In a press statement on November 15th, Scott Gottlieb, commissioner of the FDA, stated that he would direct the FDA to issue a number of decrees that would aim to limit the distribution of electronic nicotine delivery systems(ENDS) products to teenagers, especially flavored products. The FDA’s actions respond to a rapid increase in underage vaping in America, with an 80% increase among high schoolers and 50% among middle schoolers since 2017. According to the FDA’s 2018 National Youth Tobacco Survey, the number of high school and middle school using e-cigarettes has risen to 3.6 million, and more than two-thirds of those students used flavored products. While e-cigarettes can be a way for adult smokers to quit smoking cigarettes, they may also cause underage users to become addicted to nicotine, which is the leading preventable cause of death in the world.
In his press statement, Gottlieb stated that he would order the FDA to:
- Require that flavored ENDS products, excluding tobacco, mint, and menthol flavors, be sold in age-restricted, in-person locations.
- Require that flavored ENDS products, excluding tobacco, mint, and menthol flavors, have heightened age verification measures when sold online.
- Restrict the sale of ENDS products that are marketed specifically to teens
- Ban menthol in combustible tobacco products, such as cigars and cigarettes, in the future
- Ban all flavors in cigars in the future
Reasons for Gottlieb’s Proposals
Citing the increase in the popularity of flavored ENDS products among children, Gottlieb emphasized the importance of trying to keep flavored ENDS products from minors. He chose to exempt tobacco, mint, and menthol flavors because of the increased popularity of these flavors among adults compared to children. Furthermore, the presence of menthol flavors in combustible tobacco products means that adult smokers who want to switch from cigarettes to e-cigarettes may find cigarettes more appealing if ENDS products lack menthol. However, menthol flavors in ENDS products may also act as a “gateway drug” for underage users to switch to cigarettes in the future.
According to the FDA, 54% of youth smokers use menthol cigarettes, while less than a third of adult smokers use menthol cigarettes. As a result, Gottlieb wants to ban menthol in combustible tobacco products. Furthermore, a higher percentage of youth cigar smokers use flavored cigars than adult cigar users, and the FDA claims that removing flavors from cigars would remove an incentive for teens to switch from ENDS to cigars. This is the motivation behind Gottlieb’s proposal to ban cigar flavors in the future.
Effects of the Proposals
The FDA’s increased pressure on e-cigarette manufacturers has already produced some benefits. Juul Labs, the company with over 70% of the e-cigarette market share, has already stopped selling most flavors and has discontinued social media promotions, which were criticized as marketed to youth.
However, the FDA’s actions are simply not enough to stop the rapid increase in teenage use of e-cigarettes. Even though the Gottlieb’s propositions will limit e-cigarettes to teens, the intense addiction of teenagers to flavored e-cigarettes will probably motivate many minors to obtain ENDS devices from illegal manufacturers or import illegal ENDS devices from other countries. In this way, the FDA’s choices are vaguely reminiscent of the failed “War on Drugs”, where addicts obtained illegal cocaine and other drugs despite the wide measures aimed at stopping the supply of those drugs. Another scenario that may occur is that minors could switch to other, more harmful, drugs to fill the vacuum left by the removal of flavored e-cigarettes. This corresponds to the gateway drug theory, where the use of one drug leads to the later use of other drugs, which are often more potent and dangerous.
Therefore, the FDA must aim to reduce the demand for e-cigarettes as well as the supply. The FDA should require increased awareness about the effects of e-cigarettes in schools’curricula, so that teens are not as inclined to use e-cigarettes in the first place. Furthermore, better drug addiction treatment programs in schools, especially in areas of poverty, should be instituted to help addicted teens. Policies like these help to prevent addiction in the first place, which is much more effective than trying to get rid of addiction that is already established.