Prisons selling vapes? Smart public health policy and a step toward autonomy behind bars

When it comes to America’s prison system, it’s rare to find policy proposals that advance both public health and personal freedom. In the world of tobacco policy, proposals offering clear public health benefits without triggering concerns about costs or youth exposure might be even rarer. But, in a recent Filter article, author Jonathan Kirkpatrick offers a policy idea that accomplishes both: Let prisons sell safer alternatives to smoking through commissaries.  

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.

Source: https://reason.org/commentary/prisons-selling-vapes-smart-public-health-policy-and-a-step-toward-autonomy-behind-bars/