On May 7, Congressman Raja Krishnamoorthi of Illinois reintroduced his END ENDS Act—a federal bill that would cap e-cigarette nicotine levels at 20 milligrams per milliliter.
The intention was clear: The Ending Nicotine Dependence from Electronic Nicotine Delivery Systems Act—“END ENDS”—seeks to decrease the nicotine concentrations in vapes in order to make them less “addictive” and appealing to teenagers.
“Since taking office, I have been committed to fighting the youth vaping epidemic, and setting a cap on e-cigarette nicotine concentrations is a regulatory change that will make these products less addictive,” Rep. Krishnamoorthi, a Democrat and committed opponent of vaping, said in a statement. “The lack of transparency within the vaping industry has led to the false notion that e-cigarette products are harmless, when in reality the higher nicotine in some of these products makes them even more addictive.”
The notion that e-cigarettes are widely seen as harmless is not based in reality. In fact, misinformation swirling around from EVALI—the “e-cigarette, or vaping, product use-associated lung injury” cases that popped up in the summer of 2019—seems to have soured public perceptions of nicotine vaping. At the moment, many would-be vapers are confused about the harms associated with vaping, and appear to be returning to far-more-harmful cigarettes in droves.
This is a public health disaster. While the threat of teens becoming daily vapers is much lower than legislators like Krishnamoorthi claim, adult smokers continue to lose their lives at a rate of nearly half a million a year in the US. There are far more adult smokers than there are teen vapers. For most tobacco harm reductionists, the barriers to entry—for switching from combustible cigarettes to vaping products—should be significantly lowered. Adult smokers should not be actively discouraged from making the switch.
In what has become a predictable cycle, advocates, notable tobacco control experts and scientists responded swiftly, condemning the END ENDS idea. The argument is simple: Because vapes are direct substitutes for cigarettes, a current adult smoker is more likely to switch from combustibles to e-cigarettes if the product mirrors the nicotine intake—and the familiar ritual and recognizable feeling—of a traditional cigarette. They warn that nicotine caps, like in the European Union, will prevent adult smokers from, first, trying vaping and, then, fully giving up combustibles. Tobacco harm reductionists raised the same criticism when Health Canada recently released a similar proposal: a 20 mg/mL nicotine cap on vaping products.
Science is increasingly on their side. A new study funded by the Food and Drug Administration (FDA) and the National Institutes of Health (NIH), published in The Lancet in mid-April, suggests that smokers given higher-nicotine vaping products consume fewer carcinogens through continued smoking compared with their peers vaping lower-nicotine e-cigarettes.
“This bill would harm 11 million adult nicotine vapers and 34 million adult smokers,” Dr. Charles A. Gardner, the executive director of INNCO, a global nonprofit that supports the rights and well-being of adults who use safer nicotine, told Filter. “Teen smoking has plummeted over the past eight years. Teen nicotine vaping has plummeted over the past two years. So what’s the problem we’re trying to fix?”
Rep. Krishnamoorthi, who has evolved into one of the most strident anti-vaping politicians in the United States, has been on a tear as of late. He first conceived a version of the END ENDS bill in the fall of 2019, when lawmakers and elected officials were responding to both a steady surge in e-cigarette use among teens and a string of then-mysterious “vaping-related” illnesses around the country.
In the years since, the so-called teen vaping “epidemic” has somewhat faded from the news, as youth vaping rates have fallen. (According to the Centers for Disease Control and Prevention—CDC—in 2020, “19.6 percent of high school students and 4.7 percent of middle school students currently used e-cigarettes, a decline from 27.5 percent and 10.5, respectively, in 2019.) And in November 2019, a month after Krishnamoorthi initially announced END ENDS, the CDC linked EVALI to vitamin E acetate, a compound that had been discovered as an adulterant in illicitly manufactured THC cartridges.
Krishnamoorthi’s proposed legislation arrives amid a flurry of anti-vaping measures that some representatives and senators are trying to push through Congress, as attention slowly shifts away from the coronavirus pandemic. At the end of April, Krishnamoorthi joined Senate Majority Whip Dick Durbin, an established anti-smoking advocate, and other prominent Democrats to introduce a bicameral bill that would introduce the country’s first federal vaping tax. If passed and signed into law by President Joe Biden, the Tobacco Tax Equity Act will increase the tobacco tax rate—and put the same tax rate on lower-risk options, like vaping products.
Meanwhile, states across the US are pushing for e-liquid flavor bans and excise taxes that could make vapes even more expensive than cigarettes—a ridiculous and counterproductive strategy if the goal is to encourage adult smokers to embrace less-risky options.
“What madness,” Gardner said, “leads anyone to think it’s a good idea to reduce access to, and the affordability and acceptability of, safer alternatives that have the potential to benefit 45 million adults, while traditional cigarettes continue to kill 480,000 Americans every year?”
Both INNCO and The Influence Foundation, which operates Filter, have received grants from the Foundation for a Smoke-Free World.