The following op-ed was co-authored by Brian Fojtik, a senior fellow with the Reason Foundation.


San Francisco has proudly led the nation in successfully implementing harm-reduction tools for at-risk communities. By meeting adults where they are, not where we wish they were, and offering interventions that extend the quality and quantity of life, San Francisco has helped prevent HIV (and other) infection through needle exchanges, while others raised moral objections.

More recently, the “Getting to Zero” campaign has demonstrated San Francisco’s commitment to be the first U.S. city to achieve zero new HIV infections, with pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) serving as crucial harm-reduction tools to reach this goal. These approaches are grounded in a philosophy that recognizes the dignity of every life and the need to be realistic in mitigating risks related to communicable disease.

Unfortunately, an ordinance recently proposed by the city’s Board of Supervisors—and sadly, replicated by other communities across the Bay Area—threatens this legacy as a center for liberal and humane harm-reduction policies. The legislation—which is under consideration in Oakland, San Leandro, Los Gatos, Palo Alto and Contra Costa County, in addition to San Francisco—would ban the sale of flavored vapor products to adults. These proposals are shortsighted and run counter to efforts to reduce smoking-related disease.

Vapor products are not tobacco products. They also aren’t medicines designed to treat a medical condition. They are consumer products intended for adults, which is why California already prohibits their sale to anyone younger than age 21. But they also hold immense potential to reduce the death toll from smoking by providing a much safer alternative to cigarettes. Despite a half-century campaign against smoking, there are still an estimated 40 million Americans who smoke.

E-cigarettes and other vapor products contain no tobacco and produce no toxic smoke, thus providing a considerably safer alternative to deadly combustible cigarettes. According to the Centers for Disease Control and Prevention, smoking causes 485,000 premature deaths in the United States every year. The LGBTQ community faces particular risk for smoking-related disease, as smoking rates are nearly double those found in the heterosexual population.

Additionally, a recent National Institute of Health funded study concludes that “persons infected with HIV are unusually susceptible to the adverse effects of cigarette smoking. These adverse effects include a heightened risk for lower respiratory tract infections, COPD and lung cancer.” The flavor bans being considered in San Francisco, Oakland and other nearby communities will exacerbate, rather than mitigate, these risks. To maximize public health benefits, vapor products need to be affordable, accessible and at least as satisfying as smoking. Flavors play a critical role in helping smokers to switch.

Tobacco researcher Michael Russell first observed decades ago a truism that has become common knowledge among experts: “People smoke for the nicotine, but die from the tar.” It’s not nicotine that causes the lung cancer that kills smokers. Vapor products provide smokers with the nicotine they desire without the deadly tar and carbon monoxide that comes from burning tobacco. Nicotine replacement products like the gum and the patch do the same thing, but they fail more than 90 percent of the time. Vapor products seem to work better not only because they better replicate smoking behavior and rituals, but because the vapor market allows users to customize a broad range of flavors. To keep these products from smokers who could benefit is reckless and shortsighted.

We can’t mitigate the risks of smoking, intravenous drug use or sex with multiple partners simply by wishing such behaviors away. Just as condoms, clean needles and medications reduce the risk of HIV and AIDS, vapor products dramatically reduce potential for smoking-related diseases like lung cancer, heart disease and COPD.

One of the oldest medical societies in the world—the Royal College of Physicians—has concluded that vapor products are 95 percent safer than smoking. Based on that report and others, health authorities in the United Kingdom are taking a sensible approach to tobacco harm reduction by encouraging those who won’t quit or can’t quit smoking to switch to these much less harmful products. It’s the type of approach that has inspired San Francisco in the past and one to which the city’s leaders should return.

Just as an abstinence-only approach to drug use or sexual behavior ignores reality and fails a significant segment of the population, so does an abstinence-only approach to tobacco or nicotine.


Image by Engel Ching