Harm reduction or prohibition? — Comparison of policy approaches towards vaping in the U.K. vs in the U.S.

Tina Jahnel, University of Tasmania

About a century ago, the Volstead Act prohibiting intoxicating beverages became law in the U.S. Today, most people agree that Prohibition was a failure, driving the alcohol industry underground, where its products became unsafe. Since then, many countries have taken the view that it is better to legalize, regulate and tax alcohol rather than to ban it.

Similarly, in recent years, e-cigarette regulations are the topic of extensive debate and the approaches vary worldwide. Electronic cigarettes are electrically driven devices that heat elements to vaporize liquids usually containing nicotine. In contrast to traditional cigarettes, e-cigarettes do not contain tobacco, do not create smoke and do not require combustion. Although nicotine is the main reason for addiction to smoking, nicotine itself is far less harmful to smokers than the other chemicals created during combustion. Indeed, studies have shown that there are much lower levels of harmful chemicals in e-cigarette vapour than in cigarette smoke [1].

While some countries such as the U.K. promote vaping as an effective means of quitting smoking, others such as the U.S. want to see e-cigarettes prohibited altogether, fearing that it could support the tobacco industry through promoting nicotine use. Similar to the debate around alcohol prohibition, this debate places prohibition against harm reduction. Harm reduction follows the idea that it is better to regulate harmful habits in order to make their use safer, opposed to banning them altogether in the hope of enforcing abstinence.

The rapid growth in vaping has coincided with reductions in smoking rates, especially among young people in the U.K. and in the U.S. Yet there is a stark contrast in how vaping is treated by public health authorities in both countries. Backed by early studies of disease incidence suggesting that vaping is 95% safer than smoking [1], the U.K. government encourages smokers to switch to e-cigarettes. As a result, almost all e-cigarette users in the U.K. are people who have given up smoking, even among the youth [2]. While, there are no reported deaths associated with vaping in the U.K., vaping has killed at least 34 people and injured about 1,500 in the U.S. [3]. Additionally, in the U.S. vaping appears to be much more popular among the youth [4].

The question arises as to why the different experience in the U.K. and in the U.S.? The Centre for Disease Control says that most cases of illness are linked to vaping products containing THC oil that were obtained off the street or from other informal sources [3]. In addition, many nicotine containing e-cigarettes in the U.S. are much stronger than those allowed in the U.K., where there is a 2% limit on nicotine concentrations. While in the U.K. e-cigarettes are subject to strict product-safety regulations, including toxicological testing of the ingredients and emissions, few such regulations exist in the U.S. Although plans exist to establish a set of rules for regulating e-cigarettes that would echo the British approach, some fear that, given the recent events around lung disease associated with e-cigarettes, this is too late and that U.S. politicians will react by preferring prohibition instead.

Discussion questions

1.   What are benefits and disadvantages of a harm reduction approach towards e-cigarettes?

2.   What are benefits and disadvantages of banning e-cigarettes?

3.   How might prohibition and harm reduction affect youth vaping?

References

Farsalinos KE, Polosa R (2014) Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Therapeutic Advances in Drug Safety 5:67–86.

Brown J, West R, Beard E, Michie S, Shahab L, Mcneill A (2014) Prevalence and characteristics of e-cigarette users in Great Britain: Findings from a general population survey of smokers. Addict Behav 39:1120–1125.

Center for Disease Control (2019) Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. In: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html.

Miech R, Johnston L, O'Malley PM, Bachman JG, Patrick ME (2019) Adolescent Vaping and Nicotine Use in 2017-2018 - U.S. National Estimates. N Engl J Med 380:192–193.