Just when we thought our country couldn’t make a more ass-backward move in our deranged drug policies here we are in Stupidsville again.
There are two separate problems here, the first being the recent outrage surrounding vaping/e-cig injuries and several deaths which has the TV networks, the non-medical commentariat and lately even the president (a man otherwise known for his considered judgment and stoic restraint) calling for the “BANNING!” of vaping. It is the easiest panic to counter because it seems all of the vaping injuries and deaths have involved black market vaping cartridges, not legitimately produced vaping products. A corollary of this would be to ban syringes because some people put illegal things in them and shoot up. The moral? Don’t vape with black-market cartridges. And shut up NBC, “concerned parents” and of course: shut up Trump.
Further, the scale of the problem: of the nine million vapers out there – 3.7% of Americans – there have been several hundred injuries and a handful of deaths: a problem for sure, but no “epidemic”.
The second madness – buoyed by the first now – is the recent prohibition of retail and online sales of e-cigarettes in San Francisco, Seattle and Brookline, MA, etc. So adults can’t buy them, they can only buy actual cigarettes. A corollary would be a policy of cutting off opioid addicts from safe, predictable and clean oxycodone: a policy which results in them shifting their addiction to dangerous, unregulated street heroin and fentanyl. Oh wait: we do that already and tens of thousands of corpses attest to that policy’s success.
Usually, we can count on conservatives to be dumb enough to deny science and they rarely let us down. Witness their hilarious Creationism and some recent, extreme anti-abortion laws which make as much sense as being anti-appendectomy or anti-wisdom tooth extraction. But in this case the liberals are pushing these vaping bans: the same folks who give us anti-GMO panics, the denial of biological gender differences and the “natural is better” fallacy. So both sides are scientifically challenged and there’s not much difference between a red-faced preacher telling his congregation the world was made in six days and a crunchie, hairy fanatic insisting we all get deadly diseases because “vaccines are a big pharma conspiracy.”
“Vape is tobacco 2.0!” shout internet and billboard ads for “Tobacco-Free Kids,” even though tobacco isn’t involved in vaping. Beware of any pressure group with the following words in their names: freedom, family and especially “kids”. Beware and brace yourself for un-scientific moralizing and magical thinking: prepare to be underwhelmed.
Our collective ignorance established – an ignorance that always seems to rise in lockstep with certainty of its representatives – let’s review the actual science. Nicotine is addictive, very addictive. In fact of all the popular legal and illegal drugs we as a society enjoy nicotine addicts the largest percentage of its users at 33% (of casual users becoming “professional” smokers/vapers).
Whether people who take that first puff become hooked, wheezing tobacco smokers with close to 50-50 odds of having it kill them some decades hence or not, the likelihood of addiction depends on their inherited brain dynamics in which different people have synaptic flashes of pleasure at different rates with different stimuli. In a very real neurons-to-action sense we are born smokers or not, liable to become addicted or not. It’s extremely probable that “kids” (teenagers, actually) who are taking up vaping would be smoking cigarettes instead because they are vaping at a rate that has traditionally been the “hardcore” smoker percentage of people. As of these latest bans, those nicotine seekers with over-active “nACh-nicotinic receptors” in their brains in San Francisco and Seattle can only buy cigarettes.
Vaping is not risk-free: the New England Journal of Medicine reports the detection of some carcinogens in the urine of vapers and obviously the invention of vaping is too recent to properly observe the lifelong effects of the non-nicotine ingredients. The effects of the actual nicotine in vaping are well known, however, and are no more harmful than coffee, the second-hand plume no more dangerous than coffee steam. For decades doctors have prescribed nicotine replacement therapies to smokers and now they are even OTC.
It is apparent from long term research that between 15% and a third of males will be smokers at some point in their lives, slightly fewer females. Even with all the current social stigma and high cost of cigarettes (now $16 a pack in New York) that rate can and has been halted at about 15%, a percentage of “hardcore” nicotine lifers whose neuro-chemical locks of pleasure are unlocked by the neat fitting biochemical key that is nicotine.
Again, smokers are more born than made. Some of that hardcore 15% can and do quit so it’s not a lost cause but it’s important to know the difficulty in cessation differs in individuals as much as and as randomly as eye color. Raising the price is, according to the data, the second most effective way of reducing smoking, after substituting smoking for vaping which is the most effective smoking cessation method.
In the UK where the concept of harm reduction is better understood the Royal College of Physicians calls for the promotion of e-cigs (vaping) as a cessation method and debunks the “gateway to smoking” nonsense so popular in the US. The R.C.P. writes that the harms of vaping are “very small, and substantially smaller than that arising from tobacco smoking, about 5% the harm of tobacco.” That’s a loud ringing endorsement from one of the UK’s most august medical authorities. In fact, there’s talk of subsidizing e-cigs by their government to reduce tobacco smoking. Remember, in the UK the National Health Service is responsible for people’s lifelong health so its long term incentives are different to our private system where the big picture of public and individual health is secondary to corporate profits.
There are similar calls from medical authorities in the US. The New England Journal of Medicine published British research finding that smokers who use e-cigarettes are twice as successful at quitting as those who rely on other approaches. And now a similar American study has arrived at the same result. From a user’s perspective vaping compared to smoking is a bit like using condoms vs. unprotected sex: vaping, like safe sex, isn’t quite as good as the “real thing” (smoking) but it gets the job done. And it’ll save your life.
At heart, this is a philosophical question whose central nexus is harm reduction. Harm reduction strategies are often counter-intuitive to what people “feel in their guts” so are usually unpopular, particularly in populations where punitive policies (and religious faith, actually) are dominant, like the United States. But gut feelings don’t take into account actual science, statistics or epidemiology.
The bargain behind harm reduction is that people will be doing something harmful anyway, to prohibit it usually doesn’t work and almost always leads to horrible unintended consequences. Harm is better fixed by management than prohibition even though prohibition and punishment always feel better for the moralists. Further, when dealing with drugs of addiction, a whole body of evidence is missed by the gut feelers, specifically the neurobiology of addiction and psychological factors attendant to it.
This mechanisms of vaping versus smoking aren’t hard to grasp. In both, nicotine is the desired substance: with vaping virtually harmless (but still addictive, remember) nicotine is combined with glycerol to aerosolize that nicotine which is inhaled as a vapor. There are some carcinogens attendant to the glycerol though how carcinogenic they are in that context is still up in the air. With tobacco smoking, the smoke from burning vegetation and paper is inhaled along with the nicotine, a process that introduces literally hundreds of extremely nasty chemicals into the lungs. It’s those chemicals, not the nicotine, that make smoking the largest preventable cause of death in the United States. That bonfire of hazard in cigarettes simply doesn’t exist in vaping which is why it is 95% safer and recommended as a smoking cessation method by medical authorities. That’s for legitimate vaping products, remember, not illegal, cheapo and/or marijuana back-of-the-truck vaping cartridges that are causing all the problems at the moment.
There’s a deeply illiberal undertow here, a scold based “morality” where the censorious anti-pleasure instincts of the right combination with the nanny-state health-and-purity obsessions of the left: politically and socially smokers are very popular scapegoats. “Righteous punishment” is a neural reward in the striatum – the goal-seeking part of the brain – a separate joy but ironically similar to the satisfaction of smoking.
With these two ill-informed vaping flaps and in the wider opposition to harm reduction opponents have no real interest in mitigating damage or ameliorating harm but instead are motivated by a punitive, puritan cleanse.
Nicotine is an addictive but harmless drug which gives people pleasure and legitimate vaping is a relatively safe way to experience that pleasure. These are facts that taunt the fanatics – on both the left and right – with their age-old horror that somebody, somewhere might be having fun.