Tobacco Ban Could Lead to Poor Results

Harm reduction, not prohibition, should be Vermont lawmakers’ goal. Prohibition is nothing new in Vermont. The state was the second to ban alcohol in the 1850s.

Now, legislators in Montpelier are again flirting with the idea of prohibition by becoming the second state in New England to ban flavored nicotine products like e-cigarettes. A recently proposed bill in the state Legislature would prohibit the sale of flavored e-cigarettes. While lawmakers’ intentions are likely noble —preventing underage access and promoting public health — their approach will make it harder to curb combustible cigarette use.

Considering 15.1% of Vermonters smoke and it costs the state $348 million in health care and 1,000 lives annually, an abstinence-only approach is clearly not how to prevent smoking. Likewise, traditional cessation products haven’t been particularly effective at helping adults kick the habit, but there are ample reasons why policymakers should think outside the box to curtail smoking. A different approach — relying on harm reduction, rather than elimination — offers a better path forward to help individuals quit smoking.

This isn’t just our view — many leading public health organizations see harm reduction as a more rational strategy. The U.S. Food and Drug Administration; National Academies of Science, Engineering, and Medicine; Public Health England; and the Royal College of Physicians recognize nicotine-related products should be viewed on a spectrum of risk. This means combustible tobacco is at the most harmful end of the spectrum, whereas products like e-cigarettes are the least harmful.

Like combustible cigarettes, e-cigarettes contain nicotine, which is an addictive substance, but it has few adverse health effects. That’s largely the only similarity between the two. E-cigarettes do not burn tobacco. Combustibles do, and the process of lighting the cigarette releases some 7,000 chemicals — around 70 of which are deadly carcinogens.

Given this important fact, Public Health England has concluded “e-cigarettes are 95% less harmful than traditional cigarettes.” Considering electronic nicotine delivery systems don’t cause the same health consequences, legislators should be asking if it’s prudent to ban flavored nicotine products, rather than encourage adult smokers to make the switch.

Research has found these products are a safer and superior smoking cessation option than nicotine replacement therapies, like nicotine gum and the patch. The United Kingdom’s National Health Service has even endorsed electronic nicotine delivery systems as an effective tool for those attempting to quit smoking. In fact, they just announced a Swap to Stop scheme that will provide one million free e-cigarettes to smokers to help them kick the habit.

Adults stand to lose the most if e-cigarettes are banned in Vermont. Surveys of adult consumers have found most who make the switch from combustible cigarettes to e-cigarettes choose menthol, candy and fruit flavors. These flavors are part of how smokers disassociate from the tobacco flavoring, which helps them to quit. It’s highly likely that passage of S.18 will undermine smoking cessation efforts — a predictable outcome supported by research. Studies have demonstrated if flavors are prohibited, former smokers who use flavored electronic nicotine delivery systems might return to smoking cigarettes, while others would be discouraged from quitting.

The proposal will also have other unintended consequences. When Massachusetts implemented a ban on flavored nicotine products, it fostered an illicit market driven by cross-border trade. In-state sales declined as its citizens simply purchased the banned products in surrounding states, but this should be the least of public health officials’ concerns.

Such prohibitions can cultivate underground markets as people seek out any means necessary to obtain banned products. Without the safety protocols currently in place, counterfeit, unregulated and tainted products could proliferate in an illicit market — increasing the potential for deadly outcomes for the consumer using them.

There are better ways to stop young people from using nicotine products than prohibiting flavors: enforcing current laws, rolling out targeted prevention campaigns and the installation of vape detectors in schools. Legislators in Montpelier would be wise to heed the words of Thomas Edison: “A good intention with a bad approach often leads to a poor result.”