Leonard Zwelling

E-cigarettes were just on the horizon when I was working on the tobacco legislation in 2009 in the Office of the Ranking Member of the U. S. Senate Committee on Health, Education, Labor and Pensions. I don’t really remember considering the effect of the proposed Democratic legislation that eventually passed or that which Senator Enzi proposed, on this new nicotine delivery device. Ten years makes a huge difference.

Millions of Americans, many under 21, are using electronic cigarettes to deliver nicotine to their lungs and brains and to become addicted to it. Now there’s a new danger. Vaping may be lethal.

As of this writing, 7 people, mostly young, have died from the complications of vaping and almost 500 have gotten seriously ill. It is still unclear if these adverse events are complications of the legitimate use of these devices or of bootleg mixing of other ingredients in the capsules used to deliver the vapor. One of the alleged contaminants is THC which may be mixed in an oil that is vaporized when heated but which deposits in the lungs when inhaled and cooled thus creating a toxic reaction in the pulmonary system. Regardless, the Food and Drug Administration, and for that matter the executive branch and even Congress have important decisions to make. The flavored capsules have been banned. What about the whole practice of vaping? Or, if this is really for adults to get free of conventional combustible cigarettes, perhaps vaping apparatuses and the capsules ought to be obtainable with a doctor’s prescription only.

Vaping manufacturers were quick to apply pressure to the Trump White House that their products have a legitimate use for adults to quit smoking and that they ought to be allowed to stay on the market as over-the-counter products.

This is a tough one for someone like me with both a libertarian streak when it comes to human behavior and social policy and someone like me who also possesses an over-developed sense of right and wrong and the need for government to be of assistance and protect people from foreseeable danger.

On the one hand, if adults wish to use these nicotine delivery devices, they should be allowed to do so. Children on the other hand are a special case and warrant some protection from the toxicity of both nicotine dependence and whatever else is causing this rash of overt toxicity from vaping. And why should the government sanction the use of a dangerous medical device without assuring that those who use it are under a doctor’s care?

It’s all very American.

I expect in Europe it will be laissez faire. If people want to kill themselves, let them.

It seems to me that the safest and least risky approach would be to acknowledge that vaping may have a useful place in smoking cessation and make the devices available to those over 21 with a prescription. No sales should be allowed to those under 21 in any case and no further over-the-counter sales should be allowed. If it turns out that all of the complications of vaping were caused by people using devices or capsules that have been tampered with after market, then it may well be that these devices are safe. But until this epidemic of lethality from a new habit is understood, we should err on the side of safety and the protection of children.

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