I recently came across a tweet from high-profile psychedelics researcher Matthew Johnson that took my by surprise: “Nicotine,” Johnson wrote, “is an under-recognized battle front in the War on Drugs.”
Nicotine, for whatever reason, has long been relegated to the outskirts of harm reduction. Why is that still the case?
Johnson is a professor in psychiatry and behavioral sciences at Johns Hopkins, and he studies nicotine and the technology around it in the context of the drug war. I had become familiar with his work on psychedelics over the years, especially since the founding of the Johns Hopkins Center for Psychedelic Consciousness and Research, where he serves as an associate director. But he’s conducted the bulk of his research in tobacco, dating back more than two decades to his time in grad school. He has received federal grants to examine reduced nicotine in cigarettes and the effects of cigarette advertising, as well as the applications of psilocybin for treating tobacco addiction.
The interview has been lightly edited for length and clarity.
Alex Norcia: It fascinates me that, in both policy and culture, we are moving in the direction of liberation with most drugs, but in totally the opposite direction—toward more prohibition—with nicotine. Why does nicotine not have a place in this movement?
Matthew Johnson: For me, the key is more of a consensus—not only in science but in society—to move away from a criminal justice approach in dealing with drugs. That’s been the shift. Not just with cannabis and psychedelics, but with cocaine and opioids and methamphetamine. Trump bragged about criminal justice reform, for example. This is a bipartisan issue, and very few people on either side of the political aisle are really championing the drug war these days. On the conservative or Republican side, it seems like the libertarian-leaning folks have won the day. They argue, basically, that the government should stop getting involved in things—like the criminalization of drugs—that it doesn’t need to be dealing with.
I suppose [with nicotine] it’s about “siloing.” That’s now the catchy term. Many tobacco researchers, I think, are not seeing nicotine as a drug. If you ask them if it is, of course they’ll say that. More broadly, and sociologically, I suspect they’re not viewing it quite through the same lens as the history of, say, alcohol prohibition in the United States.
So they don’t contextualize it within the history of prohibition, and the cocktail of consequences that accompanies it: unregulated and consequently higher-risk products, disproportionate policing of Black and Brown communities.
Right. And another aspect with nicotine is you do have the big looming bad guy: the tobacco companies.
Don’t get me wrong, they’ve done some horrible things. I wouldn’t consult for a cigarette company. But there are some interesting cases with that, too, with companies that actually seem focused on harm reduction. Like Snus, an oral tobacco product. People lose that nuance, if it’s a safer product.
Still, the tobacco control field might be one of the most polarized fields. There’s a zealotry, and you can understand where it comes from; here are these deadly products, here are these companies that only care about money and here’s this horrible history.
If there is a future with e-cigarettes, and obviously there is, of course tobacco companies are going to jump into it. If you’re truly interested in people not dying, then you should encourage that. Like any other corporation, they’re only interested in money. Ultimately that’s a bummer, but let’s get them selling these things rather than the more deadly things.
I recently heard a Sam Harris podcast with folks advocating for the development and use of factory-grown meat, like meat actually grown at the cellular level—that is, actual animal muscle tissue grown in a vat where you’re not having to slaughter animals. I was impressed. They were saying they’re making a lot of progress with companies like Tyson, which is killing—what?—hundreds of millions of chickens. But for them, it’s not like they’re obsessed with killing animals. They just want money. If they can earn more money without the bullshit of people getting on their case about killing animals and actually make more of a profit, because it’s harder to raise animals and so forth, that’s a good thing.
I think the same thing with tobacco companies: If they’re increasing market share in e-cigarettes, that’s a good thing. We can’t be simple-minded and think that literally anything they do is bad in the end. It’s the same sort of politics if someone is opposed to Trump. Taking the role that by definition anything he did was bad, because he was Trump. A broken clock is right twice a day.
There are two hyper-polarized sides in tobacco control: those who wish to live in a nicotine-free society and those who believe that’s unrealistic. In the first camp are well-funded public health organizations that advocate for prohibition-centered measures, like flavor bans on vaping products on local and state levels. In the second are consumer advocates, drug war critics, libertarians, tax reformists, tobacco harm reduction experts and—naturally—the industry.
But the people touting the evidence-based policy often get lumped in with industry, whether they’re directly associated with tobacco companies or not. And the prohibition-minded can’t accept the idea that the industry can be nudged in a positive direction. Nothing will convince them that the industry isn’t lying.
Well, here’s yet another major factor, especially prominent for academic researchers: the so-called “light” cigarettes. There’s a realistic analysis that a lot of people died because cigarette companies conveyed the impression that they were safer products, which they were not. And stepping back, there’s no doubt some people probably would have quit smoking had they not been presented with this supposed healthier option. There’s this once-bitten, twice-shy mentality [in mainstream tobacco control].
Now, the problem is that e-cigarettes really are different. Sure, there are going to be harms identified with e-cigarettes in the long-term. But it’s something you can regulate. You can ban this particular product, or this particular ingredient if it’s harmful, without banning e-cigarettes. By no means would one expect e-cigarettes to be completely safe—in the same way that nobody would expect caffeine use in the form of coffee to be completely safe. For some people, it’s going to be unhealthy. At a certain level for certain people, it’s going to be unhealthy. Take aspirin. Take almost any example you can think of.
The question here is: If e-cigarettes can serve as substitutes for cigarettes—and there’s data that shows a good number of people treat them as so—are they safer? And the answer is much safer. The comparator is a product that kills about half a million people a year in the US, and millions a year worldwide. That swamps all other drug deaths.
Are you confident the federal government isn’t going to mess this up? In the sense of developing a comprehensive and appropriate plan.
No. I’m not confident at all. If one is going to eliminate nicotine from combustible cigarettes, the only chance that would have of working—without causing all these unintended consequences, like inflating a black market—is smartly regulating e-cigarettes. Don’t get me wrong, e-cigarettes need to be regulated, for safety, and they’re on that trajectory with the Food and Drug Administration. But I don’t think people can fathom the magnitude of a cigarette black market.
If the goal is that we make vaping products as expensive and unattractive [to teenagers] as possible that absolutely is working against their ability to serve as safer alternatives. A lot of people get worried about the vaping rates among youth. Every year for the last 70 years there’s been a new generation of kids who are new cigarette smokers. You have to look at the new number of e-cigarette users relevant to the new nicotine users. And you do see evidence emerging that a lot of what we’re seeing is replacement. In other words, even though there are some kids using e-cigs who would have never smoked cigarettes, the large majority of kids becoming e-cigs users would have been cigarette smokers. Obviously, we don’t want kids to smoke or vape. Dealing with kids is the hardest thing politically because no one wants the kids to do any of this.
But all else being equal, would you rather get them hooked on a product that is, no question, killing half a million Americans a year—or one that’s at least an order of magnitude less? That is the relevant question.