Trump Administration to Limit Access to Most Flavored E-Cigarettes

THURSDAY, Jan. 2, 2019 (HealthDay News) -- After months of delay, the Trump Administration announced Thursday that it will withdraw -- at least temporarily -- mint-, fruit- and dessert-flavored e-cigarette cartridges from the U.S. market.

"Starting in early February, FDA intends to prioritize enforcement against these illegally marketed products," Mitch Zeller, director of the U.S. Food and Drug Administration's Center for Tobacco Products, said in an afternoon media briefing.

Noticeably absent from the new regulatory action were menthol- and tobacco-flavored vaping products. The former, especially, gives kids at least one milder, enticing flavor to vape, health experts warned.

The new regulation also included one other important exception: Flavored liquid nicotine used in "open tank systems" will not be outlawed. That's widely seen as a concession to the burgeoning vape shop business. The new regulation appears to mainly affect large-scale manufacturers of vaping products.

Health experts were disappointed by the FDA's new move.

"The administration policy will fall well short of what is necessary to address this growing epidemic," said Nancy Brown, CEO of the American Heart Association.

"By allowing menthol flavors and flavored liquid nicotine used in open tank systems to remain on the market, the administration would leave a wide pathway for continued e-cigarette use among our nation's children," she said in a statement.

The White House originally proposed a full ban on flavored e-cigarettes -- thought to be especially enticing to teens -- back in September. But critics say the moves set out by the FDA on Thursday fall short.

U.S. Health and Human Services Secretary Alex Azar pushed back against the naysayers.

"We will be enforcing the law by prioritizing the [regulation of] products that most appeal to kids," he told reporters in the Thursday briefing. "We will continue to monitor [the] use of e-cigarette products by youth, and take additional action if necessary."

Still, Azar said the new move is not a full ban -- because FDA review might bring some flavored products back on the market if they don't pose a threat to children.

Trump hinted at something similar. "We think we are going to get back in the market very, very quickly," he said at a New Year's Eve news conference, held during a party at his Mar-a-Lago resort, the The New York Times reported. "We have a very big industry. We're going to take care of the industry."

Azar also believes that e-cigarettes might still serve a positive function -- helping smokers quit traditional cigarettes.

"We aim to see whether e-cigarettes could serve as an effective off-ramp for adult smokers addicted to combustible cigarettes," he told reporters. "We believe that remains a possibility. But e-cigarettes as an off-ramp from addiction must not come at the expense of e-cigarettes being an on-ramp to nicotine for a new generation of children."

But there's growing evidence that vaping is not a viable exit strategy for smokers. Indeed, on its website the American Lung Association states that, "The Food and Drug Administration has not found any e-cigarette to be safe and effective in helping smokers quit."

And a study released in October shows just how popular -- and addictive -- flavored vapes can be for the young.

According to 2018 data, nearly 2.4 million middle and high school teens say they used a flavored e-cigarette at least once over the past 30 days, the study found.

Among teens, "e-cigarettes were the most commonly used flavored tobacco product in 2018; flavored e-cigarette use has increased in recent years," according to researchers led by Karen Cullen. She's from the Center for Tobacco Products at the U.S. Food and Drug Administration.

In fact, almost two-thirds (about 65%) of the nearly 5 million teenagers who used some form of tobacco product in 2018 said they had used a flavored e-cigarette over the past month. The figures come from annual National Youth Tobacco Surveys.

Experts in lung health said the numbers are troubling, because any nicotine-containing product that comes in fruit, candy or other flavors can be a gateway to lifelong addiction.

"In order to make vaping more enticing, flavors have been introduced into the manufacturing of both commercial brands and black market products," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.

"Young people are attracted to the flavorings, but as they get older, they add other substances like nicotine and THC," he added. THC is the chemical in marijuana that provides a high.

And there's an even more frightening issue emerging -- cases of serious lung injury linked to vaping. According to the latest figures, more than 2,600 such cases have occurred this year across the United States, including 55 deaths.

The suspected culprit is vitamin E acetate, an additive used in some vaping products.

Responding to the epidemic of youth vaping and the recent spate of vaping-linked lung injuries, many state governments have already moved to ban flavored e-cigarettes.

Cullen and her colleagues believe such efforts can help. They point out that after New York City initiated an almost total ban on the sale of many flavored cigars and "chew" products in 2009, cigar sales dropped by 12%, even as sales rose elsewhere in the nation.

Juul, by far the largest marketer of vape products in the United States, announced earlier this fall that it was ceasing production of most of its flavored e-cigarettes.

One lung health specialist agreed that something must be done to spare kids a lifetime of addiction to nicotine.

"Many youth admit that flavored e-cigarettes are the major reason they started vaping," said Dr. Mina Makaryus, a pulmonary specialist at Northwell Health in New Hyde Park, N.Y.

"Given the addictive nature of nicotine, these youth are now addicted to nicotine at a very young age, and they are more likely to continue using e-cigarettes and even start smoking regular combustion cigarettes in the future," he said.

More information

The American Lung Association has more about vaping and lung health.