Earlier this month, U.S. Representative Raja Krishnamoorthi (D-Illinois) introduced H.R. 3051 which seeks to implement a cap on nicotine concentration in e-cigarettes at 20 milligrams per milliliter. The proposed bill, titled the END ENDS Act (Ending Nicotine Dependency from Electronic Nicotine Delivery Systems), is aimed at “making e-cigarettes less addictive and appealing to youth”. While well-intentioned, Rep. Krishnamoorthi’s proposal would increase youth smoking, prevent adult cigarette smokers from quitting, and devastate countless small businesses across the country.
In a press release, Rep. Krishnamoorthi stated that the intent of H.R. 3051 is to, “successfully replicate international efforts to prevent youth from using e-cigarettes”. Citing the United Kingdom and European Union as examples, Rep. Krishnamoorthi correctly claims that imposed caps on nicotine levels have led to lower rates of youth vaping in those countries. However, he chooses to ignore the overwhelming evidence that nicotine caps have led to increases in youth cigarette smoking.
Comparing youth nicotine use in the United States, Canada, and the United Kingdom, the overall rate of nicotine use is nearly identical. In the US, the rate of those aged 16-19 who reported vaping or smoking in the last 30 days was 21.3% as of 2019. The rate of prevalence was 21.6% in Canada and 21.0% in the UK.
However, when looking at the data more closely, the situation is significantly worse in the UK than the US or Canada. 8.4% of youth between the ages of 16 and 19 smoked only cigarettes in the past 30 days in the UK, while a mere 2.8% of youth in the US smoked only cigarettes. In Canada, 3.8% of youth reported smoking only cigarettes in the past 30 days.
The United Kingdom has a 20 mg/ml cap on nicotine concentration, identical to the proposal of Rep. Krishnamoorthi. If youth smoking rates are any indication, this policy has not been successful at improving public health. E-cigarettes are proven to be 95% less harmful than combustible cigarettes and have been endorsed by dozens of the world’s leading public health organizations as safer than smoking. Decreasing youth vaping use is critical and should be addressed, but policies that would lower e-cigarette prevalence at the expense of increased cigarette smoking among teenagers would harm the health of our youth more than e-cigarettes ever could.
It is also vital to acknowledge that nicotine caps hurt adult cigarette smokers seeking to quit. E-cigarettes are the most effective method of smoking cessation, more than twice as effective as nicotine patches or gum. Capping the amount of nicotine allowed in e-cigarettes makes it much more difficult for vapes to compete with cigarettes, protecting cigarette companies and their sales at the expense of public health. E-cigarettes must be able to deliver sufficient nicotine to quell the cravings of those addicted to nicotine and lowering the amount of nicotine removes their ability to do so. Data shows this, as a study of adult smokers demonstrated that higher levels of nicotine “significantly reduced craving and withdrawal”, compared to lower strength nicotine.
There is also noteworthy evidence revealing that nicotine caps make it harder for adults to quit smoking. The rates of cigarette smokers switching to e-cigarettes is 40% lower in the UK, where a 20 mg/ml limit exists, then in the United States and Canada where no such limit is yet in place nationwide.
In addition to helping smokers quit, high strength e-cigarettes are immensely valuable for members of disadvantaged groups, like those struggling with schizophrenia and other mental-health related illnesses. A study authored by Dr. Richard Polosa and published by the Oxford University Press found that, among a sample of schizophrenic cigarette smokers, 40% had completely quit cigarette use after twelve weeks of vaping high strength nicotine products and 92.5% of participants had reduced their cigarette consumption by 50% or more. By the end of the study, 61.9% of participants reported feeling more awake, less irritable, and had a greater ability to concentrate.
With data showing that people with mental health issues smoke at three to four times the national average, it is unsurprising that a study from researchers at the University of Glasgow determined that e-cigarettes are particularly helpful for members of disadvantaged communities. Imposing a nicotine cap, which would prohibit products like the one used by Dr. Polosa in his study, would exacerbate existing socioeconomic inequalities in health and fail to address such disparities.
In the Canadian province of Nova Scotia, a 20 mg/ml nicotine cap was implemented in April of 2020 along with a ban on flavored vape products. This policy caused the closure of 50% of all specialty vape shops in the province, destroying businesses and livelihoods. Additionally, cigarette sales increased by 25%, further evidence that nicotine caps drive vapers back to higher risk, combustible cigarettes.
While these harmful effects were in part a result of the flavor ban, which is not included in H.R. 3051, Rep. Krishnamoorthi signed on to a letter earlier this year that called for the removal of all flavored e-cigarettes. Nicotine caps are a part, but not all, of the anti-vaping agenda being pushed by advocates on both sides of the aisle. Flavor bans are another aspect of this agenda and at least 13 states have introduced proposals to ban flavors in e-cigarettes. If implemented, these policies will increase smoking rates among youths and adults, prevent adult cigarette smokers from making the life-saving switch to vaping, and ravage businesses all over the US, costing thousands of jobs. In the interests of public health and protecting the American economy at a time when it is most vulnerable, H.R. 3051 must be rejected.