Rhode Island Should Focus on Tobacco Harm Reduction, Not E-Cigarette Flavor Bans

For a time in 2019, the U.S. media was flooded with reports suggesting people were suffering vaping-related lung injuries. But there were reasons to doubt these claims. Although e-cigarettes had already been on the market for over a decade, never before had there been an outbreak of injuries and deaths resulting from the use of these devices. Additionally, there weren’t claims of similar outbreaks in other countries where e-cigarettes were also widely used, such as the United Kingdom.

The Centers for Disease Control and Prevention (CDC) set up a special unit to investigate the issue and termed the condition EVALI (E-cigarette or Vaping Product Use-Associated Lung Injury). Several governors quickly responded to the alleged crisis, using executive orders to ban the sale of flavored e-cigarettes, which were already under fire for allegedly fueling a rise in youth vaping. At the federal level, non-tobacco and menthol flavors in pod-based vaping systems such as Juul were banned until approved by the Food and Drug Administration.

But even before the CDC concluded its investigation, the cause of the outbreak became clear. Almost all of those suffering from EVALI had been vaping black market THC cartridges laced with Vitamin E acetate, a substance that cannot be mixed with nicotine e-liquid. Unfortunately, it took months for the CDC to conclude that EVALI was not the result of nicotine e-cigarettes such as those sold in vape shops.

The damage, however, was done. Public confidence in the relative safety of e-cigarettes, which was already shaky in the United States, was shattered and the urge to maintain the prohibition on the largest part of the e-cigarette market continued.

In response to the investigation, Rhode Island banned the sale of flavored e-cigarettes in September of 2019. The prohibition is still in effect today. Advocates for the state’s ban consistently claimed e-cigarette flavors were the main reason young people started vaping and posed a severe health risk to youth. In reality, the vast majority of youth experiment with vaping because of curiosity, peer influences, and even to perform vape tricks, as demonstrated by a survey conducted by the CDC.

Prohibition advocates in Rhode Island also claimed the ban was wildly popular with state residents. According to a poll conducted for the Campaign for Tobacco-Free Kids, 68 percent of respondents supported a continuation of the flavor ban. But the wording of the question was heavily weighted to elicit a favorable response as it framed these flavors as especially appealing to kids.

A separate question asked whether it was more important to protect the rights of adults to buy flavored vapes or reduce the number of kids using tobacco by banning e-cigarette flavors. Unsurprisingly, the majority opted for the latter. But the question posed a false dichotomy.

First, there is no tobacco in e-cigarettes. Second, there was no mention in any of the questions that the vast majority of adult vapers use flavored e-cigarettes and use them to quit combustible cigarettes, which are the most dangerous consumer product on the market. The choice between reducing youth vaping and giving adult smokers the option to switch to a safer nicotine alternative is a false one. Rhode Island State Rep. Julie Casimiro, once a supporter of prohibition,  recognizes the need to keep safer alternatives to smoking available for adults while protecting youth. To that end, Casimiro introduced a bill earlier this year to end Rhode Island’s prohibition on e-cigarette flavors.

Rep. Casimiro co-authored a Providence Journal op-ed that concluded:

We understand the fear and anxiety that has developed around these products, but we cannot craft functional public health policy through fear and emotions. Across the country where flavor bans have been enacted, not only has youth vaping continued to increase, but adult vape users have been forced to either use dangerous black market products or return to cigarettes, eliminating the personal and public health benefits of discontinuing combustible tobacco use.

Youth vaping is a public health problem that needs to be addressed, but not at the expense of adults who are relying on these products to lead healthier lifestyles. There is a solution, but it must come from study, facts and data, not emotions, fear and prohibition.

Casimiro’s bill strikes a delicate balance by ensuring stiff penalties for sales to youth as well as restrictions on advertisements that may be designed to appeal to minors. By allowing the flavored e-cigarettes to be sold in the state once again, Rhode Island smokers would have access to one of the most successful tools to quit smoking while ensuring youth access to these products is strictly prohibited.

Despite the ongoing COVID-19 pandemic, one can argue that traditional cigarettes came out of 2020 a winner. Cigarette sales declined at a slower rate than previous years as fewer people quit smoking. One of the reasons for this was that fewer smokers were switching to e-cigarettes.

Since Rhode Island banned the sale of flavored e-cigarettes, the evidence for their effectiveness as a smoking cessation device has become increasingly clear. The Cochrane Review, recognized as the gold standard for evidence-based medicine, concluded e-cigarettes increase the chances of someone quitting smoking compared to nicotine gum or patches. A study conducted by Yale School of Public Health’s Abigail Friedman found vapers were more likely to quit smoking if they used non-tobacco flavored e-cigarettes.

Repealing Rhode Island’s prohibition would make it easier for people to quit smoking and be a win for the small businesses. Additionally, doing away with the ban would mean the state’s vapers would no longer have to buy their product out of state, make their own e-liquid, or worse, relapse to smoking.