R Street’s Dr. Joel Nitzkin testified yesterday before the Oregon Legislature regarding bills that would ban sales of e-cigarettes to minors and ban their use in areas where smoking is already prohibited. His full testimony is here. A few highlights follow:
Restrict minors’ access to e-cigarettes:
There are two reasons to implement and enforce prohibition of sales of nicotine delivery products to minors. The first has to do with adverse impacts of nicotine on the still-developing adolescent brain. The second is the documented fact that, if a person does not initiate tobacco use until after about 24 years of age, he or she is unlikely to ever become addicted to nicotine. With this in mind, not only should you to extend the age restrictions currently in place to e-cigarettes, you should also consider moving the age cut-off from the 18th to the 21st birthday. Upping the age of purchase would remove cigarettes from the high school environment.
Don’t ban e-cigarettes in public places
There is no credible public health justification for banning e-cigarettes in no-smoking areas. An estimated 70 percent to 80 percent of the indoor air pollution from cigarettes is due to side-stream smoke – the smoke that curls off the end of the cigarette when no one is sucking on it. The smoke exhaled by the smoker contributes relatively little to this pollution. E-cigarettes have no side-stream smoke…Banning e-cigarettes in no-smoking areas could do harm from a public health perspective by signaling to smokers that e-cigarettes pose the same risk as cigarettes and, by that means, inhibiting smokers from switching to these far less hazardous products.
Work for “smoke free,” not “tobacco free”
Tobacco harm reduction is an educational initiative by which smokers who are unable or unwilling to quit are advised that they can lower their risk of a potentially fatal tobacco-attributable illness by 98 percent or better by switching to any one of the smokeless products now on the American market…Since e-cigarettes are basically a nicotine-only product with only the smallest traces of the carcinogens and other toxins found in smokeless tobacco product, e-cigarettes likely carry even less risk. “Harm reduction” does not mean “harmless.” All of these products, including the pharmaceutical nicotine products, pose more of a potential health risk than usually accepted in other consumer products. None are risk free. It is only in comparison to cigarettes that they can be considered very low risk. Nicotine addicts, but it is the other toxins in cigarette smoke, when inhaled deep into the lung, that kill.
All of the 480,000 estimated tobacco-attributable deaths each year in the United States are due to a single tobacco product – the cigarette. Deaths from all other tobacco products are so low in number and so hard to distinguish from background that they are not tracked by our federal agencies. Simply changing the mantra from a “tobacco-free society” to a “smoke-free society” would align tobacco control policy with the science and evidence base.
Harm reduction could save millions of lives.
Right now, the best we have to offer current smokers is a set of pharmaceutical-based smoking cessation protocols that we know will fail about 90 percent of smokers who use them, under the best of study conditions, with results measured at six to twelve months. The flaws in the current “evidence-based” policies are fairly obvious. They do not satisfy the urge to smoke in the majority of smokers, the dose is too low, the duration of treatment too short and there is no built-in provision for self-reinforcement when the urge to smoke returns.
A modestly successful tobacco harm reduction initiative, if added to current tobacco control programming, would satisfy the urge to smoke in a majority of smokers, and would likely save the lives of 1.5 to 4.8 million current adult American smokers, with the numbers depended on the rate of switching to lower-risk, smoke-free products. In Year 20 of such an intervention, again, depending on switch rates, the annual numbers of smokers and deaths would likely be down 30 percent to 80 percent from current levels.
Interested? The entire testimony and all of the supporting materials are well worth a read. Check them out here: