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October 7, 2019

On October 4, 2019, the Rhode Island Department of Health issued “emergency health regulations banning the sale of flavored” electronic cigarettes and vaping devices. The ban on flavored e-cigarette products will be in effect for 120 days, “and can be extended for an additional 60 days.”

Prior to the ban’s implementation, Rhode Island Gov. Gina Raimondo issued an executive order declaring a “health epidemic of youth e-cigarette use.” The rule also comes in the wake of a recent report by the Centers for Disease Control and Prevention (CDC) that there have been 1,080 “lung injury cases associated with e-cigarette use,” and 18 deaths in 15 states.

Although addressing youth e-cigarette use is  laudable, flavor bans do not actually reduce youth use of such products. Further, banning flavors is likely to create a thriving black market. Even worse, such regulations could lead to more hospitalizations. Several states and the CDC have already linked the vast majority of vaping-hospitalizations to the use of unregulated, illicit vaping products containing tetrahydrocannabinol (THC). In other words, banning flavors will have zero impact on the true cause of the hospitalizations and will likely lead to more cases.

The Heartland Institute analyzed results from the 2017-18 California Youth Tobacco Survey (CYTS) and found that despite flavor restrictions in some localities, youth use of e-cigarettes in those areas had increased after the bans went into place.

Santa Clara County, California, banned flavored tobacco product sales to age-restricted stores in 2014. Despite this, youth e-cigarette use increased while the ban was in effect. For example, in the 2015-16 CYTS, 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18 CYTS, this increased to 10.7 percent.


Despite fearmongering headlines, the vast majority of e-cigarette products available in brick-and-mortar and convenience stores are regulated. Since 2012, the U.S. Food and Drug Administration (FDA) has had the authority to regulate such products. In 2016, FDA issued deeming regulations that extended the agency’s authority over e-cigarettes and vaping devices. Since 2016, all e-cigarette products must complete a lengthy and expensive process known as a “premarket tobacco product application.” Additionally, FDA required all e-cigarette products be registered with the agency by December 31, 2016.

It should be noted that these regulated devices have been on the market for years. Further, no single product has been identified as causing the recent spate of vaping-related hospitalizations. In fact, many states and the CDC have linked a majority, if not all, of such hospitalizations to the use of products containing THC.

A CDC Morbidity and Mortality Weekly Report obtained information for 514 of 805 possible vaping-related hospitalizations. Of the 514 patients, 395, or 77 percent, “reported using THC-containing products.” Furthermore, 210 patients, 41 percent, reported “using both THC-containing and nicotine-containing products.” Only 16 percent, or 82 patients, “reported exclusive use of nicotine-containing products.” The CDC is still unable to identify the “specific chemical exposure(s) causing this outbreak.”

The CDC findings are similar to other conclusions by state health departments. Oregon’s two vaping-related deaths have been attributed to THC products, as announced on September 3 and September 26. The Minnesota Department of Health reported an individual died from a “lung injury [that] was associated with vaping illicit THC products.”

The Connecticut Department of Health “interviewed 9 of [their state’s] 13 patients with vaping-related injury.” All nine patients reported the use of THC products. The Texas Department of State Health Services recently identified 75 potential vaping-related hospitalizations, with “87% of cases interviewed” reporting using THC products. Of the 23 vaping-related hospitalizations in Iowa, 18 “have reported the use of THC.”

Rather than restricting adult access to tobacco harm reduction products that are 95 percent safer than combustible cigarettes, policymakers should utilize existing tobacco moneys on programs to reduce youth e-cigarette use. In 2019, Rhode Island received an estimated $195 million in tobacco settlement payments and taxes. In the same year, the Ocean State spent only $390,926, or 0.002 percent, on tobacco control programs including education and prevention efforts.

It is disingenuous that policymakers would enforce unilateral decisions that will shut down small businesses and restrict adult access to tobacco harm reduction products. Moreover, as more data indicate that recent hospitalizations are due to illicit products, flavor bans are likely to increase hospitalizations as flavored e-cigarette products move to black markets. Rather than imposing bans on e-cigarettes, policymakers should reallocate tobacco moneys on programs to reduce youth usage.

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.

Centers for Disease Control and Prevention Link Majority of Vaping-Related Hospitalizations to THC: Welcome
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