The U.S. Food and Drug Administration last week gave itself much broader authority to regulate tobacco products, which is long overdue. Expect the agency to focus heavily on e-cigarettes. Its first priority should be to analyze the dangers — and benefits — of e-cigarettes, which some smokers are using to help them cut back on or end their cigarette use.
As Surgeon General Vivek Murthy said last year, U.S. officials are in “desperate need of clarity” when it comes to e-cigarettes. Without more clarity, the FDA and other agencies are unlikely to write effective policies regarding the sale and regulation of e-cigarettes.
Here’s what is readily known: E-cigarettes, which users fill with liquid containing nicotine and a flavor, are safer than cigarettes, which shorten the life expectancy of smokers by an average of 10 years. Tobacco-related illnesses are the leading cause of preventable death in the United States.
Last year, Public Health England said that e-cigarettes are 95 percent safer than cigarettes. This prompted the Royal College of Physicians to endorse e-cigarettes as a valuable tool in helping people to quit smoking. In England, e-cigarettes are now the most commonly used anti-smoking aid.
At the same time, it does not appear that e-cigarette use is benign. The vapor contains potentially harmful chemicals, according to a 2014 FDA analysis. The dangers of the nicotine in e-cigarettes and the second-hand effects of e-cigarette vapor also need more study. And it is unclear if e-cigarette use leads to cigarette smoking, which could negate the positive effects of their use in smoking cessation.
American and British health officials agree that regulations are needed to keep e-cigarettes out of the hands of children. According to FDA data, e-cigarette use among high school students has skyrocketed, from 1.5 percent in 2011 to 16 percent in 2015. A 2015 Maine survey found that 18 percent of high school students here had used e-cigarettes in the previous month. Last year, 3 million middle and high school students nationwide used e-cigarettes.
The increase in e-cigarette use among young people is a troubling development after a steady decline in youth smoking in Maine that has now slowed.
Cases of poisoning from the liquid nicotine used in e-cigarettes are on the rise — an unfortunate consequence of e-cigarettes’ rising popularity. In 2014, more than half the reported exposures were among children under the age of 6, heightening calls for child-proof packaging of e-cigarette cartridges.
American officials argue that the most important front in the battle against tobacco is to prevent young people from ever beginning to smoke. Reducing youth access to e-cigarettes is an important part of their plan.
“As a regulatory agency, we have to make decisions at the population level. That’s where it gets complicated,” Mitch Zeller, director of the FDA’s Center for Tobacco Products, recently told Vox. “E-cigarettes have a positive and negative impact. In the U.S., that kids’ use of e-cigarettes is way [up] is a negative.”
Zeller is right that the agency should focus on unanswered questions, such as why so many adults use both cigarettes and e-cigarettes. Are they transitioning away from cigarette smoking, which would be a good thing, or simply using both products? Although e-cigarettes are safer than cigarettes, do former smokers need to use them for the rest of their lives to satisfy nicotine cravings?
In addition to answering such questions, the FDA’s challenge will be finding ways to restrict the availability of e-cigarettes to young people — who are at risk of using them as a gateway to cigarette smoking — while not limiting their availability to adults who successfully use e-cigarettes to stop smoking.