Banning e-cigs

Why not encourage them, as a harm-reducing alternative to conventional smoking?

The Los Angeles City Council just voted for a complete ban on e-cigarettes wherever real cigarettes are banned, including parks, beaches, and bars. (UCLA adopted a similar policy campus-wide a few months ago.) Seems to me like a bizarre choice, and likely to retard the movement from cancer sticks to e-cigs that, if not interrupted, might save hundreds of thousands of lives per year. This morning on KPCC I debated the issue with a member of the city council majority.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

15 thoughts on “Banning e-cigs”

  1. I can understand why they did it. There are some outstanding questions though.

    But right now, I can already tell you that the new verb "vaping" annoys the sh*t out of me. And if people have to do that outside, oh well.

    If it helped more people quit than the number of new smokers attracted by the "coolness" of all those little bottles of flavors, maybe I would change my mind. But are all these new entrepreneurs really interested in helping people quit? Won't they then be out of business? Or, are they not actually quitting?

    1. You are correct. Most entrepreneurs probably are not all that interested in helping people quit. They are, however, interested in cashing in on something that might help you quit. Think of it this way: Maytag couldn't care less that you save hours a week, and energy to boot, by not washing your clothes in the stream. They will, though, sell you a washing machine that helps you do so. And of course they might advertise such. It doesn't make them bad just because they sell you convenience, but don't really care whether your life is easier.

  2. Mark,

    I used to be very enthusiastic about snus because I learned that in Sweden, many cigarettes smokers quit by using it. But then I learned that in Norway, the reverse was norm: snus was the gateway to cigarette smoking. Question for you: Do we know what is happening with e-cigs in this regard?

  3. Mark, thank you for doing this. I started smoking cigarettes in college to deal with stress and smoked for a number of years, always planning on quitting when I was going to have a less "stressful" time – say, after grad school. Eventually, I realized I was fooling myself. Then I started noticing e-cigs everywhere, but I was pretty skeptical that they'd work well, they just seemed like a gimmick, and I had no clue that they might be less harmful. But then I read a post of yours from the summer of 2012 that advocated them, and decided I might try one. Looked on the internet, found a good brand for beginners – one that looked and felt like a regular cigarette – and from the day I got it, I've rarely smoked again (maybe 4 cigarettes total in over a year and a half). Now I've moved on to the larger ones that use refillable e-liquids and have felt much better healthwise. I also introduced them to a few of my friends/neighbors, and they've drastically cut down their cigarette use.

    As to Keith's question: I've never met a person who started on e-cigs and then moved to cigarettes. The tastes are completely different, and once I got used to e-cigs, I couldn't stand smoking a cigarette. E-cigs are very sweet, and you notice more how bitter cigarette smoke is. I've gotten my taste buds back, and cigarettes just taste awful to me now. The few times I've smoked them since I started using e-cigs were when my battery died late at night while out with friends. Even a single smoke would make me feel light-headed and leave me with a bad taste in my mouth and the feeling of heavier lungs. I've also never been stigmatized for vaping – in fact, I have strangers every few days come up and ask me what it is, curious about them and glad that I was able to quit. With smoking, you get a lot more negative attention, especially in a place like LA. At the same time, outside of a place like Long Beach, where weird is cool and no one cared if you smoked inside, no one thinks e-cigs are particularly cool. So I could imagine younger people using e-cigs instead of smoking, but I doubt they'd move to smoking or that e-cigs would attract young people who wouldn't consider smoking cigarettes in the first place.

    In any case, even just realizing that you don't smell awful all the time is a huge mental and physical plus to using them. I'm glad everyday that I switched.

  4. We are in the process of turning our campus into a tobacco-free campus. The state legislature passed a memorial calling on the state's university campuses to go tobacco-free. We'll be banning sales and use anywhere on campus. The intent is to ban e-cigs along with coughin' nails (say it). The policy will allow FDA approved smoking abatement devices: gums and patches, basically.

    I'm not at all sure that banning the things will do any more than increase the number of butts on our sidewalks, but I suppose we will see what happens. Someone needs to get the research machine geared up to assess these things. If they are really less harmful than smoked tobacco, we need to know it so we can set policies in a reasonable way. It seems to me reasonable to ban smoked and smokeless tobacco given the serious health risks of each. If e-cigs do not pose the cancer and cardiopulmonary risks, let's allow them so our addicts have another choice to satisfy their habits.

  5. I've got a lot of questions about e-cigarettes (in no small part because while I'm mildly curious about them, I'm not remotely curious enough to do any research on the subject). In no particular order:

    1) Does anyone know what the health impact is likely to be? I assume that delivering moderate doses of nicotine is an acceptable risk, because the FDA approved the patch, and I assume that a lot of the health impact of smoking has to do with inhaling hot particulates, ions, and combustion products into your lung (similarly, that the damage caused by chewing tobacco is likely to come in no small part from the non-nicotine components). Still: have any compelling studies yet been done?

    2) What regulation is there of e-cigarettes, and especially of the fluids they're charged with? Nicotine may not be responsible for most cigarette-caused cancers (I'm assuming, it's not an assertion of fact), but it's a potently neuroactive compound, and for that matter it's a potent neurotoxin (at high concentrations), and has been used as an insecticide. Does the FDA control nicotine infusions for e-cigarettes? What about the many other intoxicants and stimulants that could be similarly delivered?

    3) How could "vaping" be effectively regulated at the point of use, rather than supply? Are anti-smoking laws even consistently relevant? How do the authorities prove nicotine is being "vaped", on the spot, as opposed to getting an answer back from the lab days or weeks later? Someone "vaping" an odorant (for the sake of argument, free of nicotine or any other stimulant or intoxicant) will be noxious to their neighbors – but that would also be true if they were spritzing themselves with perfume, or humming loudly, or eating an odoriferous sandwich. Sure, there might be public-nuisance laws they're violating – but the anti-smoking laws are justified as a health measure, not to enforce halfway decent manners.

    4) Similarly to the previous: if you are regulating use of e-cigarettes on the basis of redolence of cigarette use rather than on the basis of public health, doesn't this become a free-speech issue? Is it illegal to hold an unlit cigarette between your fingers or in your mouth in areas where smoking is proscribed? If not, how is an e-cigarette with no health impact and no stimulants or intoxicants different?

    1. Per # 3: this is what makes so much sense about making people go outside to use them. Already mobile phones have led to a massive increase in people being jerks (and sometimes getting shot, which of course, I *do not condone*…)

      If someone is outside "vaping," they are not dosing me with *whatever it is* they have in their little gizmo, which let's face it, will soon be pretty much any and everything, from their medical mj to liquid cigarette fluid. The police won't have time to come out, take a sample, send it to a lab, etc etc. So, I say, making them go outside is not that much to ask.

      Even if it were just fragrance, and even if nicotin vapor turns out to be harmless, I still do not want to be forced to smell it. And it is high time in this country that someone had to prove a chemical was harmless *before* they go ahead and put it on everyone. Enough.

      1. OK. I'm certainly open to this viewpoint, and I share your reluctance to have my neurochemistry subject to the whim of everyone near me. Even at a less worrisome level, I should have very right to object to sharing a work space with someone who'd apparently been dipped in cologne or perfume.

        Still: what if instead of putting the liquid nicotine solution in a simulated cigarette they put it in an atomizer, or in a room humidifier, or in a steaming hot bowl of soup? Nicotine passes through the skin just fine (this is why the Patch works, and it's one of the warnings about riskily high concentrations of nicotine). This would be inefficient, but a glance at the Sigma website tells me nicotine is less than $3 per ml at 99% purity; it looks like a normal delivered dose of nicotine (one cigarette) is about one to two milligrams, worth less than a tenth of a nickel – you can afford to be inefficient (though the risk of an overdose would presumably greatly increase with these less-controlled, less-direct delivery devices; Wikipedia suggests toxicity is a worry at less than 100x normal dosage).

        I think we need to consider what the appropriate and practical regulation here is. Some may be possible at the supply side (so it's not trivial to get hold of the stimulants or depressants or intoxicants). And maybe we can prohibit the public use of these devices because of their capacity to dose your neighbor without their consent. But I think that last will be hard, because they also have the capacity, when used properly, to have no such effect on your neighbors (if only a flavor or odor is delivered), and they're far from the only device that could deliver a drug. We could ban the public use of perfume spritzers, humidifiers, censers, etcetera at the same time – but without the obvious connection to "cigarettes" I suspect it will be a difficult sell.

        PS On yet another hand: is this a non-issue? What dose does your neighbor receive? 5% of your dose? 1%? It's quite plausible that the "secondhand vaping" concentration of the active ingredient is too low to be effective, which would make these devices exactly like the perfume sprayer or the odoriferous lunch: a public nuisance but not a public menace.

  6. Is there any proof of the claims made by the Council that these products will be a gateway drug?

    1. Not that the people in our school of public health are aware of, and I trust they would be aware of any such studies. There are anecdotal reports on both sides.

      I think it's unlikely to be a gateway mechanism. I've never smoked, but I had asthma as a child and did spend a fair amount of time breathing drugs from a nebulizer. I've also breathed smoke from fires and side-stream tobacco smoke. Breathing a vapor is almost, but not quite, entirely unlike breathing smoke.

  7. There are multiple reasons for society to disapprove of something, and manifest its disapproval.

    One reason (but only one) is that behavior has negative externalities. This is obviously the case with smoking (of tobacco or marijuana) where the smoke drifts to other people, and makes hotel rooms, restaurants, etc smell bad.

    But, as I said, that's not the only reason. Most people do not want to be enslaved, even when the enslavement is to themselves. We're born with a few drives we have limited control over, even though they limit our freedom of action — the need to eat, to drink, to breathe, to excrete, and the desire, if not need, for sex. We can't do much about these. But we CAN try to limit our additional masters.

    Society as a whole is sending the message that this activity is unwanted, it's lower class, it's something you should limit and not engage in for your own well-being. All of this is true, all of it is desirable insofar as it is actually INCREASING autonomy where it matters (regardless of the minor decrease of autonomy that results from you not being able to huff your drug in certain public spaces). I fail to see the slightest problem there.

    Society also limits one's freedom to pee wherever one wants (even if one is willing to pee into a container that one will subsequently seal and take home). Society limits one's ability to display one's genitals, or to copulate with a willing partner, in public. Society limits one's ability to drink alcohol in many public places.
    All of these prohibitions exist not merely on the grounds of negative externalities, but as an acknowledgement that we are not purely rational animals. We have immediate "animal" desires, but it is in the interests of both society as a whole, and each of us as individuals, to limit and control those desires as much as possible, and one way to help us all in this endeavor is these sorts of general prohibitions.

    1. Yeah, but what's the limiting principle here? Because our public exhibitionism laws are based in part on public morality / civilizing behavior, does that mean we should pass more laws going in that direction? Or that we should recognize those as sort of traditional exceptions?

  8. Electronic cigarettes are no more dangerous because it has flavored solution which feels like the fruit juice or any other liquid solution I used e-cigarette and enjoy my self and with my friends. fuma vapor

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