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AG Nessel pushes FDA to increase regulations on e-cigarettes, prevent underage nicotine addiction

September 14, 2023
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Michigan Attorney General Dana Nessel is pushing the U.S. Food and Drug Administration to do more to protect kids from e-cigarettes. In a press release on Aug. 31, Nessel and 33 other attorneys general announced a four-part recommendation for the regulation of e-cigarettes.

According to the release, the recommendations were included in a response letter to a request from the FDA’s Center for Tobacco Products for the Attorneys General Coalition to review their newly-established five-year strategic plan.

While one of the Center’s strategic goals is to “develop, advance and communicate comprehensive and impactful tobacco regulations and guidance,” the coalition urged them to “set up guardrails” preventing nicotine addiction in young people.

In the release, Nessel said nicotine use by young people has reached epidemic proportions. Pediatric Pulmonology Specialist Ryan Thomas agreed and said in spite of progress in youth nicotine addiction in recent years, the peak in e-cigarette use is fueling a new era of nicotine addiction.

“The data suggests that as many as 30% of high school students reported using e-cigarettes,” Thomas said. “That's higher than any other nicotine product has had amongst high school students in decades.” 

Thomas said regulating e-cigarettes now is essential in preventing possible epidemics in the future. The problem, he said, is that data on the effects of e-cigarette use is limited because there are few long-term users to study. While health consequences have started to appear, Thomas said researchers can’t be sure if it is at the level of traditional cigarettes.

“A lot of the complications are likely to be delayed,” Thomas said. “What we do know about it is that a few reports have noted that people who use e-cigarettes are more likely to have chronic coughing, wheezing, asthma, shortness of breath, when compared to their peers, and that e-cigarette use increases the risk of asthma attacks in adolescents with asthma.”

Although current data may not show the full dangers of e-cigarette use, Thomas said it is necessary to worry about the long term effects before we see them show up in research.

“A lot of people would have told you that cigarettes were safe for a very long time until it became very clear they weren't,” Thomas said. “We don't want to find ourselves in that situation, again, 20, 30 years from now, where we have epidemics of (chronic obstructive pulmonary disease) and lung cancer that could have been prevented by enacting some common sense policies right now.”

The recommendations

The coalition’s first recommendation was that the FDA prohibit all non-tobacco flavors in e-cigarettes. The press release states that flavors mimicking candies and fruits are a “major reason young people try e-cigarettes in the first place.”

Thomas said the prohibition of flavors is important for several reasons, including the fact that it makes devices more palatable for young people. He said there have also been instances of nicotine toxicity in toddlers who ingest the liquid because it smells like candy.

“As little as a half teaspoon of that liquid can kill a young child,” Thomas said. “They don't need to drink much of it for it to make them quite sick.”

The second recommendation from the attorneys general is to enact evidence-based limits on nicotine in e-cigarettes. Thomas said this regulation is important because e-cigarettes tend to have more nicotine than a traditional cigarette, which makes them more addictive.

“If you are able to cut down on the amount of nicotine in these products, you're going to give someone who picks it up casually a better chance of not developing the addiction,” Thomas said.

The coalition also recommended that the FDA restrict e-cigarette marketing that attracts youth, primarily by making sure young people aren’t “bombarded with ads.” The press release stated that many companies have used social media to attract teenagers.

Reflecting on ad campaigns from the past like Joe Camel and the Marlboro Man, Thomas said marketing is an important aspect of why youth in particular try nicotine products. He said decreasing media exposure seems to have worked with traditional cigarettes and is an important regulation for e-cigarettes as well.

The final recommendation from the coalition is to close the “disposable loophole.” The press release said the disposable loophole refers to the fact that disposable e-cigarettes have not been subject to the same regulation as cartridge e-cigarettes.

Thomas said increasing regulation on disposable e-cigarettes is important because all nicotine products should be thoroughly tested and regulated.

“These things are delivering drugs to people and we want to make sure that it's happening, if it has to happen at all, but it's happening in as safe a way as possible,” Thomas said. 

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