September 12, 2019

expert reaction to Trump’s decision to ban flavourings in e-cigarettes

President Trump has decided to ban flavourings in e-cigarettes in the USA, in light of the recent illness and deaths being linked to e-cigarette use there.

Prof Linda Bauld, Professor of Public Health, University of Edinburgh, said:

“Solutions are needed to address the recent outbreak of serious respiratory diseases linked to vaping in the USA. But banning flavoured e-cigarettes is not the answer.

“The evidence accumulating in America points to contaminants in black market products as having caused these cases, particularly cannabis oils that are being vaped. Nicotine-containing flavoured vaping products are almost certainly not the main cause. These products have been available for a decade and have been used by around 10 million Americans (primarily to quit or cut down smoking) with few adverse effects. It is true that a rising number of American teenagers have tried or recently used flavoured vapes and this has caused alarm. But by removing all these products from the market, the proposed US policy forgets that the flavours are an important part of the appeal to adult smokers trying to quit smoking. In fact, in surveys in both the UK and the USA, fruit and sweet flavours are far more commonly used by adult ex-smokers as they help separate smoking from vaping and help transition smokers to using a far less harmful product.

“In Europe, flavoured e-cigarettes have contributed to recent declines in adult smoking and well-conducted randomised controlled trials show that these products do help people quit. In addition, in the UK, rates of use among youth who have never smoked remain low. This may be explained by our very different regulatory framework. It includes limits on nicotine content, child- and tamper-proof packaging, prohibition of certain chemicals and, importantly, a ban on many forms of advertising that are still permitted in the USA. 

“My concern is that if most e-cigarettes are banned in the USA, adult smokers will return to tobacco and for those who don’t, demand for black market products will rise. A flourishing illicit market is far more likely to cause health harms than pursuing proportionate regulation of the type we’ve aimed for in Europe.”

Dr Lion Shahab, Associate Professor in Health Psychology at University College London, said:

“While evidence about the precise cause of the recent spate of ‘vaping lung disease’ in the USA is still being evaluated, it appears that cases were mainly seen in young users of e-cigarettes who bought bootlegged products illegally that contained cannabis ingredients. Crucially, these products used oil as suspension liquid as cannabis is not easily dissolved in standard e-liquids. Oil is not recommended as a carrier liquid for e-liquids as it will damage the lungs when inhaled and likely caused the lung disease described in reports.

“Legal products available in the UK are compliant with EU regulation, using propylene glycol and glycerine as suspension and carrier liquid for nicotine and flavourings to produce the vapour, not oil. Standard e-liquids have been used safely by millions of people to help them stop smoking for over a decade now, without any of the adverse health effects reported in the US.

“Flavours are therefore unlikely to be the cause of ‘vaping lung disease’ and banning them would not have prevented this recent outbreak.  It is, of course, unfortunate that people use bootlegged products to vape illegal drugs; however, this problem is not unique to e-cigarettes and similarly applies to bootlegged alcohol and Class A drugs used for recreational purposes.”

Declared interests

None to declare.