THE VAPE TRAP
New research affirms that as for opioids, medical model “treatments” and harm reduction for a non-medical problem become epidemic, trapping new nicotine users in dependence and worse
by Clark Miller
Published September 27, 2024
A turning point in America’s vaping epidemic came in late 2017 when after decades of steady, significant decline in youth and adult use of traditional combustible tobacco cigarettes, “smoking”, an FDA plan for harm reduction and cessation was lauded as “innovative” in America’s top medical journal – support and encouragement of use by smokers of electronic cigarettes to replace smoking of cigarettes. That endorsement would have been taken as authoritative and as another “gold standard” treatment by impressionable American medical professionals, as were assurances from pill salesmen and medical experts a few decades earlier – despite disconfirming research and evidence available for decades prior – that opioid medications could be used safety and effectively to treat pain long term. From pill salesmen.
As would have been predicted by many who have some understanding of what actually drives problem compulsive substance use including in youth, those benighted models and their outcomes have come full circle, with increasing and strong evidence that after decades of decline in addictive, problem use of nicotine, millions of new young Americans – a new generation – are now dependent on use of nicotine by new means of administration and with increasing risk of return to use of combustible cigarettes.
That likelihood of return to traditional smoking increases with misguided, reactive responses to the epidemic including bans, fear-based campaigns, prohibitions, disciplinary actions, and other punitive, controlling or coercive measures by authority that contributed in the first place to young people reclaiming dignity and autonomy by demonstrably engaging in the very adult, very assertive behaviors of use of dangerous substances. That is to say, young people driven by healthy underlying drives to reclaim autonomy and sense of control, to be accepted and validated by a group of others rather than controlled by them in response to a world of punitive, distant, controlling parents and others whose modeling behaviors are distinctly at odds with their rules and demands. Reclaim unfortunately by self-defeating methods and choices.
Now, 7 years on and with a new generation of young people dependent on nicotine by initiating vaping of it – in much higher concentrations than in the combustible cigarettes that vapes were predicted to replace – there are expressed reactive threats to “crack down” on youth who are vaping, daily warnings about catastrophic health effects and of severe consequences for youth detected and apprehended for vaping at school.
So, that JAMA-endorsed innovative plan seems to have not worked out.
And, if only “not worked out” could represent simply the failure of vaping to replace use of traditional cigarettes, acting as promised by America’s expert class as a cessation aid, we would not be facing an escalating epidemic of nicotine dependence-driven illness and gateway substance use as research increasingly establishes – just as in the predictable failure of runaway medical dispensing of addictive opioids for the nonmedical condition of chronic pain.
Uncontrolled lethal epidemics are much larger problems than another failure of a medical intervention for a nonmedical problem. Prevalence of smoking of traditional tobacco cigarettes, it may be remembered, had been dropping steadily, year by year over decades . . . until the “innovative” medical harm reduction intervention of vaping was endorsed, protected from regulation, and exploded. Smoking rates have not decreased since then.
BELOW – New research, large study: “Vaping is linked to smoking cigarettes, using marijuana, and other drugs over time”
The immense popularity of electronic cigarettes, or e-cigarettes, among young people has led many policymakers to restrict the sale of flavored varieties. But rather than nudging people away from “vapes,” as these e-cigarettes are called, such measures could backfire by driving users to instead buy conventional cigarettes, a much more dangerous product, according to researchers at the Yale School of Public Health (YSPH).
In a large-scale, long-term analysis of policies and sales data, the researchers found that for every 0.7 milliliters of “e-liquid” (the consumable content inside e-cigarettes, also known as vape juice) that goes unsold due to flavor restrictions, 15 additional traditional cigarettes are sold. The substitution was especially evident among cigarette brands popular with young people aged 20 and under, suggesting that flavor restrictions may increase smoking among youth as well as adults.
The results suggest that this type of policy, which is intended to curb nicotine-related harms, may instead magnify them.
That is not good. But was predictable, from the start.
The same grim picture emerges from other locales, from additional data and analyses, from direct reports of the young people.
Experts warn that predictable return to use of combustible cigarettes by restricting access to flavored vapes argues strongly against . . . because use of nicotine by vaping is less harmful.
And?
In Australia, where youth nicotine vaping is epidemic as in the U.S. –
And here from Fiilter online magazine –
A new paper published in the Journal of Health Economics suggests that burdensome taxes on vaping products lead to an increase in cigarette sales.
The co-authors of the peer-reviewed article—including Michael Pesko, a leading tobacco economist in the United States—used the NielsenIQ Retail Scanner Dataset (NRSD) over the years 2013 to 2019, which tracks weekly sales of many national retailers and a large percentage of total sales among drug stores, food stores, dollar stores, club stores and mass merchandisers. They found that e-cigarette taxes almost fully pass through to consumer retail prices—meaning, in short, that vapers typically have to pay most of the tax. The authors estimate, more specifically, that a $1 increase in e-cigarette taxes increases e-cigarette prices by 90 cents. Policymakers, therefore, heavily influence the retail price of e-cigarettes through tax legislation.
“Our study finds that for every one Juul-sized e-cigarette eliminated as a result of an e-cigarette tax, 1.9 packs [of cigarettes] are purchased instead.”
Continuing research is reinforcing the predicted outcomes and effects.
From the Newsweek report,
But a new working paper published in the National Bureau of Economic Research finds “evidence of an unintended effect” in the youngest consumers who, rather than quit nicotine products in the face of flavored vape bans, appear to simply move to combustible cigarettes, widely considered to be a more dangerous product.
“The restrictions are associated with a decline in flavored electronic nicotine delivery system (ENDS) sales, but also an increase in cigarette sales,” according to the paper, titled “The Effect of E-Cigarette Flavor Bans on Tobacco Use.”
This recent report, updated June, 2024, points to a critically important and overlooked feature of research that potentially distorts and compromises outcomes. Cigarette sales are a valid and objective measure of trends in cigarette use. That’s distinct from self-reports of substance use, especially when confidentiality of reports are not ensured, as in the Monitoring the Future report relied on by America’s top drug expert in America’s top news source to assure America there is much less to worry about these days regarding youth drug use.
America’s most trusted institutions including medical, healthcare, research, and watchdog media have trapped themselves and generations of young people in a no-win, lethal nicotine trap, having created an epidemic of growing risk and harm to a new generation of vape users while ignoring the predictable costs now of restricting or making less appealing use of vapes with their own serious health risks – public health costs associated with the shift back to higher-risk use of tobacco cigarettes, their use steadily declining over decades prior to upturns in nicotine use by vaping, then flatlining.
Quite distinct from an effective role as a smoking cessation device,
or as harm reduction, the signs have been present all along that vaping became a means by which young people and adults are set up to become more vulnerable to continue compulsive use of nicotine if vaping becomes more difficult, punished, controlled, and/or expensive, including by shift to alternative delivery methods depending on circumstances of availability, cost, shifts in social appeal and norms, and especially for young people, contribution to sense of self and self-image and perception by others as on top of a new trend, edgy, rebellious, and other traits that are more potent than physiological dependence or other factors.
As described increasingly in observational accounts.
Vapes and ZYN nicotine pouches are modern and interesting, with fresh flavors and new brands seemingly emerging daily. The appeal of these devices has long been explored and explained.
It now seems, though, that cigarettes also have been making their way back into the hands and lungs of young people — maybe even more so than vapes.
Some Loyola students are switching from vaping to smoking cigarettes. The Louisiana Office of Alcohol and Tobacco Control banned six major vape brands in March 2024. Design junior Daniel Garces speculates this may have influenced a shift in student habits.
“Compared to my other semesters here, I have seen way less vapes on students,” Garces said. “Seeing a cigarette used to be rare, but now it’s just a common sight.”
After the vape brand bans, local smoke shops increased their prices, Garces said. Now, The Boot store and other smoke shops only carry off-brand vapes, according to Garces. The price increase and lower quality of vape stock now deter students from buying vapes, he said.
“One complaint I’ve repeatedly heard is that The Boot has raised the price of vapes, taking full advantage of the scarcity and ban,” he said. “Prices used to be around $15. Now, it’s around $30, plus tax.”
Popular and commercial music junior Maddie Polley believes the ban has had minimal success in combating nicotine addictions. Instead, Polley said the ban has pushed some Loyola students to start smoking cigarettes.
“I think that people should be able to put whatever chemicals they want in their body,” Polley said. “But I do understand why they were banned because I feel like the vaping culture has gotten really big, especially with younger people under 21. I understand the ban, but I still think banning substances is kind of stupid.”
Although Polley said she understands the reasoning behind the ban, she believes the goal of tackling nicotine use with young adults will be unsuccessful.
“I feel like the ban on vapes maybe is changing some peoples’ minds, maybe, but overall, I don’t really think that it’s doing much to be honest,” she said. “When people are addicted to something, they’re going to find a way to get it no matter what.”
Garces said the increased cigarette use reflects a cultural phenomenon fueled online.
“It’s also been a trend on social media to pick up cigarettes, so I think the ban allowed that transition to happen smoothly,” he said. “It’s easy to tell on a night out who’s smoking cigs to fit an aesthetic, especially if they’re posing with it for pictures.”
According to Garces, some student attitudes are changing in favor of cigarettes and against vapes.
“I’ve heard people say they prefer cigarettes because it’s cheaper and looks cooler than hitting a colored stick with flavored air,” he said.
Smoking cigarettes has undergone a transformative shift in perception and prevalence among the youth of Generation Z, largely influenced by the popularity of social media within this demographic.
Nothing projects an essence of coolness like a nice little burnable nicotine stick that can add a touch of rebellion to your fit pic or photo dump. . .
Beyond Hollywood, we are currently seeing more young people smoking outside of clubs, dive bars, college campuses, and anywhere frequented by ‘creative,’ ‘alternative’ types. . . .
When taking selfies or making content for social media, I realized this lens has become a dynamic force in shaping the vices of today’s youth. Smoking evokes a timeless sense of rebellion and dash of sophistication. How else are we supposed to show that we’re rebels without a cigarette?
Here are some direct accounts from Gen Zers on returning to use of traditional cigarettes.
As Neil Young put it, “Every wave is new until it breaks”.
STILL TO COME, JUST BELOW – New research, large study: “Vaping is linked to smoking cigarettes, using marijuana, and other drugs over time”
It should be clear, has always been clear, that while the primary, real forces driving uptake of compulsive use of nicotine by any route are psychological, developmental, and social, “psychosocial”, the derelict disregard of those factors has and is continuing to generate and worsen lethal, epidemic effects.
Like these forces, fueled by media, entertainment, even sports.
Ex-vaper Charley in a skirt is a new Marlboro Man
LANCASTER, Pa. — Charley Hull stood next to the rope line left of the 18th green in the final round of the U.S. Women’s Open and looked back down the fairway. Her ball rested safely 10 feet below the hole, but her playing partner, Jenny Shin, wasn’t so fortunate. After catching the lip of a fairway bunker with her approach, Shin still had 121 yards of baked-out turf between her ball and the hole.
As Shin and her caddie deliberated over how best to play the shot, a fan called out to Hull. Can I get a picture with you? The 28-year-old from Northamptonshire, England, obliged, posing for a selfie with the fan. Another request soon followed. Then another. And another. Hull eventually had to step away from the rope line. She still had a birdie look after all.
The putt didn’t drop, but that didn’t dampen the crowd’s enthusiasm. As Hull walked from the 18th green to the scoring tent, where she’d sign for a closing three-under 67 that will secure her a top-20 finish, fans showered her with praise. We love you Charley! Way to go! In just a week, Hull had gone from a relative unknown among casual golf fans to a cult hero among the eastern Pennsylvania galleries and far beyond.
And it all started with a cigarette. . . .
Her explanation for why she smokes only helped grow her legend.
“I was a bit stressed last year and I just kind of vaped,” she said. “And I wanted to stop vaping, and even though smoking is not better than vaping, it’s just you can vape indoors all the time. I thought if I smoke, I’m going to go outside and smoke a cigarette.”
Cigarettes might carry a stigma, but smoking didn’t do much to diminish Hull’s popularity at Lancaster Country Club. In fact, quite the opposite has happened. . . .
“It’s been crazy,” she said. “Like the fans have been shouting my name this week … It’s been a bit of a wild week. Pretty cool, and I wish the crowds were like this more often.”
When a couple of teenage boys asked for Hull’s autograph earlier this week, they asked that she hang a cigarette from her lips as they dangled white tees from theirs. Another fan asked to bum a cigarette from her as she passed by.
Something is happening here,
and wherever by accumulating reports young people are observed to be returning to use of traditional combustible cigarettes, something powerful, deeply social, psychological, cultural, and ignored.
Something is happening, and you don’t know what it is. Do you, Mr. Jones?
The rationale offered by the new icon of cool, of smoking is the new vaping, is a grim, lethal twist of irony. Ms. Hull reasons that related to etiquette along with social and other restrictions on smoking versus vaping, she would reduce her use by sticking to cigarettes. Regular use of traditional cigarettes does pose higher risk of illness and death than vaping, supported by strong evidence. But she doesn’t see it that way, more as a toss-up, “smoking is not better than vaping”.
She’s not alone in that distorted appraisal, instead joined by a large majority of polled smokers worldwide believing that vaping is at least as harmful as smoking cigarettes. In some ways, yet to be reckoned with, it is.
Medically approved and promoted as a cessation aid and as harm reduction, compulsive use of nicotine by vaping predictably has become a complementary way to maintain nicotine dependence, falsely normalized, promoted, and reported by experts and authorities as providing some benefit for individuals at risk of harms and death by tobacco use, now contributing to that risk and recruiting millions of new users by maintaining the appeal of and dependence on nicotine. That is to say, vaping is the Suboxone of America’s 500,000-deaths-per-year public health smoking problem.
The decades long yearly decrease in prevalence of cigarette smoking has flatlined, corresponding exactly with rising use of e-cigarettes.
Instead of reducing cigarette use, vaping leads to “smoking cigarettes, using marijuana, and other drugs” –
Some of the research outcomes as reported in Newsweek,
“We found that this risk was persistent over time and was a risk for both adolescents and young adults,” study author Rebecca Evans-Polce, a research assistant professor at the U-M School of Nursing, said in a statement. “The risk for starting to use cannabis was the same regardless of whether someone was using e-cigarettes or was using other tobacco products.”
For the 18 to 25 group, those who vaped and used other tobacco were 22 times more likely to start smoking, nine times more likely to start using marijuana and three times more likely to start using other drugs.
Those who just vaped, meanwhile, were 11 times more likely to start smoking, six times more likely to start using marijuana and twice as likely to start using other drugs.
This mirrored the findings for the 12 to 17 group as well, who were 54 times more likely to start smoking, eight times more likely to start using marijuana and three times more likely to start using other drugs if they vaped and used other tobacco.
“The really high odds of cigarette initiation regardless of what type of nicotine or tobacco products you’re using is important,” Evans-Polce said. “I think it really highlights that to the extent that you can prevent initiation of vaping and other tobacco products, too, you’ll also go really far in preventing cigarette initiation over the long term.”
Those predictable research outcomes, congruent with observational and sociological reports, should be alarming in the face of 2.1 million kids using e-cigarettes and 4,000 kids starting vaping each day.
The dose factor
Successfully branded, promoted, and enabled by major and social media, medical, research, and public health institutions as effective smoking cessation and benign harm reduction, adult and youth vaping surged, but with even higher dependence potential due partly to the dramatically higher, unregulated levels of nicotine delivered compared to traditional cigarettes.
When the FDA first asserted the authority to regulate e-cigarettes in 2016, many people assumed the agency would quickly get rid of vapes with flavors like cotton candy, gummy bears, and Froot Loops that appeal to kids.
Instead, the FDA allowed all e-cigarettes already on the market to stay while their manufacturers applied for the OK to market them.
Seven years later, vaping has ballooned into an $8.2 billion industry, and manufacturers are flooding the market with thousands of products — most sold illegally and without FDA permission — that can be far more addictive.
“The FDA has failed to protect public health,” said Eric Lindblom, former senior adviser to the director of the FDA’s Center for Tobacco Products. “It’s a tragedy.” . . .
Meanwhile, today’s vapes have become “bigger, badder, and cheaper” than older models, said Robin Koval, CEO of the Truth Initiative, a tobacco control advocacy group. The enormous amount of nicotine in e-cigarettes — up 76% over five years — can addict kids in a matter of days, Koval said.
E-cigarettes in the U.S. now contain nicotine concentrations that are, on average, more than twice the level allowed in Canada and Europe. The U.S. sets no limits on the nicotine content of any tobacco product.
“We’ve never delivered this level of nicotine before,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids, which opposes youth vaping. “We really don’t know the long-term health implications.”
In fact, we do have an emerging picture of the “long-term health implications” and it is grim – accumulating, consistent evidence that the explosive use among youth of higher levels of nicotine by vaping is tied to worsening predictions of a latent juvenile diabetes epidemic driven by the established, direct link between nicotine and insulin resistance.
Vaping has become a trap,
the benign, innovative medical harm-reduction plan endorsed by trusted public health institutions and regulators bas become a trap, with high risk of epidemic public health outcomes and illness for those who don’t escape.
The magnitude of those trapped, including youth introduced to nicotine and newly dependent on it by vaping, is large.
From a recent post –
So vaping, not so long ago in America’s top medical journal and persistently hailed as a form of harm reduction or falsely as effective means to stop use of cigarettes, instead has introduced (2 million and counting) and resulted in dependence (for at least 25 percent of those 2 million who are daily users) on nicotine for a new generation of youth.
Worse than that, as regulators belatedly and ineffectively crack down on flavored vapes, a body of evidence predictably accumulates affirming that nicotine vapers move back to use of traditional combustible cigarettes, that evidence outlined in the upcoming post “THE VAPE TRAP”.
That’s not smoking cessation, or treatment, or harm reduction.
So, populations of users, having become dependent on the relieving effects of a chemical substance, vulnerable to the absence of its effects, will actually switch to alternate forms and sources, alternate formulations, forms and chemical cousins for gaining relief from that chemical substance? And switch again? Who knew?
This does sound familiar doesn’t it? Harm reduction, use of addictive drugs to quit drugs, and safer supply? A lethal trap.
Back to our current post –
The vape trap is the new reality, just as is a steadily worsening opioid crisis, steadily worsening the more expert gold standard treatments are administered to the medically treated diseased brains, American Medicine’s gold standard, “proven” cures for the non-medical condition of compulsive substance use established as fueling the lethal crisis.
It is the new reality for state legislators, regulators, Americans and their children trapped in another epidemic, walled in by the dilemma and lethal risks.
A trap increasingly made real by longstanding and accumulating observational accounts and research results.
A new reality with no treatment plan or even credible understanding of the problem that could lead to expectations for relief, prevention, and wellness from the medical, research and public health institutions helping to lay the trap, no more than for the opioid crisis, no more than for any entirely non-medical problem hijacked by America’s medical/media collusion.
That reality is not new.
