 

Meanwhile, governments that continue to focus on youth prevention, no matter the cost, are suffering predictable consequences. Australia, which outlawed the importation of nicotine e-cigarettes in 2021 due to youth vaping hysteria, is now struggling to contain the explosion in crime and even greater access to these outlawed products Australian youth now appear to have. To a lesser degree, this is what we’re beginning to see in the U.S. as cities and states adopt increasingly restrictive laws, leaving those adults who wish to use nicotine with cigarettes as their only feasible option. 

The uncomfortable truth is that neither smoking nor any other potentially risky behavior can be eliminated through force. Attempting to do so is not only deeply inhumane but also entirely unnecessary. As the national youth tobacco survey indicates, tobacco no longer poses a major health threat to youth, and the risk of dependency posed by youth use of noncombustible nicotine is declining. The nearly 30 million American adults who continue to smoke, however, are in immediate and lethal danger and their lives should not be sacrificed to marginally reduce already low risks to youth. 

Our tobacco policies must align with the evidence and embrace harm reduction. If the goal is to save lives, some of the energy and resources spent shielding youth from the relatively minor risks of nicotine must be reallocated toward preventing death in adult smokers. If policymakers can balance the needs of both youth and adults when it comes to cannabis, alcohol, opioids, and other adult behaviors, there is no reason they cannot do the same when it comes to nicotine.

The post With youth vaping hitting a 10-year low, policymakers should focus on harm-reduction appeared first on Reason Foundation.

Here’s what you need to know to separate fact from fiction about popcorn lung, its potential causes, and whether there is a link between the disease and e-cigarette use. 

What is popcorn lung?

Bronchiolitis obliterans, or popcorn lung, is a rare disease in which the bronchioles—the lungs’ smallest airways—become inflamed and ultimately obstructed by scar tissue, making breathing difficult. The damage is irreversible, and while treatments are available, the prognosis for patients is generally poor. 

What causes popcorn lung?

The disease is associated with a number of medical and environmental factors. Around half of all lung transplant patients will develop bronchiolitis obliterans syndrome to some degree within five years. Another major risk factor for the condition is exposure to toxic inhalable chemicals used in various industries and professions. 

The condition’s link to microwave popcorn gave it its nickname. In the early 2000s, eight cases of bronchiolitis obliterans were reported to Missouri health authorities, with all sufferers reporting former employment at the same microwave popcorn plant. After analyzing the plant and current workers, researchers found the greatest risk for the disease among those employees working with or around the heated oil vats where flavoring agents are added during production. Researchers identified the flavor additive diacetyl—the most prominent chemical in the butter flavor mixture—as the likely cause of workers’ poor lung health. 

What is diacetyl?

Diacetyl is a naturally occurring chemical in cultured dairy and fermented products. Both natural and artificial diacetyl are used as flavor additives, giving a variety of packaged foods their butter flavor and aromas, including some flavored coffee beans, margarine, baking sprays, snack foods, and candies, among other items. 

Though deemed safe to ingest, animal testing conducted during the last two decades has shown that inhaling diacetyl can be hazardous to lung health. This is because, in its gaseous form, diacetyl irritates the airways. Over time and at a high enough level of exposure, this can trigger lung inflammation, damage, a build-up of scar tissue, and impaired lung function. 

Do nicotine e-cigarettes contain diacetyl?

In the early generations of nicotine vapor technology, some brands and flavors of e-cigarettes were found to contain diacetyl, particularly those intended to have a buttery or creamy flavor and aroma. The potential hazard was first identified in a 2014 study that found diacetyl in nearly 70 percent of the 160 e-cigarette products tested. This was quickly followed by a 2015 paper in which researchers at the Harvard T.H. Chan School of Public Health reported finding diacetyl in 39 of the 51 e-cigarette flavors they tested. Due to the known link between inhaled diacetyl and bronchiolitis obliterans, these revelations sparked immediate and widespread concern among health authorities, vapor consumers, and the vapor industry. 

In response, the industry across much of the world voluntarily removed diacetyl as a flavoring agent, with some of the largest retailers quickly marketing “diketone-free” e-liquid to consumers now wary of exposure to diacetyl. Governments also took action, with several, such as the United Kingdom, Australia, and the European Union, prohibiting diacetyl in vapor products. 

These steps have led to a significant decline in diacetyl-containing e-cigarette products. In a 2021 study, Canadian researchers tested 825 e-cigarettes and found just two products containing diacetyl and zero among the samples collected after 2018. 

Do e-cigarettes cause popcorn lung?

The persistence of the idea that vaping is directly linked to popcorn lung has prompted several health bodies, including Health Canada, the New Zealand Ministry of Health, and the UK Health Security Agency, to clarify that no evidence exists for such a link. Independent charities and research institutions, like Cancer Research UK and Action on Smoking and Health, have made similar statements. Yet, the myth continues to appear in news headlines around the world. (Credit where credit is due: The Washington Post, at least, published an article in 2019 debunking the myth.)  

These misleading headlines are being published at the same time anti-tobacco organizations are continuing to promote the mythical link between vaping and popcorn lung as a reason to support more restrictive policies on e-cigarettes. But, contrary to what frightening headlines would have you believe, there is no evidence that e-cigarettes cause popcorn lung. In fact, all of the evidence points to the contrary. 

For one thing, with the rise in popularity of e-cigarette use over the last 15 years, one would expect a concurrent increase in popcorn lung cases where the two are related. The news media periodically reports on individuals suffering from alleged vaping-induced popcorn lung, but none have been confirmed. Health authorities report no increase in bronchiolitis obliterans. Some countries’ health departments, such as Canada’s, have even admitted that there has never been a confirmed case of e-cigarette-associated popcorn lung in their country’s history. 

More importantly, if vaping nicotine e-cigarettes increases the risk of popcorn lung, one should expect an even clearer connection between popcorn lung and traditional smoking. Conventional combustible cigarettes contain diacetyl—significantly more than what was found in even early-generation e-cigarettes before voluntary industry changes and governmental prohibitions on diacetyl in e-cigarettes. 

The 2015 Harvard study, for example, found an average of nine micrograms of diacetyl per e-cigarette cartridge in the samples that tested positive for the chemical. Combustible cigarettes, meanwhile, contain approximately 336 micrograms of diacetyl per cigarette. This means that a cartridge-per-day vaper would be exposed to just nine micrograms of diacetyl, while pack-per-day smokers are exposed to more than 6,700 micrograms of diacetyl every day—750 times more diacetyl exposure than vapers. Yet, a link between smoking and popcorn lung has yet to materialize. In fact, during the initial studies of popcorn factory workers, researchers observed that those employees who reported smoking showed fewer signs of bronchiolitis obliterans than their non-smoking counterparts. 

If smokers are at no greater risk of popcorn lung because of the diacetyl in cigarettes, why would nicotine vapers be at risk of the disease when their exposure to diacetyl is several hundred times less than smokers? The answer: They aren’t.

The myth that vaping causes popcorn lung continues to haunt the discourse around e-cigarettes in part because it is a sensational idea. Tragic stories of individuals allegedly stricken ill by a controversial product, like e-cigarettes, make for attention-grabbing news headlines and fodder for anti-tobacco advocates. But, the glaring lack of concrete evidence refutes the notion that vaping causes popcorn lung. E-cigarettes may not be free of risk, but the facts are that they are significantly safer than smoking, and whatever risks might be associated with vaping, popcorn lung is not one of them.

The post Debunking the myth that vaping causes popcorn lung appeared first on Reason Foundation.

In Sept. 2021, Utah banned the sale of e-cigarettes with a nicotine concentration higher than 3%, mostly in response to the rise in youth vaping. Most of the vaping market consists of e-cigarettes that have nicotine in the 4% to 6% range. Now, Utah’s Department of Health and Human Services (DHHS) is considering changes as part of a settlement resulting from a legal challenge by the Utah Vapor Business Association.

The proposed rule change would allow the sale of any e-cigarette authorized by the U.S. Food and Drug Administration (FDA), regardless of its nicotine strength. The FDA has already approved several e-cigarettes for sale that exceed Utah’s nicotine cap. 

Utah’s caps on nicotine in e-cigarettes limit the public health potential of e-cigarettes, which can be used to help smokers switch to safer options because e-cigarettes don’t provide the nicotine that a regular cigarette can deliver.

A study published in the journal Nicotine & Tobacco Research found that smokers who tried switching to vaping were far more likely to quit cigarettes when using a higher-nicotine e-cigarette than those of a lower strength. Research also suggests that limiting vapers to lower-nicotine vapes can lead them to vape more to get their desired nicotine. 

Some fear revising Utah’s nicotine limits could induce more young people to vape. Fortunately, there’s little reason to suggest this would be the case. Youth vaping has fallen by almost 50% across the country since 2019 despite 48 states having no limit on nicotine in e-cigarettes. Ensuring access to safer, effective alternatives for adult smokers need not and has not come at the expense of reducing youth vaping. 

There are around 170,000 smokers in Utah, and the state sees 1,300 smoking-related deaths each year. Whether intended or not, nicotine caps for e-cigarettes encourage smokers to continue using combustible cigarettes rather than switching to better alternatives. Utah’s rule is especially nonsensical given that no nicotine limits exist on other harm-reduction products like nicotine pouches. 

Utah has an opportunity to reduce the number of smoking deaths by revising restrictions on nicotine vapes while informing the public about the existence of these safer alternatives. E-cigarettes are safer than cigarettes because while nicotine may be addictive, it’s the burning of tobacco and the toxicity of the resulting smoke that makes cigarettes so lethal. Because there is no burning tobacco, e-cigarettes are dramatically less harmful. As public health researcher Michael Russell once said, “People smoke for the nicotine, but they die from the tar.” 

E-cigarettes aren’t just safer than traditional cigarettes; according to the most exhaustive reviews of the scientific evidence, they’re more effective in helping people quit smoking than nicotine replacement therapies, such as nicotine patches. If every smoker in America switched to vaping, the country could avoid 6.6 million premature deaths, according to a study in Tobacco Control. And for Utah, encouraging more smokers to switch to safer alternatives could dramatically reduce the state’s current annual 1,300 smoking-related deaths.

Reforming Utah’s unnecessary and outdated nicotine cap would save lives and accelerate the demise of traditional cigarettes. DHHS should be applauded for re-examining this issue, and state regulators should embrace the potential of vaping to improve public health. 

The post How Utah can reduce smoking-related deaths appeared first on Reason Foundation.