• April 17, 2024

A Misguided Crusade

 A Misguided Crusade
Photo: Swedish Match

The campaigns against lower risk nicotine products serve political goals at the expense of public health.

By Catharine Dockery

Cigarette smoking remains the leading cause of preventable death in the United States and many other countries. Shouldn’t our leaders do everything they can to prevent deaths and reduce harm? 

Unfortunately, U.S. Senator Chuck Schumer and the Food and Drug Administration have missed a profound public health opportunity by not encouraging reduced-harm nicotine products such as Zyn. Instead, they are targeting these lifesaving products and proposing wide-reaching bans.

While youth usage of nicotine is a deeply concerning issue, product prohibitions are an ineffective distraction from the failure of the FDA to act proactively to protect Americans. Flavored recreational nicotine options are essential tools to present combustible cigarette smokers with less harmful options they enjoy. Public health officials need to stop scapegoating harm reduction products targeted to adult smokers and instead focus on addressing youth use.

Other public health organizations, such as the U.K. National Health Service (NHS), have recognized the potential of harm reduction products in saving lives and promoted recreational nicotine options. For example, their “swap to stop” program has offered new noncombustible tobacco products to smokers in an effort to move them to lower risk alternatives. The NHS website offers that “[i]n recent years, e-cigarettes have become a very popular stop-smoking aid in the U.K. Also known as vapes or e-cigs, they’re far less harmful than cigarettes and can help you quit smoking for good.”

In the United States, by contrast, government officials and public health agencies are spurning a significant opportunity in reduced-harm nicotine products. In 2023, nearly half a million adults died in the United States from the effects of cigarettes.

Research demonstrates that flavored nicotine products provide a less harmful option for adult cigarette smokers who are trying to find a substitute for their habit.

A 2021 study found that among U.S. adults who smoke, despite only 29 percent being aware of nicotine pouches, nearly 17 percent expressed interest in trying the products in the coming six months.

To the extent adult smokers are able to substitute pouches for cigarettes, it’s absolutely appropriate to view these products as lower harm options on a continuum of risk.

Some research indicates that e-cigarettes can be more effective than nicotine-replacement therapy products like gums and lozenges at helping smokers quit, showing the role of these products in the public health fight against tobacco-related harm.

Policymakers’ efforts to restrict harm reduction products are often done under the guise of protecting children. But in no other industry do we consider product bans a reasonable control to address underage use. It would be unheard of to ban alcohol to prevent underage drinking. 

Product bans have been largely unsuccessful in addressing youth vaping, a failure made clear by the fact that the top 2 youth e-cigarette brands of 2023 are illegal (Elf Bar and Esco Bar, used by 57 percent and 22 percent of youth surveyed, respectively). The FDA has completely failed to enforce bans on these illegal brands with flavors and designs designed specifically to appeal to underage users. The numbers are clear—10 percent of middle school and high school students use tobacco products, and the vast majority of those (7.7 percent) use e-cigarettes. 

We also need to engage with the facts of youth nicotine abuse. E-cigarettes are far and away the main method of consumption among underage users, used by 7.7 percent of students in 2023 relative to the 1.5 percent using nicotine pouches. Significantly more effort is needed to crack down on illegal sales, particularly online sales, of these products. If product bans can’t solve youth usage issues, can we really justify the public health costs of denying vital options to smokers?

On this issue, we’re repeatedly offered a false choice between youth nicotine abuse and robust options for adult smokers. This is a purely political characterization of the problem. There are a multitude of actions that can be taken to protect youth from the dangers of nicotine. Significantly stronger enforcement is needed at retailers, both for age verification and to prevent the sale of illegal products.

A strong FDA focused on hands-on enforcement is needed to ensure that nicotine companies operate responsibly and avoid appealing to underage consumers. We also need stronger import controls on these products, with illegal imports often coming from unfriendly nations. These common-sense actions can protect youth without dramatic costs to adult smokers.

The public health conversation around nicotine has been unfortunately politicized, and we’ve lost sight of the most important goal: saving lives. Product bans and public policies targeting reduced-harm products would have material impacts on the options available to adult smokers while doing little to address the underlying factors enabling youth nicotine use in this country. Targeting some of the lowest risk tobacco products available is an unacceptable government overreach, serving political rather than public health goals.