The Double Standards of Cannabis and Nicotine - By Michelle Minton September 2020
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
The Double
Standards of
Cannabis and
Nicotine
By Michelle Minton
September 2020
ISSUE ANALYSIS 2020 NO. 7The Double Standards
of Cannabis and Nicotine
By Michelle Minton
Executive Summary Though different in nature and purpose, the scientific
The principal benefit of recreational cannabis, as the evidence on cannabis and nicotine is remarkably
name implies, is recreation. Many who enjoy using similar, in terms of the risks they might pose. Decades
the substance do so solely because of the pleasure they of research and popular use confirm that the harms
derive from it. Nicotine vapor products or “e-cigarettes” associated with regular cannabis use are, for most
are not only a source of pleasure, but also a critical people, relatively minimal, even if some questions
tool that has helped millions of adults kick their remain, such as, for example, on how it interacts with
deadly smoking habit. Yet, at the same time that certain medications and psychiatric conditions or how
public and political support for legalizing recreational it might impact adolescent development.
cannabis has soared, so also have calls to virtually
More importantly, history provides compelling evidence
eliminate or prohibit legal access to potentially
that whatever hazards might be associated with
life-saving nicotine vapor products.
cannabis, they are preferable to those created by its
Since e-cigarettes first entered the U.S. market around prohibition. The federal ban on cannabis did little to
2007, anti-smoking advocates have voiced concern stop its widespread use. As with alcohol before it,
about their possible hazards and demanded that prohibiting cannabis spawned a sophisticated
government restrict their availability. That stance might illicit market, incited contempt for the law, cost the
have seemed reasonable in the beginning, since, as economy billions of dollars, fomented distrust of law
opponents argued, research on the products and their enforcement, and ruined countless lives. Thus, with
potential health effects was limited. It also implied research unable to identify any meaningful harms
that detractors would withdraw, or at least temper, caused by cannabis use and witnessing the damage
their opposition to the sale of e-cigarettes should caused by its prohibition, the general consensus is that
sufficient evidence reasonably establish their relative our society would be healthier, freer, and more just by
safety. restoring adults’ ability to use cannabis legally.
The evidence has emerged that e-cigarettes are vastly Like cannabis, many unknowns remain about the
safer than smoking, even if not risk-free, and have the effects of nicotine and nicotine vaping, but there is
potential to save or improve millions of lives. Yet, enough to know its risks are minimal and are
anti-vaping advocates’ hostility toward e-cigarettes has substantially lower than for combustible tobacco. We
only intensified and governments around the world have also know that nicotine vapor products help adult
begun banning the products. The reason, as this paper smokers quit smoking, providing an immediate public
demonstrates, is that regulation of certain controversial health benefit by diverting smokers to less harmful
substances often has little to do with evidence. As the alternatives. Banning e-cigarettes will not stop people
comparison of the evidence on and debate over nicotine from using them, but like every prohibition before it,
and cannabis reveal, the way some activists and policy push many toward more hazardous behaviors, such as
makers treat controversal substances depends less on buying from the illicit market or continuing to smoke.
science and evidence than on the prevailing narrative Yet, restrictions and bans on e-cigarettes continue to
they choose to believe and promote. sweep across the nation.
Minton: The Double Standards of Cannabis and Nicotine 1This different treatment of two relatively analogous Decades of promoting hostility toward “Big Tobacco”
substances cannot be explained by the scientific proved helpful for this effort. Like tobacco companies
evidence. It arises from what the public and, in that once sought to deceive the public about the risks
particular, those in power choose to accept as evidence of smoking, anti-vaping activists waged a campaign to
and the popular narrative this creates. Popular culture, sow doubt about the safety of e-cigarettes. With billions
the media, reform advocates, and individual users in public funding, an army of affiliated academics,
coalesced around a consensus that many adults enjoy allies in government and media, and the support of
cannabis and will continue to do so regardless of its industries threatened by new competition, activists
legality. The general public now overwhelmingly generated a steady stream of negative headlines about
believes that cannabis use is inevitable, prohibition is “vaping.”
futile, and adults should have the right to use it simply
They knew from their fight with Big Tobacco that they
because they enjoy it. But the same does not apply for
could persuade the public of the need for government
nicotine.
intervention if they believed that a choice posed risks,
For a long time, the narrative surrounding nicotine not just to the individual making it, but to those
vapor has been one of fear and suspicion. It has around him. So, as with secondhand smoke and youth
increasingly focused on unknown risks and the threat smoking, anti-vaping advocacy focused on the threat
e-cigarettes might pose to adolescents, even as the e-cigarettes supposedly posed to adolescents and to
scientific evidence consistently shows these fears are public health.
overstated, and demonstrates the products’ safety and
The strategy has been wildly successful. While the
benefits for adults. This was no accident.
evidence continues to mount in favor of e-cigarettes’
Prior to the advent of e-cigarettes, declining smoking effectiveness for smoking cessation, public opinion is
rates posed an existential threat to anti-tobacco increasingly in favor of banning the products. Even as
activists and groups. As smoking declined in America embraces an approach aimed at reducing the
popularity, those who had built careers and harms of risky behavior with policies like clean needle
organizations in the well-funded battle against exchanges, sexual education, and cannabis legalization,
smoking found themselves victims of their own we are turning more toward a zero-tolerance approach
success. E-cigarettes provided the perfect bogeyman when it comes to nicotine. Unfortunately, that is
to stoke public anxiety and revive fundraising. Thus, because evidence is not the driving factor in the
anti-tobacco activists redirected their efforts toward political debate over substance use.
turning public opinion against these novel products.
2 Minton: The Double Standards of Cannabis and NicotineIntroduction American adults said they currently
A large proportion of nicotine vapor used marijuana, with 35 percent using
users credit the products with saving it regularly.1 In contrast, nicotine use
their lives, a claim rarely—if ever— in the U.S. is at a historic low, with
made by those who use cannabis purely under 14 percent of adults categorized The case for
for recreation. Yet, while legalizing as current smokers and only 8 percent
recreational cannabis is now a cause of adults saying they vaped within the legalizing
célèbre among liberal and some past week as of 2019.2 cannabis
conservative politicians, a prohibition
on nicotine vapor products—sometimes
Public opinion, among users and is strong.
non-users alike, has evolved alongside
referred to as electronic cigarettes—
these consumption patterns. A Gallup
has become an equally fashionable
poll in 2019 found that 66 percent of
position, often among the same
the American public supported
individuals.
legalizing marijuana.3 The same year, a
Advocates of greater restrictions or poll by the Kaiser Family Foundation
bans on nicotine vaping cite a lack of found that a majority (52 percent) of
evidence on the effects of vaping. That Americans favored banning all but
seems to imply that their position might tobacco-flavored e-cigarettes, while
change if the products’ safety and nearly half (49 percent) favored a total
efficacy were ever proved by research, ban on nicotine vaping products.4 But
but it has become clear that such a this evolution in opinion, among both
prospect is just a political smokescreen. the public and politicians, is not based
As the divergent treatment of cannabis on conclusive scientific evidence.
and nicotine demonstrates, when it
After decades of research, there is
comes to the regulation of substances,
enough evidence to assume that the
neither evidence, principles, nor even
health effects of cannabis use are
justice actually matter. All that matters
unlikely to be life-threatening. For at
is the popularity of the given narrative
least 20 years of study and public
about a substance.
debate, the case for legalizing
Cannabis and nicotine are both cannabis—in terms of public safety, as
pleasurable substances that have well as social, economic, and personal
enjoyed widespread popularity for well-being—is strong. This evidence,
hundreds of years. Both have a large along with efforts by activists and
body of scientific research, as well as health professionals to destigmatize
many unanswered questions, about the drug and its users, largely explain
their effects on human health. Yet, in why the public and subsequently
recent years cannabis has become far lawmakers have begun to look more
more popular. In 2017, 55 percent of favorably on legalizing cannabis.
Minton: The Double Standards of Cannabis and Nicotine 3However, the scientific evidence on the law. And, of course, the rise of the
the health effects of cannabis has illicit market, with its outsized profits,
remained largely inconclusive.5 draws many people into risky or
Hampered by regulatory barriers, criminal behavior, with often terrible
The costs of researchers have been able to shed consequences both for the individuals
light on some aspects of the drug’s engaging in illicit activities and their
prohibition on impact on health, but major questions communities.
individuals, remain unanswered.6 For example,
By weighing what we do know about
there is very limited data on how
society, and tetrahydrocannabinol (THC) affects
the health effects of cannabis against
the known consequences of prohibition,
the economy heart health.7 We are just beginning
America has come to the reasonable
to understand how different patterns
have proven of use may interact—either positively
conclusion that whatever risks might
ultimately be associated with cannabis
catastrophic. or negatively—with other physical
use, they are lesser than, or preferable
and psychological conditions,
to, the harms created by its prohibition.
predispositions, and treatments.8
Furthermore, little is known about how
cannabis alters brain function in adults
Regulation in the Face
and brain development in adolescents.9
of Uncertainty
On the other hand, the costs of In the absence of complete and perfect
prohibition on individuals, society, and scientific information—something
the economy have proven catastrophic. almost no topic enjoys—regulators
For the last half century, Americans must carefully weigh the strength of
have observed the utter failure of the evidence we do have about the
banning cannabis to stop its widespread potential harms and benefits of giving
use; how it spawned sophisticated, consumers legal access to substances
international drug-trafficking networks; against the likely harms and benefits
cost our economy billions; fomented of prohibiting that substance. With
distrust between the citizenry and law regard to cannabis, regulators,
enforcement; and ruined untold researchers, and the general public, for
numbers of lives.10 Outlawing the drug the most part, have rightly come to the
did not stop demand. Instead, it drove conclusion that the costs of prohibition
millions into the illicit market, where, far outweigh the potential risks
in addition to any risks inherent to the associated with legal access to the drug.
drug, they are exposed to the additional
Were regulators and lawmakers to
hazards of interacting with criminals,
objectively perform this sort of
potentially consuming adulterated or
calculation for nicotine, they would
tainted products, and running afoul of
4 Minton: The Double Standards of Cannabis and Nicotineconclude the same for that substance. As with recreational cannabis, the
While it is true that, as with clinical evidence indicates that the
recreational cannabis, we may not health effects of nicotine vaping are
fully understand all of the effects of minimal—at least minimal enough
nicotine vaping, there is enough that researchers have been unable to As with
evidence to conclude that the effects consistently demonstrate any negative
on health are limited to the degree that effects at all. This is why nicotine recreational
a regulatory scheme that maintains replacement therapy, for example, is cannabis,
legal access to these products will be not associated with increased risk of
less detrimental to individual and cancer, cardiovascular disease, stroke, the clinical
public health than a prohibition on or other diseases commonly linked evidence
such products. with smoking.12 Furthermore, the
benefits to society of providing access indicates that
Nicotine vaping devices are a
relatively new category of products,
to smokeless nicotine has been the health
validated by studying the experiences
but tobacco and nicotine use, in
of countries that have embraced lower effects of
various forms, is not. Though public
health professionals have historically
risk tobacco alternatives, like Sweden. nicotine
conflated the effects of smoking and Snus, a moist tobacco chew, has been vaping are
nicotine, the advent of nicotine vaping, in use in Sweden since the 17 century,
th
which separates the effects of nicotine but it gained in popularity beginning minimal.
from combustion, has become the in the 1980s as the dangers of smoking
subject of intense scientific study over became clearer and more well known.
the last 15 years. Because of public By 2016, approximately 21 percent of
interest and the lack of regulatory Swedish men were classified as current
barriers on its study, current clinical snus users, while just 7 percent of the
data on nicotine is as robust as that for population continued to smoke, and
recreational cannabis, if not more so. just 5 percent smoked daily.13 As a
We have more than 400 years of result of replacing a combustible
observation about non-combustible tobacco with a non-combustible
tobacco use, such as tobacco chew, product, Sweden has not only the
snuff, and snus (moist snuff).11 There lowest smoking rate in Europe, but
is also plenty of information available also the lowest rate of lung cancer—
on the social and economic effects by far—and among the lowest rates
of various regulatory schemes for of mouth cancer.14 In the rest of the
nicotine products, based on experiences European Union, where snus is
in the U.S. and around the world. banned, 24 percent of the population,
on average, smoked as of 2016.15
Minton: The Double Standards of Cannabis and Nicotine 5Similar effects have been observed in their stoner comedy films, beginning
Japan, where the rate of decline in with the 1978 cult classic Up in Smoke.
cigarette sales has quintupled since And beginning in the 1970s, hip hop
the introduction of Philip Morris and rap artists used marijuana in their
Government International’s heated tobacco product, lyrics (and lives) as a form of rebellion
IQOS.16 Great Britain and the United against and rejection of a mainstream
policies that States, where the government embraces society they believe marginalizes
seek to restrict or tolerates e-cigarettes, respectively, individuals and communities of color.20
have seen similar accelerations in the By the 1990s rap and the stoner
legal access decline of smoking.17 comedy had been incorporated, at
to nicotine do More importantly, perhaps, evidence
least in some forms, into popular mass
media. It was this “mainstreaming” of
not prevent from around the world demonstrates
art forms with positive and often
that government policies that seek to
nicotine use. restrict legal access to nicotine,
celebratory representations of cannabis
use, more than any scientific break-
whether through regulatory barriers,
through, that acted to destigmatize the
bans, or price controls, do not prevent
drug, change popular opinion, and
nicotine use. Instead, illicit markets,
pave the way for legalization.21
and all of the harms that accompany
them, rise to meet the demand.18 Though different in their chemical
makeup, biological effects, and
The ability and willingness of the
purpose, the scientific literature on
public to flout restrictive drug laws
recreational cannabis and nicotine are
has been on display in the United
remarkably analogous. Current clinical
States and elsewhere with regard to
data suggests both substances are
cannabis. Not only did Americans
relatively safe, emerging evidence
continue to use the substance after its
even points to potential health benefits
ban, but some made ostentatious
for both, and plenty of research
displays out of flouting the prohibition.
demonstrates the harms associated
Cannabis was popular among jazz
with the prohibition of either. Nicotine
musicians during the first half of the
vapor products have the additional
20th century, a fact not lost on
benefit of typically being used,
prohibitionists of that era, who
not just for enjoyment, but as a
pursued famous musicians, like Louie
replacement for deadly combustible
Armstrong and Billie Holiday.19
tobacco products, like cigarettes. Yet,
And long before the first U.S. state
one of these drugs—cannabis—enjoys
legalized its use, the comedy duo
increasing popular and political
Cheech and Chong arguably
support and decreased stigmatization,
established a new genre of cinema with
6 Minton: The Double Standards of Cannabis and Nicotinewhile the other—nicotine—is of vaping, this evidence is available.
progressively maligned, stigmatized, Toxicology studies show that even the
and the target of bans and restrictions. earliest e-cigarette devices on the
market contained only a fraction of the
This asymmetry in the treatment of the
two substances cannot be explained by
harmful and potentially harmful As with
constituents found in traditional
the amount or strength of the scientific
cigarettes.24 Studies also show that cannabis,
evidence for their relative benefits or
harms. Instead, it stems from what
exhaled vapor contains 99 percent evidence has
fewer carcinogens than secondhand
those in power are willing to accept as
smoke.25 Epidemiological studies have disproved
evidence.22 The notion that people enjoy
using cannabis and will continue to do
repeatedly found that the vast majority the claim
of those using nicotine vapor products
so regardless of its legal status is now
are former smokers.26 that nicotine
widely accepted. The inevitability of
widespread cannabis use and the As with cannabis, evidence has also vaping is a
futility and harm of its continued disproved the claim that nicotine “gateway” to
prohibition are sufficient justification vaping is a “gateway” to more harmful
to advocate for an end of the federal substances, in this case smoking more harmful
cannabis ban. That logic, though combustible tobacco.27 Perhaps the substances,
demonstrably true for both cannabis most convincing evidence against the
and nicotine, has proved insufficient idea that vaping leads to smoking is in this case
to convince advocates, regulators, that, even as youth experimentation smoking
and even some researchers. Unlike with vaping has risen significantly over
recreational cannabis, for nicotine the 13 years since its introduction, combustible
vapor they demand “proof” of the youth and adult smoking have tobacco.
products’ value before they are continued to decrease. Studies,
allowed onto the market.23 Yet, it including one randomized clinical trial
remains unclear what type of—and (considered by some to be the gold
how much—evidence it would take to standard in health research), have even
meet their threshold of proof. demonstrated that nicotine vapor
products are two to three times more
effective at helping smokers quit than
Drug Double Standard other nicotine replacement therapies
It is reasonable for public health (NRT).28
professionals, lawmakers, and the
Each of the aforementioned studies,
public to want evidence about products
along with any before or since showing
prior to making decisions about how
similar findings, were, without
they ought to be regulated. In the case
exception, rejected by the individuals
Minton: The Double Standards of Cannabis and Nicotine 7and groups demanding proof of the and questions the researchers did not
value of nicotine vapor products. As seek to answer.
Clive Bates, the former director of the
Dozens of observational studies are
British tobacco control group Action
often dismissed as being merely based
on Smoking and Health, wrote in
on anecdotes. Those dismissals are
2018, the justifications provided by
often accompanied by calls for
anti-vaping advocates for spurning
randomized controlled trials, which
these studies follow an almost
could really prove whether nicotine
comically predictable pattern.
vapor products are effective as
Harm is the essential currency of cessation tools.30 When researchers
tobacco control campaigning. For performed a randomized controlled
these activists, cancer and other trial and found that e-cigarettes were
harms have acquired valuable twice as effective as other nicotine
utility: it is the “killer” arguments replacement therapies for smoking
to justify the forceful action of the cessation, anti-vaping interests
state. If there is no cancer or other dismissed it as being too clinical and
harms, they have lost an argument “not a study of e-cigarettes as most
to support the real goal. Hence, people use them.”31
we see desperate, often risible,
The most consistently employed
efforts to turn nugatory risks into
argument against studies showing few
full-blown moral panics. If
or no negative health effects related to
concerned about health, why
nicotine vapor is that they are not
do they never talk about how
conducted over a long enough period
e-cigarette vapour has few of the of time to reveal the harms from
harmful agents present in chronic use of the products over
cigarette smoke and those that are decades. When supplied with research
present at far lower concentrations? that follows participants for years—
Because disease risk creates the which would be able to identify bio-
currency of fear and righteous logical changes related to long-term
indignation, and fear and health—anti-tobacco activists simply
indignation is the gateway to return to the other tactical arguments.
regulation.29 [Emphases in
original] For example, in 2017 researchers
published the results of a study
Typically, critics of nicotine vaping comparing circulating levels of
respond to studies with results they smoking-related toxins linked to
dislike by quibbling over flaws in the cancer, heart disease, and lung disease
methodology, the length of the study, among long-term smokers, e-cigarette
8 Minton: The Double Standards of Cannabis and Nicotineusers, users of nicotine replacement smoking.” The study did not, and
therapies, and “dual” users—those could not by design, determine the
who both smoke and use NRT or prevalence of dual use in the population
e-cigarettes. While dual users in any because the researchers recruited
combination had similar levels of equal numbers of participants for each Even if it were
harmful toxins to that of smokers, group studied. More importantly, even
individuals using e-cigarettes if it were true that many e-cigarette true that many
exclusively for six months or more users continue to smoke, that, along e-cigarette users
had similarly low or significantly with the results of this study, in no way
lower levels of circulating toxins than supports the claim that e-cigarettes continue to
exclusive NRT users.32 Rather than have “no health benefits” for smokers. smoke, that in
celebrate this as evidence that long-term In the real world, the study’s ground-
e-cigarette use is, at the very least, no breaking finding, that the harms of no way supports
more harmful than long-term NRT long-term e-cigarette use are as low the claim that
use—a practice widely encouraged by and possibly lower than long-term
anti-tobacco advocates— vaping NRT use, is compelling evidence that e-cigarettes have
opponents focused on the finding that researchers and activists, like Glantz, “no health
e-cigarette users who also smoked had should figure out how to encourage
toxin levels similar to smokers, an smokers to switch to e-cigarettes benefits” for
unsurprising result that is largely, if not exclusively. Indeed, this was smokers.
entirely, explained by their smoking. suggested by the study’s authors, who
wrote that their finding of similar
“Everyone—including me—agrees
nicotine intake levels among smokers,
that switching entirely from cigarettes
exclusive NRT users, and exclusive
to e-cigarettes (assuming no effects on
e-cigarette users “supports the view
cessation) would be a good thing,”
that users seek a particular level of
wrote Stanton Glantz, a longtime
nicotine intake, regardless of the
anti-tobacco activist and professor at
delivery system.” Thus, they
the University of California, San
concluded that “dual users should
Francisco.33 “The problem is, as this
be encouraged to cease using
paper notes, that almost all e-cigarette
combustible products to reduce
users keep smoking cigarettes … for
long-term health risks.”35
the great majority of e-cigarette users
as they are actually used in the real The argument made by Glantz provides
world, there is no health benefit of a good example of the double standard
e-cigarettes” he continued.34 of proof applied to nicotine vapor
[Emphasis in original] products. Based solely on the
unsupported idea that most e-cigarette
Glantz is incorrect that the study found
users continue to smoke, Glantz is
“almost all e-cigarette users keep
Minton: The Double Standards of Cannabis and Nicotine 9willing to dismiss the possibility that amount of time to understand the
nicotine vapor products have any effects of nicotine vaping. That is a
benefit and to advocate for their total disingenuous argument, given that
prohibition.36 Interestingly, Glantz research on smoking began in the
For almost every omits from this conversation the 1940s when science on the topic
evidence that continued smoking by was nascent.
other aspect users of nicotine replacement therapies
It certainly would be nice to have
of human life, is also extremely common. According
multidecade studies on every possible
to some estimates, as little as 1 or 2
we recognize percent of NRT users even attempt to
consequence of a product prior to its
introduction on the market. But that
the reality that achieve abstinence from smoking,
criterion is as impractical as it is
while a higher percentage intend
proof of total merely to reduce their cigarette
unnecessary. Virtually nothing in life
is free of risk entirely. As Fred Smith,
safety is consumption.37 However, studies have
the founder of the Competitive
found that smokers who use NRTs
unrealistic. actually smoke more cigarettes than
Enterprise Institute, once remarked, if
“society demands unattainable levels
smokers not using such products.38
of safety—a risk-free world—public
This real world experience with NRTs
policy becomes divorced from
has not led anti-tobacco activists to
reality.”42 For almost every other aspect
call for banning the products.39 In fact,
of human life, we recognize the reality
some of the most vociferously
that proof of total safety is unrealistic.
anti-vaping entities, like the Campaign
Moreover, we inherently grasp that
for Tobacco-Free Kids, not only
applying such a standard would
support over-the-counter sales of NRT
produce economic, technological, and
products, but advocate for governments
personal paralysis. But, when it comes
to subsidize their provision to adult
to lower-risk means of nicotine
smokers.40
consumption, that is the standard that
Criticisms of the evidence that activists demand, despite the potential
nicotine vaping is relatively harmless of such products to save and improve
or even beneficial are often joined millions of lives around the world.
with statements about the lack of
There are already hundreds, if not
long-term evidence and how many
thousands, of studies on nicotine
decades it took researchers to
vaping, including on animals and
demonstrate the devastating harms
humans, observational and clinical,
associated with smoking.41 This
and short- and long-term.43 These
implies that it would take modern
studies, while not answering every
researchers, despite all the advances in
possible question that might arise
science and technology, a similar
surrounding nicotine vapor, are enough
10 Minton: The Double Standards of Cannabis and Nicotinefor researchers to measure biological even less study, such as the ultra-low-
changes that would indicate long-term nicotine cigarettes approved by the
risk. Thus far, the research does not FDA in December 2019, for which the
indicate any significant long-term longest studies were a mere 20 weeks,
harms, particularly for those who are with many questions remaining about The standard
using nicotine vaping to replace the whether smokers using low nicotine
far more harmful habit of smoking. cigarettes will actually smoke more.48 of evidence that
The standard of evidence that anti-
As for cannabis, only a single product anti-tobacco
has been approved by the FDA. In this
tobacco activists demand for nicotine
case, studies of the CBD medication activists demand
vaping is not applied to any other
category of consumer good. For
intended to treat seizure disorders for nicotine
lasted less than a year.49 No other
instance, a lack of decades-long
cannabis products sold in the U.S., with vaping is not
studies that might definitively and
comprehensively reveal all possible
or without THC, have undergone such applied to
a review. Yet, the lack of certainty about
risks has not stopped the introduction
how cannabis affects adolescent brain any other
of new pharmaceutical drugs.44
Although the entire approval process
development, an issue on which category of
anti-vaping advocates seem singularly
is arduous and lengthy, lasting
focused when it comes to nicotine, consumer
upwards of a decade or longer, the
duration of individual trials, which
has not stopped the growing—and good.
justified—push for cannabis
form the evidence for a new drug’s
legalization.50
safety and efficacy, can last for just one
year.45 Even for many drugs intended The American Lung Association
to be taken regularly over a period of (ALA), for example, has been vocally
many years, like antidepressants and opposed to nicotine vapor products
cholesterol-lowering statins, long-term and has lobbied state and federal
studies are not required prior to their governments to institute bans and
introduction to the market, so long restrictions against their sale and
as there are at least two positive advertising.51 With regard to cannabis,
short-term (eight- to 12-week) trials.46 the ALA once was a vocal opponent of
the drug’s use, claimed that “marijuana
For example, in March 2019, the U.S.
deposits four times more tar in the lungs
Food and Drug Administration (FDA)
than tobacco,” and ran a campaign in
approved Spravato, a nasal spray
the 1980s titled, “Don’t Let Your
antidepressant chemically related to the
Lungs Go to Pot.”52 Today, however,
drug ketamine. This approval occurred
apart from advocating that cannabis be
even though the longest trial of the
included in indoor smoking bans, the
drug was no more than 60 weeks.47
ALA is conspicuously silent on the
Non-pharmaceutical products require
Minton: The Double Standards of Cannabis and Nicotine 11issue of cannabis legalization and Moral Entrepreneurs
regulation.53 At the heart of the modern tobacco
control movement are what sociologist
As with cannabis, a lack of definitive
Howard S. Becker calls “moral
evidence has neither stopped the
A lack of government from approving, nor
entrepreneurs.”54 These professional
arbiters of morality or rule makers
definitive society from accepting, a range of
typically begin as passionate amateurs,
other products, medications, and
evidence has devices. That is as it should be.
often with humanitarian motives. They
do not simply want to impose their
neither stopped Long-term studies that unequivocally
moral views on others, but operate
tell us, for example, how cannabis
the government would affect every aspect of individual
from the belief that doing so will
improve the well-being of society.
from approving, and social welfare are not only
This ostensibly pure intention
impossible for each facet of the drug’s
nor society from development and deployment, they are
provides justification for moral
crusaders to pursue their goals by any
accepting, a also unnecessary. We now have enough
means necessary, including working
information to know that whatever
range of other harms may be associated with cannabis
with those with dubious motives,
exaggeration, defamation of the
products, use, they are minimal in comparison to
opposition, disregarding others’
the harms created by prohibition. The
medications, same is true of nicotine and nicotine
autonomy, and persecuting those who
disobey—for their own good, of course.
and devices. vapor products. Yet, when it comes to
nicotine vaping, the evidence doesn’t The crusader who manages to
That is as it seem to matter. The constant appeals convince the public of the validity of
should be. for proof and the way substances are his cause may be able to build large
treated by lawmakers, regulators, organizational structures around it and
the media, and the public are not turn his passion into a vocation. But
determined by scientific evidence, but this presents a conundrum for the
are based on how people feel about the crusader: If successful, he would
substance. In the current moment, at essentially be putting himself out of a
least, the majority of the public now job. Such was the case for the
accepts cannabis use as a relatively enterprise of anti-smoking activism.
harmless activity, akin to drinking After decades of raising awareness
alcohol. Unfortunately, the way about its risks and convincing the
most people feel about nicotine is public and government officials of the
inextricably linked to their feelings need to control smoking, the habit was
about “Big Tobacco.” headed toward extinction. By the 21st
century, smoking had become a
socially stigmatized, deviant behavior
12 Minton: The Double Standards of Cannabis and Nicotinein many developed nations. Many clove cigarettes, and nicotine-free
countries, particularly the U.S., had cigarettes fell flat.56 But then came
also banned smoking in public spaces, electronic cigarettes. With a similar-
imposed taxes on the products, and sounding name, look, and even
adopted strict tobacco control policies. smoke-like plumes of vapor emitted The rise in
from the devices, electronic cigarettes
By the mid-2000s, precipitous declines popularity of
proved the perfect new target for
in smoking had diminished public
moral entrepreneurs to continue their nicotine vaping
concern over the habit’s health effects,
crusade against Big Tobacco—even
which in turn lessened interest in occurred at the
if Big Tobacco, particularly in the
funding cessation efforts. This waning
beginning, had nothing to do with the same time as the
attention threatened what had become
novel products.
a multi-billion-dollar anti-smoking anti-smoking
industry and the thousands of agencies,
activism industry
departments, charities, and careers
The “Big Tobacco” Bogeyman
built around it. Rather than kill the was desperately
With good reason, people maintain a
anti-smoking cash cow, activists sought
deep distrust of big tobacco companies, searching for
to expand their crusade to new
which historically had long denied the
targets—not only smoking, but any a new target.
deadly effects of combustible tobacco
use of tobacco and, more recently, any
of which they were aware, putting
use of non-pharmaceutical nicotine.
significant resources into casting doubt
As Becker wrote, a moral crusader
on and undermining evidence of those
who manages to achieve his original
harms as it emerged. However, this
goal “may generalize his interest and
understandable mistrust has been
discover something new to view with
extended, often intentionally, by
alarm, a new evil about which
anti-tobacco advocates, to any person,
something ought to be done. He
group, or industry that appears to be,
becomes a professional discoverer
or is accused of being, linked to big
of wrongs to be righted, of situations
tobacco companies.
requiring new rules.”55
This near-universal contempt for Big
The rise in popularity of nicotine
Tobacco and the effectiveness of guilt
vaping occurred, not coincidentally,
by association with it is well-known
at the same time as the anti-smoking
among activists of all stripes. This
activism industry was desperately
explains the proliferation of accusations
searching for a new target. Their
of “stealing a page out of the Big
attempts to foment renewed moral
Tobacco playbook” hurled at various
panic over products like flavored
businesses and industries— including
nicotine lozenges, bidis (mini cigars),
food marketers, soda companies, the
Minton: The Double Standards of Cannabis and Nicotine 13alcohol industry, the tech industry, relative harmlessness or possible
social media platforms, climate change benefits of the substance.
skeptics, lawmakers, and even the
Anti-tobacco groups have used this
National Football League. 57
tactic to paint the nicotine vapor
Those who oppose the use of nicotine industry as no different from Big
on moral grounds have made little Tobacco. But this simplistic view
attempt to hide their use of this tactic ignores the fact that while large
as a way to discredit any person or tobacco companies have now entered
study unsupportive of their abstinence- the nicotine vapor market, the industry
only approach. In a 1986 handbook on was initially established and remains
anti-tobacco activism, the authors— primarily populated by small,
including the aforementioned Stanton independent vapor companies that
Glantz—advised that inconvenient were never involved in the tobacco
studies could be easily explained business.
away by pointing to “the self-interest
More importantly, it also fails to
of the authors, defective methodology,
acknowledge that the central reason
or sheer weight of numbers of
these independent vapor companies
contradictory studies” and that
and shops exist is to displace
activists should “suggest that the
combustible tobacco. Still, the mere
person is simply a shill for the tobacco
fact that the initial generations of
industry.”58 A few years later, Glantz,
nicotine vapor products looked similar
in a speech, noted that a similar
to cigarettes, were sometimes called
approach could be used to convince
electronic cigarettes, and contained
reluctant lawmakers to support their
nicotine despite not having any
anti-tobacco policies, noting that a
tobacco, was enough for activists to
good way to change their minds is to
convince the federal government to
convince them that “if they oppose
deem the products “tobacco” in 2016.60
you they would be perceived as dupes
This bureaucratic categorization of
of the cigarette companies.”59
nicotine vapor as tobacco product,
As blatant and opportunistic as that plus the superficial similarities with
is, the strategy continues to work traditional cigarettes, made it easy for
effectively in convincing many that any activists to convince those unfamiliar
nicotine product, not produced by “Big with the novel products that they were
Pharma,” is merely an extension of the same as combustible tobacco, made
“Big Tobacco.” That leaves them free by the same companies, with the same
to disregard any evidence about the purpose and risks. (This is a little like
14 Minton: The Double Standards of Cannabis and Nicotineviewing distilled spirits and rubbing In the case of nicotine vaping,
alcohol in the same light.) evidence continues to mount that it is
relatively harmless for adults. Even
the assertion that nicotine is “highly
Merchants of Doubt and Fear addictive,” something most people In the case
Ironically, both the impossibly high believe is irrefutably true, is
double standard for scientific evidence contradicted by evidence and logic. of nicotine
and attempts to create a mental link People rarely become addicted to vaping,
between nicotine vaping and Big nicotine patches, gums, or lozenges.
Tobacco are exactly the same strategies Animal and human studies have found evidence
used by Big Tobacco since the 1950s that nicotine alone is not sufficient to continues to
to suppress growing evidence of the prompt self-administration or nicotine-
harms associated with smoking.61 This seeking behavior—for instance, lab mount that
awareness of Big Tobacco’s past bad mice do not press the lever delivering it is relatively
behavior and the public’s distrust of nicotine over the lever that delivers
the industry significantly increase the food. That suggests that is some other harmless
potency of anti-tobacco activists’ chemical, combination of chemicals, for adults.
primary argument against nicotine or feature of cigarettes that makes
vaping: the safety of children. products containing nicotine habit-
forming.63
“Won’t somebody think of the children”
was the oft-repeated catchphrase of Unable to justify their opposition to
Helen Lovejoy, wife of Reverend nicotine use based on demonstrable
Lovejoy on the television comedy harms to adults, anti-tobacco activists
The Simpsons. This parody of the instead have focused on the imaginary
overwrought and myopic focus on risks nicotine vapor products pose to
child welfare, which often pervades children. Among the most frequently
real-world political debates, was so cited concerns are claims that nicotine
deft that Toronto Star reporter Edward vaping harms the adolescent brain and
Keenan coined the term “Lovejoy’s leads to future smoking—claims for
Law.” In Keenan’s words, if one side which the evidence is weak, non-
of a debate uses “the children” to existent, or invalidating.
justify their position, one can assume
The idea that nicotine damages
it is an attempt to manipulate and that,
adolescent brains or impairs their
“they’re probably either lying, trying
development are based primarily on
to screw you over or hoping to distract
rat and mouse studies that report
you from the worthlessness of their
relatively minor effects, like changes
position.”62
Minton: The Double Standards of Cannabis and Nicotine 15in learning, attention, and memory.64 increasing public acceptance of
Interestingly, as a topic of debate, the cannabis use has made the continuation
effects of substances on youth brain of prohibition on the drug unfeasible
health seem exclusive to public for politicians and a bad target for
discourse on nicotine and tobacco. As moral entrepreneurs. But these
researchers Lynn Kozlowski of the circumstances may be tenuous and
University of Buffalo and Kenneth temporary. As a recent article in The
Warner of the University of Michigan Atlantic pointed out, 2020 democratic
pointed out in 2017, there has been presidential candidate Joe Biden has
little public interest in the impact on not fully endorsed the idea of cannabis
brain health of other substances legalization despite broad public
commonly used by youth, like support, particularly among democratic
alcohol, cannabis, caffeine, and voters. One explanation provided for
psychotropic medications. “If his reticence is the divergent treatment
anything, the concern should be of nicotine vaping and cannabis.
greater regarding kids’ cigarette Liberal lawmakers have argued for
smoking but it was rarely brought into restrictions on vaping because of a
discussions of youth smoking,” they lack of clarity on its health effects, but
wrote.65 Given the fact that there are these same lawmakers have not
many decades of studies on smokers, applied that standard to marijuana,
most of whom began smoking as young which they mostly favor legalizing.66
adults, the evidence that nicotine Yet, should moral entrepreneurs
causes brain damage or significant decide to make pot smoking their next
cognitive impairment should be strong target, they could easily rely on all of
and abundant. Until relatively recently, the same dubious arguments and
in fact, a significant portion of youth evidence that have been used against
reported daily smoking. If nicotine nicotine vaping, including the claim
caused significant harms on the that cannabis may “harm” adolescent
developing brain, it would be apparent brain development.67
in the scientific literature, but it is not.
Another pseudoscientific argument
Yet, the adolescent brain issue has
regularly employed in public policy
become one of the central arguments
debates over drugs is the “gateway”
used by anti-vaping activists.
theory: the idea that the use of
It is worth noting that while the relatively benign drugs, like cannabis
adolescent brain issue has not yet been or nicotine, will lead to harder drugs
a major factor in the public discourse and subsequent harms. The idea seems
about cannabis, this could quickly to make logical sense, since individuals
change. As this paper argues, who go on to use drugs like heroin
16 Minton: The Double Standards of Cannabis and Nicotinetypically begin experimenting with little to slow down activists, lawmakers,
“softer” drugs. But the correlation and regulators from trying to implement
does not necessarily prove that the increasingly restrictive rules and
cannabis use, for example, caused a outright bans on the products. For these
person to later use heroin, as many interests, there is little downside to As with
other factors better explain individuals’ pursuing an anti-vaping agenda, as long
likelihood to use either drug, such as a as it is perceived as being anti-Big cannabis
proclivity for risk taking.68 Tobacco—even if achieving that the evidence
agenda would have no benefit for, or
Similarly, some have claimed that
even harm, public health. indicates that
vaping among youth, even
experimental, will lead to future there is no
smoking. But, as with cannabis, the
Lower-Risk Nicotine: “gateway”
evidence indicates that there is no
“gateway” effect from using nicotine
The Low-Hanging Fruit effect from
When it comes to persuading
vapor products. Research on the
lawmakers to support their cause, using nicotine
gateway effect finds that teens who
are likely to smoke are also likely to
anti-tobacco activists have discovered vapor products.
that even more effective than the old
try nicotine vaping, due to shared
tactic of guilt by association is what
characteristics, such as a greater
could be called “hero by association”—
propensity for risk taking, not because
going after an easily identifiable
vaping somehow causes them to
villain to make yourself look heroic.
progress to smoking.69 The clearest
For ambitious politicians looking to
piece of evidence against the vaping
generate positive public attention,
gateway theory is the fact that despite
targeting “Big Tobacco” is among the
nearly a decade of popular use, youth
surefire ways to achieve that.
smoking has not increased. In fact, the
number of adolescents who smoke is The only potential pitfall to that
now lower than it has ever been.70 approach is that Big Tobacco—real
Moreover, most youth don’t vape, Big Tobacco—is an established, large,
fewer vape regularly, and almost of all well-funded, and well-connected
those who do vape regularly are or international industry. Attacking the
were smokers, a behavior that would makers of cigarettes, farmers who grow
cause at least as much damage tobacco, and smokers is not without
as vaping. political risk. The vapor market, on
the other hand, is nascent, smaller, and
Yet, lack of evidence that nicotine
has less consumer popularity and
vaping harms or even poses a risk to
political influence. Incurring the wrath
the nation’s young people has done
of the vapor industry and its customers
Minton: The Double Standards of Cannabis and Nicotine 17is a comparatively small risk for entire vapor industry, was part of
politicians—but also politically less Big Tobacco all along.71 But the
profitable if there is a widespread circumstances and regulatory pressure
belief that vapor products are less created by anti-vaping advocacy made
For anti-vaping harmful alternatives to smoking. such a merger a practical necessity for
Juul to survive as a company. The
advocates, the For anti-vaping advocates, the best
main benefit Juul reaps from the
environment for them to operate is the
best environment current one, in which the majority of
merger with Altria is expertise and
money to contend with increasingly
for them to the public believe that going after
intense regulatory challenges and
“vaping” is the same as taking on Big
operate is the Tobacco. This situation allows
lawsuits the company now faces as a
result of anti-tobacco activism.72
current one, lawmakers who attack “vaping” to
appear as if they are defenders of Notwithstanding that reality, anti-
in which the public health against a powerful tobacco activists have successfully
majority of the opponent like Big Tobacco, with little used the bugbear of Big Tobacco, guilt
risk of political blowback—even by association, and exaggerated
public believe when the outcome of their proposed concerns about adolescents’ health to
that going after legislative solutions would help Big advance their policy agenda with
Tobacco by crippling or outright considerable success. At no time in
“vaping” is the eliminating its primary competitors. the past has their approach been more
same as taking The main culprit anti-vaping activists
brazenly on display than over the
past year.
on Big Tobacco. point to as evidence of Big Tobacco’s
control of the nicotine vaping industry COVID-19 Gives Activists
is the company Juul. Founded by a New Front
Pax Labs, Juul began as a San Around July 2019, news stories began
Francisco-based startup technology circulating about a sudden rash of
firm with no connections to the people, mostly teenagers, being
tobacco industry. However, as activists hospitalized with a mysterious and
fomented panic over youth vaping and severe lung ailment linked to
regulators put increasing pressure on “vaping.”73 As the number of cases
the company, threatening its existence, began rising and details trickled out
in 2018 Juul—then independent from through local news reporting, it
Pax Labs—sold a 35 percent stake in became clear that the behavior shared
the company to Altria Group— in common among most—if not all—
formerly known as Philip Morris of the patients was not “vaping,” but
Companies, Inc. The deal was the use of cannabis vaporizers
misleadingly portrayed by activists of purchased illegally on the street.74
proof that Juul, and by extension the For example, when New York state
18 Minton: The Double Standards of Cannabis and Nicotineauthorities tested the vaping products contrary. And members of Congress
used by those hospitalized with the have considered legislation to restrict
lung ailment, they found that every the devices at the federal level.79
single one had been using at least one
It wasn’t until January 19, 2020 that
THC vaping product purchased
the CDC acknowledged that illegal
illicitly. They also found very high
cannabis vaporizers tainted with
levels of vitamin E acetate—an oil
vitamin E acetate—not nicotine vaping
that cannot be present in nicotine
products—were behind the outbreak.80
e-liquid—in many.75 Soon other states
But anti-vaping interests would not
reported similar findings with all or
have to wait long for a new opportunity
nearly all patients admitting to using
to spread unwarranted fears over
illicit THC products, even in states
nicotine vaping.
where cannabis is not legal.76 Despite
all this, the Centers for Disease At the beginning of the global
Control and Prevention (CDC) outbreak of the novel coronavirus,
downplayed the role of illicit THC SARS-CoV-2, it was assumed that
products, urging consumers instead smoking was a risk factor for
to avoid “all e-cigarette, or vaping contracting COVID-19 or for severe
products.”77 progression of the disease. While there
was no specific data on this novel
Anti-tobacco activists across the
virus, the assumption seemed
country capitalized on the confusion
reasonable, based on the fact that
created by the CDC’s misleading
smokers are at greater risk for certain
messaging to spread fears about
respiratory infections, like colds, flu,
nicotine vapor products and advance
pneumonia, and tuberculosis.81
their regulatory and legislative agenda.
Governors in states like Michigan, However, anti-tobacco activists, in
New York, and Massachusetts, and outside government, ignored the
encouraged by anti-tobacco groups, emerging data indicating that smokers
imposed emergency bans on nicotine did not appear to be more at risk of
vaping products, despite all the COVID-19 than non-smokers, as well
evidence indicating their having as the absence of any data on how
nothing to do with the outbreak.78 vaping might affect progression of the
Congress held two hearings on the disease. Instead, interest groups, health
issue of nicotine vaping, at which organizations, and politicians around
activists invited to testify gleefully the world seized on the opportunity
blamed nicotine vaping products for to promote the idea that vaping is
the outbreak of lung injuries, despite dangerous, and especially so during
the demonstrable evidence to the the outbreak.
Minton: The Double Standards of Cannabis and Nicotine 19New York Mayor Bill de Blasio told academics, like Stanton Glantz,
journalists that a 22-year old who was argued that vaping makes it harder for
hospitalized with COVID-19 in early lungs to resist infection, even going so
March had no known risk factors, far as to give the unsupported medical
except his use of vaping products. advice that quitting vaping would lower
“Why is a 22-year-old man stable but the risks associated with the disease.86
hospitalized at this point? The one
This narrative has become increasingly
factor we know of is he is a vaper,”
difficult to sustain the more researchers
de Blasio said. “So, we don’t know of
look into the disease, and it now
any preexisting conditions, but we do
appears that nicotine—not smoking
think the fact that he is a vaper is
per se—may actually have a
affecting this situation.”82 The
protective effect.
resulting speculation led to news
articles and opinion pieces warning Early data on the outbreak from China
that smokers and vapers could be at did not suggest that smokers were
greater risk during the outbreak.83 more likely to contract COVID-19. In
fact, they appeared less likely to be
Health agencies added fuel to the fire.
hospitalized with the disease. That data
The National Institute on Drug Abuse
contradicted assertions that smoking
(part of the National Institutes of
might explain why Chinese men—
Health) issued a warning that
over half of whom smoke—were dying
“because it attacks the lungs, the
at much higher rates than women, of
coronavirus that causes COVID-19
whom only 3 percent smoke.87 But,
could be an especially serious threat to
when researchers looked into the
those who smoke tobacco … or who
smoking habits of patients in that
vape.”84 The mere suggestion that
country, they found just 1.4 to 12.6
nicotine vaping might have any impact
percent of those hospitalized with the
on the outbreak was proof enough for
disease were classified as current
activists and lawmakers to push for
smokers, making smokers significantly
temporary bans on the products at the
underrepresented in hospitalized cases
state and federal level.
compared to the general public.88
Groups like the New York State
This underrepresentation of smokers
Academy of Family Physicians
among COVID-19 patients has been
appealed to the governor to institute a
found by numerous studies in
statewide ban on all tobacco products,
populations around the world.89 These
while members of the House Oversight
counterintuitive results led some
Committee appealed to the FDA to do
researchers to question which
the same across the nation.85 Activist
ingredient or factor linked to smoking
20 Minton: The Double Standards of Cannabis and NicotineYou can also read
