In an interview last week on Bloomberg TV, Emily Chang asked me about my opinion on the impending San Francisco ban on the sale of e-cigarettes lacking FDA premarket approval. For those unfamiliar with this news, this action taken by San Francisco has effectively eliminated all sales of e-cigarettes (including the incredibly popular JUUL) unless they can gain FDA authorization in the next 7 months. Despite speculation that the move was intended to force the FDA approval process to move faster, it seems likely that most products will be banned when this rule comes into effect.
I’ve found few vice-related topics as divisive as e-cigarettes. As a vertical, there’s a massive divergence between the potential for social harm reduction by replacement of combustible tobacco and the dangers of underage consumption. The fact that many of these products were recently developed also leaves open some questions about their long term effects, and the involvement of big tobacco in the industry breeds distrust of consumer protections. Although I regard the e-cigarette market as largely developed (and not a promising area of early-stage venture investment), many of the questions I get from prospective investors directly relate to the national debate over JUUL and vaping.
When nicotine salts were first developed, few could predict the problems which would arise around teen vaping. Teenage nicotine use was on the lows, with young Americans trying tobacco products in record low rates. There’s no denying that underage use is a real issue and that certain elements of the products (such as flavors, product inconspicuousness, and nicotine delivery strength) exacerbated the problem. The old methods of protecting against underage consumption, which often relied on looking for smoke or smells, don’t work for vaping. The rapid spread of these products among teens is justifiably concerning to parents, but we should think twice before writing this hysteria into policy.
What concerns me most about this decision is that it feels a bit clumsy and has a real potential for unintended consequences. I mentioned on Bloomberg the fact that outright bans such as this often tend to lead to unpredictable negative effects. Banning a substance from informed adult consumers often creates more safety issues than it solves. The prohibition of alcohol was directly connected to ethanol poisonings throughout the 20s, the inclusion of cannabis as a schedule I drug helped lead to mass incarceration, and the banning of needle exchanges directly contributed to the spread of HIV. At best, prohibition has historically allowed us to cover our eyes while problems got worse.
Even on the intended purpose of reducing underage use, this plan leaves several questions irresponsibly unanswered. From a product which delivers nicotine more directly than a combustible cigarette, we now have an entire population of minors who are dependent on nicotine. If e-cigarette pods suddenly become more difficult to get than combustible cigarettes, are we not responsible for encouraging a generation of teen users into an option we know is dangerous and cancer-causing?
The current lack of FDA pre-authorization is of concern, to be sure, but when the alternatives are known to be incredibly harmful, it seems illogical to ban something simply for lacking research. The irony strikes me as well that this is happening in California, where you have cancer warnings everywhere you turn (this article is known by the State of California to cause you cancer, by the way). If San Francisco prefers more nuanced approaches in topics like sexual education, it stands to reason that they should think twice before pushing through the abstinence-only approach towards e-cigarettes.
Finally, there are also real issues around effectively banning the sale of an adults-only product to address the issue of illegal underage use. Underage individuals across the country consume alcohol, often with real impacts felt in the form of DUIs and other impaired decision making, yet we don’t call for an outright ban on the sale of alcohol. In this case, adults were absolutely using these products for harm reduction — vaping is a frequently used method to quit combustible cigarettes — a claim which can’t be made about alcohol. It feels that San Francisco has thrown up their hands at the very real problem of purchase age verification and instead sacrificed the needs of responsible and informed adults who depended on these products.
I don’t vape, or use nicotine of any kind. It’s undeniable that teen usage of all substances is a problem, and that the e-cigarette phenomenon has spread to the underage population. What’s much less clear, however, is if a black-and-white approach like an all-out ban is likely to be effective. Speaking as someone who drank while underage, I’d suspect this approach will only add to the allure of the products, raise prices teens are willing to pay and drive teens to combustible cigarettes. For that, it really isn’t worth sacrificing the needs of responsible adult users.