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Research & Commentary: Montana’s Premature Flavor Ban Ignores Harm Reduction, Unlikely to Reduce Recent Vaping-Related Hospitalizations

October 15, 2019

The ban goes into effect on October 22, will be in place for 120 days, and temporarily bans the sale of flavored e-cigarettes, including mint menthol, but does not include tobacco and marijuana flavors.

On October 8, Montana Gov. Steve Bullock “directed the Montana Department of Health and Human Services (DPHHS) to implement emergency administrative rules to temporarily prohibit the sale of flavored e-cigarettes.” The ban includes mint and menthol, but does not include tobacco and marijuana flavors. The rules will become effective October 22, and will be in place for 120 days.

Bullock is responding to recent vaping-related hospitalizations and youth e-cigarette use. Although addressing these issues is laudable, an encroaching ban on e-cigarette products restricts adult access to tobacco harm reduction products and will likely lead former smokers back to much more harmful combustible cigarettes. Moreover, there is overwhelming evidence that recent vaping-related hospitalizations are due to the use of illegal vaping products containing tetrahydrocannabinol (THC).

Massachusetts, Michigan, New York, Oregon, Rhode Island, and Washington have imposed similar rules banning the sales of some flavored (or in one case, all) e-cigarettes. Montana’s recent ban is rather premature, as the DPHHS has reported only two vaping-related hospitalizations and zero deaths. Mind you, deaths have been reported in other states that have yet to ban e-cigarettes, and deaths have been reported in two states (Massachusetts and Michigan) after their respective bans went into effect.

Despite recent fearmongering, almost all electronic cigarettes and vaping devices are regulated. In 2016, the U.S. Food and Drug Administration (FDA) issued deeming regulations on e-cigarettes and extended the agency’s authority to regulate e-cigarettes as tobacco products. As of August 8, 2016, all e-cigarettes have required FDA approval before coming to market. Furthermore, all e-cigarette products have been registered with FDA since December 31, 2016. Moreover, all companies selling e-cigarettes and vaping devices must complete a premarket tobacco product application by May 12, 2020.

Since their introduction to the U.S. market in 2007, e-cigarettes have helped an estimated three million American adults quit smoking combustible cigarettes. E-cigarettes are also twice as effective as nicotine replacement therapy in helping smokers quit. In other words, e-cigarettes are significantly less harmful than combustible cigarettes.

In 2015, Public Health England (PHE) found e-cigarettes to be 95 percent less harmful than combustible cigarettes. In 2018, PHE reiterated this finding, noting that e-cigarette use is “at least 95% less harmful than smoking.”

In 2016, the Royal College of Physicians found e-cigarette use “unlikely to exceed 5% of the harm from smoking tobacco.” In 2018, the National Academies of Sciences, Engineering and Medicine concluded e-cigarette use results in “reduced short-term adverse health outcomes in several organs.”

Most recently, in June 2019, the American Cancer Society found that “e-cigarette use [is] significantly less harmful for adults than smoking regular cigarettes […] because e-cigarettes do not contain or burn tobacco.”  

Despite claims that flavors are only in electronic cigarettes to attract children, many adults credit flavors in helping them quit combustible cigarettes. Indeed, a 2018 survey of nearly 70,000 adults who use vaping devices, with “almost 95% of participants [reporting] that they were ever smokers,” found only 20 percent of respondents reported “using tobacco flavors” at the point of e-cigarette initiation. Further, 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively.

Moreover, the recent move by Montana’s governor ignores findings by state and national health agencies, which have linked recent vaping-related hospitalizations to the use of illegal and unregulated vaping devices containing THC.

An October 3 report by the Centers for Disease Control and Prevention examining vaping-related hospitalizations found that 78 percent of patients “reported using THC-containing products.” Other state health departments, including Minnesota, Oregon, Texas, Utah, and Wisconsin, have linked recent vaping-related hospitalizations to vaping products containing THC.

Although Bullock seeks to prevent youth e-cigarette use, Montana currently dedicates very little of existing moneys towards programs that could deter youth from using e-cigarettes. For example, in 2019, Montana received an estimated $108.5 million in tobacco settlement payments and taxes.  In the same year, the Treasure State dedicated only $5 million, or 0.04 percent, of state funding towards tobacco control programs, including education and prevention.

It is troublesome that lawmakers would play “whack-a-mole” and enact aggressive bans on products that have helped American adults quit smoking cigarettes. Further, flavor bans are ineffective policy measures and unlikely to impact recent vaping-related hospitalizations as more health departments link these to the use of unregulated, illegal THC-devices. If Montana policymakers actually seek to address youth vaping, they should direct existing tobacco moneys to programs that are intended to combat youth e-cigarette use.

The following documents provide more information on electronic cigarettes and tobacco harm reduction.

Tobacco Harm Reduction 101: A Guidebook for Policymakers
https://www.heartland.org/publications-resources/publications/latest-heartland-policy-booklet-addresses-vaping-myths
This booklet from The Heartland Institute aims to inform key stakeholders on the much-needed information on the benefits of electronic cigarettes and vaping devices. Tobacco Harm Reduction 101details the history of e-cigarettes, including regulatory actions on these products. The booklet also explains the role of nicotine, addresses tax policy and debunks many of the myths associated with e-cigarettes, including assertions about “popcorn lung,” formaldehyde, and the so-called youth vaping epidemic.

Podcast Series: Voices of Vapers
https://www.heartland.org/multimedia/podcasts?fromDate=&toDate=&q=voices+of+vapers
In this weekly podcast series, State Government Relations Manager Lindsey Stroud talks with researchers, advocates, and policymakers about tobacco harm reduction and electronic cigarettes. The series provides important information about the thousands of entrepreneurs who have started small businesses thanks to THRs and the millions of adults that have used electronic cigarettes and vaping devices to quit smoking tobacco cigarettes.

Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking
https://www.heartland.org/publications-resources/publications/vaping-e-cigarettes-and-public-policy-toward-alternatives-to-smoking
For decades, lawmakers and regulators have used taxes, bans, and burdensome regulations as part of their attempt to reduce the negative health effects of smoking. Recently, some have sought to extend those policies to electronic cigarettes. This booklet from The Heartland Institute urges policymakers to re-think that tax-and-regulate strategy. Policymakers should be mindful of the extensive research that supports tobacco harm reduction and understand bans, excessive regulations, and high taxes on e-cigarettes often encourage smokers to continue using more-harmful traditional cigarette products.

Research & Commentary: Centers for Disease Control and Prevention Link Major of Vaping-Related Hospitalizations to THC Product
https://www.heartland.org/publications-resources/publications/research--commentary-centers-for-disease-control-and-prevention-link-majority-of-vaping-related-hospitalizations-to-thc-products
In this Research & Commentary, Heartland State Government Relations Manager Lindsey Stroud examines the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report which found nearly 77 percent of vaping-related hospitalizations are due to the use of tetrahydrocannabinol products. These findings are similar to what have been reported in other states, including Connecticut, Oregon, Texas, and Utah.

Research & Commentary: Flavor Bans Do Not Reduce Youth E-Cigarette Use
https://www.heartland.org/publications-resources/publications/research--commentary-flavor-bans-do-not-reduce-youth-e-cigarette-use
In this Research & Commentary, State Government Relations Manager Lindsey Stroud examines the California Youth Tobacco Survey results from 2017-18, finding youth vaping has increased in several California localities that have restricted access to flavored tobacco product. Stroud finds youth vaping has increased in both Santa Clara and Contra Costa counties. Stroud also notes that banning flavored e-cigarettes is likely to reduce the number of adult smokers switching from combustible cigarettes to tobacco harm reduction devices, and could lead former smokers back to cigarettes.

Research & Commentary: Qualitative Study on E-cigarettes Shows More Evidence of Tobacco Harm Reduction
https://www.heartland.org/publications-resources/publications/qualitative-study-on-e-cigarettes-shows-more-evidence-of-tobacco-harm-reduction?source=policybot
In this Research & Commentary, Heartland Institute State Government Relations Manager Lindsey Stroud examines a study, published in The International Journal of Environmental Research and Public Health in June 2016, that provides additional evidence showing e-cigarettes and vaporized nicotine products (VNPs) are an effective tobacco harm-reduction tool.

Research & Commentary: Study Reports Health Benefits from E-cigarette Use
https://www.heartland.org/policy-documents/study-reports-health-benefits-e-cigarette-use
In June 2016, the British Medical Journal published a study that examined electronic cigarette use after 24 months. Finding a 40 percent disparity between smokers who used e-cigarettes to quit smoking and smokers who did not use e-cigarettes, the authors found, “[E]-cigarette use alone might support tobacco quitters remaining abstinent from smoking.” In this Research & Commentary, Government Relations Coordinator Lindsey Stroud argues the growing body of evidence suggests the Food and Drug Administration may have been too hasty in its May 2016 decision to regulate e-cigarettes as tobacco products.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this and other topics, visit the Budget & Tax News website, The Heartland Institute’s website, our Consumer Freedom Lounge, and PolicyBot, Heartland’s free online research database.

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state; or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Heartland’s government relations department, at governmentrelations@heartland.org or 312/377-4000.