From the Kansas Health Institute:
Kansas health advocates lauded the Food and Drug Administration’s decision Thursday to regulate electronic cigarettes, while those in the vaping industry pointed to harm to businesses and people trying to quit smoking.
The FDA announced that it would ban selling or giving free samples of e-cigarettes and their nicotine cartridges, cigars, hookahs and pipe tobacco to people younger than 18. Kansas law already forbids the sale of e-cigarettes to minors.
But another change the FDA announced Thursday may be more far-reaching. Any tobacco or nicotine product that went on the market after Feb. 15, 2007, will have to go before the FDA for approval. Companies have a two-year grace period to prepare their applications and can continue selling their products for a third year while the FDA reviews the application.
John Neuberger, a professor in the department of preventive medicine and public health at the University of Kansas Medical Center, said the rule will be a step toward evaluating the risks associated with e-cigarettes, which currently aren’t regulated. Nicotine is toxic to the heart and brain at high doses, he said, and vapor liquids vary widely in their contents.
“It’s very difficult to know what are you inhaling,” he said.
The American Heart Association also welcomed the decision as a step toward reducing the number of teenagers who become smokers. Smoking increases a person’s risk of heart disease and stroke.
“We applaud the FDA for issuing rules regarding electronic cigarettes, hookah and cigars. Use of these products has risen dramatically — especially among youth — so it is imperative the FDA have authority over these previously unregulated tobacco products,” said Kevin Walker, regional vice president of advocacy for the American Heart Association in Kansas, Missouri and Iowa.
Spencer Duncan, who lobbies on behalf of the vaping industry in Kansas, said the regulations will increase the cost of e-cigarettes and reduce smokers’ access to one way of weaning themselves off tobacco.
“If you are not a smoker, I would never suggest that you start using e-cigarettes,” he said. “If I’m a two-pack-a-day smoker desperately trying to quit tobacco and using this, you’re not helping me” by requiring approval of e-cigarettes.
On-ramp or off-ramp?
Research hasn’t provided easy answers on potential health risks of e-cigarettes or whether they could have benefits for smokers. Britain’s Royal College of Physicians released an opinion in June 2014 that e-cigarettes could be beneficial if smokers transition away from traditional cigarettes, though it supports regulating them.
On the other hand, a study published in JAMA Pediatrics in November 2015 found that teens who used e-cigarettes were more likely to start smoking tobacco cigarettes. Right now, there is more evidence of an increased risk of becoming a smoker for e-cigarette users, Neuberger said.
“It’s kind of, do you believe it’s an on-ramp to tobacco use or that it’s an off-ramp for people to stop smoking?” he asked. “Right now, the evidence is it’s more of an on-ramp.”
Mitch Zeller, director of the FDA’s Center for Tobacco Products, said Thursday that about 70 percent of e-cigarette users also smoke cigarettes. The products may even reduce smokers’ willingness to quit, he said, because they can use e-cigarettes to get nicotine in places where it is illegal or socially unacceptable to smoke cigarettes.
The FDA will need to weigh the dangers of any chemicals in e-cigarettes, whether they make smokers more or less likely to quit cigarettes and whether they increase the rate of youths becoming smokers, Zeller said. A 2015 survey found about 16 percent of high school students admitted using e-cigarettes, he said.
“If (a smoker) completely switched to e-cigarettes, there’s no question that person would reduce his or her risk,” he said. “We can’t make national policy based on a hypothetical individual.”
Long-term health effects of e-cigarettes aren’t clear. Nicotine can raise a person’s blood pressure and heart rate, but the bigger concern comes from lack of knowledge about other chemicals in the inhaled vapor and their effects on the body over time. Some groups, like the American Public Health Association, have taken the view that e-cigarettes are less dangerous than traditional cigarettes but haven’t been proven safe.
The FDA’s proposed regulations also will hurt the roughly 400 Kansas shops selling mostly e-cigarette products, Duncan said. A 20-cent per milliliter state tax on the nicotine liquid in e-cigarettes also will come into effect in July, creating a double hit on those who sell vaping products in Kansas, he said.
“If the rules, as written, stand, it will put people out of business,” he said.
“It’s kind of, do you believe it’s an on-ramp to tobacco use or that it’s an off-ramp for people to stop smoking? Right now, the evidence is it’s more of an on-ramp.”
- John Neuberger, a professor in the department of preventive medicine and public health at the University of Kansas Medical Center
For example, the FDA has indicated it will regulate not only the liquid but the devices themselves, effectively ending businesses’ practices of customizing them, Duncan said.
Topeka, Olathe, Overland Park, Kansas City, Park City and McPherson ban e-cigarette use in public places where tobacco smoking also is banned. Sedgwick County, however, took the opposite approach, explicitly allowing e-cigarettes in county buildings.
Eric Cope, who owns Top Shelf Vapors in Topeka, said he doesn’t oppose some regulation of the ingredients in liquid used for vaping. He is concerned that the approval process will be so expensive that only large tobacco companies will be left in the market. His store sells products from about 50 manufacturers, he said, and fewer choices for customers would put his business in jeopardy.
Most of his customers use only e-cigarettes, Cope said, and some use them as a substitute for cigarettes. If they can’t vape, many will go back to tobacco, he said.
“They may find this is a harmful substance, but it’s not as harmful as smoking,” he said. “The biggest thing (government officials) are not considering is the decreased health care expenditures they’re going to have” if people quit smoking.
The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.