On August 21, 2019 the Connecticut Department of Public Health (CDPH) reported two cases of vaping-related hospitalizations involving patients who admitted to vaping “both nicotine and marijuana products.” On September 19, CDPH confirmed 11 more cases, for a grand total of 13. Of these, CDPH interviewed nine patients, who all admitted “using vaping products containing tetrahydrocannabinol (THC), a psychoactive component of the marijuana plant.” Alarmingly, and curiously, CDPH press releases on October 3 and October 11 did not mention anything about which substances individuals vaped prior to hospitalizations.

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CDPH’s lack of transparency is alarming and misleads the American public to the harms, or lack of, associated with legal and regulated e-cigarettes. Recently, the Centers for Disease Control and Prevention (CDC) found a majority of vaping-related hospitalizations were due to vaping THC products. On October 3, CDC announced 78 percent of patients with vaping-related illnesses “reported using THC-containing products.” Similar results have been reported by health departments in Minnesota, Oregon, Texas, and Utah.

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It is imperative lawmakers understand these illegal, unregulated THC-laden “vaping cartridges,” which are mostly homemade or available on the black market, are not e-cigarette products regulated by the U.S. Food and Drug Administration (FDA). E-cigarettes and vaping devices first entered the U.S. market in 2007. In 2012, FDA was granted authority to regulate vaping devices as tobacco products. In 2016, FDA extended its regulatory authority over e-cigarettes, issuing deeming regulations. Under these rules, no new vaping product could come to market after August 8, 2016, without first completing a premarket tobacco application (PMTA). Further, all existing vaping devices must have been registered and approved by FDA by December 31, 2016. In addition, all legal products must complete a PMTA by May 12, 2020, as established by a 2019 U.S. District Court ruling. This will have drastic effects on current vaping products because each PMTA costs about $330,000.

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Despite recent fearmongering campaigns by the media and public health groups, e-cigarettes have emerged as an effective tobacco harm reduction tool. Since their introduction in the United States, an estimated three million American adults have used vaping devices to quit smoking tobacco cigarettes. Further, e-cigarettes are twice as effective as nicotine replacement therapy in helping smokers quit.

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Numerous public health agencies have found e-cigarettes to be significantly less harmful than combustible cigarettes. In 2015, Public Health England (PHE), a leading health agency in the United Kingdom, found e-cigarette use to be “around 95% safer than smoking.” In 2018, PHE reiterated their findings, noting that vaping is “at least 95% less harmful than smoking.”

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In 2016, the Royal College of Physicians noted that e-cigarettes are “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.”

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

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Moreover, e-cigarettes can provide much-needed relief to state budgets because their use reduces health care costs related to smoking. A 2015 policy analysis by State Budget Solutions estimated Medicaid savings could have amounted to $48 billion in 2012 if e-cigarettes had been adopted in place of combustible cigarettes by all Medicaid recipients who smoked combustible cigarettes. A 2017 study by R Street Institute used a samples size of “1% of smokers [within Medicaid] groups permanently” switching. In this analysis, the authors estimated that Medicaid savings “will be approximately $2.8 billion per 1 percent of enrollees,” over the next 25 years.

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Making matters worse, far too many policymakers seek to reduce youth e-cigarette use, yet spend little tobacco revenue on such programs. Notably, Connecticut sued tobacco companies in 1996 to recover costs to Medicaid spent on smoking-related health effects. In 1998, the Constitution State joined several other states in settling with tobacco companies in what became known as “The Master Settlement Agreement (MSA).” The Nutmeg State is estimated to receive “between $3.6 and 5 billion over the first 25 years” in MSA payments.  Despite this, Connecticut lawmakers continue to shortchange anti-smoking efforts. In 2019, Connecticut received an estimated $500.8 million in tobacco settlement payments and taxes, yet dedicated $0 of state funds towards smoking education and prevention programs.

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As CDC and state health departments continue to link vaping lung illnesses to the use of unregulated, illegal e-cigarette products containing THC, CDPH should completely stop lumping regulated e-cigarettes into the same category. Further, the use of electronic cigarettes as a tobacco harm reduction tool should be encouraged, and any policy aimed at reducing youth e-cigarette use should utilize vast amounts of readily available tobacco revenue, rather than vaporize tobacco harm reduction options for current adult smokers.

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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 or Tobacco Harm Reduction 101.