The vaping panic is looking eerily like the start of a new drug war
There's a vaping panic in the US.
- The vaping "epidemic" is really a classic moral panic fueled by sensationalistic media reports that ignored evidence and exacerbated by opportunistic politicians.
- Legal nicotine vapes almost certainly had nothing to do with the spate of vaping-related illnesses last year, and the increase in teen vaping corresponds with a massive historic drop in teen smoking.
- It might be too late to have a reasonable debate about vaping because sweeping prohibitions are already causing trouble.
- The vaping panic appears to be leading us into a new drug war.
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The vaping epidemic was one of 2019's biggest health and policy stories. The really bad news is yet to come.
Over the past year, a media narrative emerged that any given American could be maimed by a Juul. Government officials also piled on.
Just this week, Surgeon General Jerome M. Adams tweeted, "@CDCgov reports a total of 2,602 hospitalizations and 57 deaths associated with e-cigarettes and vaping lung injuries. A single death or hospitalization is one too many!"
Lawmakers have tripped over themselves to impose sweeping bans on flavored vapes (and in some cases, all vapes).
And that's all fed back into public opinion. A YouGov-Economist poll released last week showed 67% of US adults respondents supported banning flavored vapes. Even smokers - the group whose lives could be saved by switching from tobacco cigarettes to nicotine vapes - mostly support such bans, with 56% of respondents who identified as smokers giving their approval.
But there is one important aspect of this issue that has been buried: Just about everyone's understanding of the "vaping epidemic" is completely wrong.
On Friday, the Centers for Disease Control and Prevention toned down its blanket recommendation against all vaping, instead targeting its recommendation against THC vapes. But it not be possible to correct the resulting mass ignorance that is laying the groundwork for what could look a lot like a new drug war.
Much like the failed war on drugs, the results of vaping prohibition will almost certainly include black markets flooded with dangerous and substandard products, the overcriminalization of at-risk groups, and, very likely, increased cigarette smoking.
The mass misunderstanding of 2 'epidemics'
Drug wars start with prohibitions, and prohibitions start with panic. Look no further than the "Reefer Madness" propaganda of the 1930s and the grand failure of alcohol prohibition - which was in part the result of a moral panic over the influx of Southern and Eastern European immigrants around the turn of the 20th century.
In the case of the vaping panic, two different crises have been mistakenly conflated, with nuance completely stripped from the discussion.
The rash of lung illnesses and the 59 confirmed deaths attributed to vaping were one catalyst for the panic. What was less publicized was when the CDC finally confirmed what the readily available data already showed: The "epidemic" of vaping-related illnesses was almost entirely confined to black-market THC cartridges containing vitamin E acetate.
But it's too late to unring the panic bell.
The Food and Drug Administration has banned nearly all flavored vapes. Some cities have banned vaping entirely. The race to pile on new prohibitions is a bipartisan effort. And while vape-panic diehards will point to the small percentage (about 10 to 15%) of patients who said they vaped nicotine products only, there's reason to suspect such self-reporting comes with a margin of error.
As Bruce Barcott noted on the cannabis-news site Leafly, THC is still federally criminalized, and it remains illegal for recreational use in most US states. That comes with a stigma, and as a result, Barcott said "shamed and embarrassed patients probably lied to their doctors."
Barcott wrote that such "socially desirable reporting" has been studied by social scientists, including Dana Hunt. In her 2015 study of adults who had tested positive for marijuana, only 84% were willing to own up to their drug use. And that was after they had been presented with the results.
The second panic catalyst was the context-free reading of the rising rates of nicotine vaping among young people.
According to a study in the New England Journal of Medicine, the percentage of high-school seniors who vaped in the previous 30 days more than doubled - from 11 to 25.4% - between 2017 and 2019.
Developing brains and bodies becoming addicted to nicotine - physiologically one of the hardest drugs to quit - is a serious concern. Big Tobacco, which after trying to destroy the vaping industry is now a major investor in it, has a well-documented history of marketing to minors and lying about the effects of its product. It is not to be trusted. These concerns are valid.
However, there's a rarely reported caveat. Fewer teens are smoking cigarettes than at any time since such statistics have been recorded.
In 1976, 28.8% of high-school seniors said they were regular smokers. Even in 1996, well after everyone knew smoking was deadly and high-school health classes relentlessly drove the point home by showing teenagers photos of black lungs, 26.6% of 12th graders still smoked daily.
By 2018, just 3.6% of high-school seniors smoked, according to the Department of Health and Human Services. That is a remarkable public-health victory.
Unfortunately, all anyone is interested in is the scary out-of-context stat that teen vaping is up, which is how you get panic-stoking graphics like the one produced by the Partnership for a Drug-Free New Jersey, adorned with the slogan "Vaping is as safe as skydiving without a parachute."
That level of science-denying fearmongering is straight out of the early days of the drug war and a threat to public health.
Media framing is crucial as well. Distressingly, too many journalists are engaged in a dangerous form of groupthink and fail to question the preconceived wisdom.
To cite an example (but not to single it out), a PBS article published this week reported the largest single-year drop in cancer deaths ever - 2.2% between 2016 and 2017.
But rather than exploring whether the increase in nicotine vaping, a smoking-cessation tool, had anything to do with fewer Americans being diagnosed with cancer, the article inexplicably asks, "Could vaping e-cigarettes lead to a rebound in US lung cancer deaths?"
The author paraphrased a medical expert at the American Lung Association as saying, "It is too soon to know if e-cigarettes will cause cancer" - which is another way of saying there's no scientific evidence vaping causes cancer. From there, the article launches straight into a rehash of the basic stats on the vaping illnesses and teen-vaping rates.
It's almost like the narrative writes itself. The problem is the narrative happens to be wrong, and it's already producing nasty consequences.
Prohibition leads to the opportunity for a black market.
A new drug war
The "legislate first, consider the evidence later (maybe)" ethos was exemplified by 2020 Democratic candidate Sen. Bernie Sanders in a recent speech.
"I think we shut down the industry if they're causing addiction and if the evidence is that people are getting sick as a result of inhaling a lot of bad stuff," Sanders said earlier this month at a town hall. His campaign quickly walked the severity of that statement back, but the sentiment remains the predominant one in US politics.
What's less discussed amid the vaping panic are stories like what's going on in Texas high schools.
The Texas Tribune last month reported some high-school students in the state were facing felony charges and expulsion as part of the sweep to tamp down on the "epidemic."
In the 2018-19 school year, nearly 20,000 Texas students faced suspension or expulsion for nicotine-vape possession. A stunning 1,600 faced felony controlled-substance charges for possessing THC vapes.
This is what the beginning of a new drug war looks like.
When substances are banned, they don't go away; they get more expensive and more dangerous. And the laws that forbid them are enforced at the barrel of a gun.
Public Health England says nicotine vaping is 95% safer than smoking, which kills about half a million Americans per year. With numbers that stark, the idea that vaping nicotine is the public-health scourge of our time suggests a classic moral panic in a distinctly American style.
The "vaping epidemic" is the wrong way to frame what's happening: It's a vaping panic. When the damage is tallied, it could very well prove to be one of the grossest cases of media malpractice and political opportunism of the modern era.
This is an opinion column. The thoughts expressed are those of the author(s).
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