Experts Call for More Regulation of E-Cigarettes Ahead of Major FDA Decision

Experts Call for More Regulation of E-Cigarettes Ahead of Major FDA Decision
A researcher holding various vape pens. (Photo: Craig Mitchelldyer, AP)

A new, international survey of experts found wide agreement that vaping devices like e-cigarettes are safer than traditional tobacco products. But the experts also expressed that vaping products should only be sold in specialised stores and shouldn’t be used inside public spaces. The findings come just before the U.S. Food and Drug Administration is preparing its final decisions this week on the state of the vaping market in the U.S.

E-cigarettes and heated tobacco products are marketed as better and safer alternatives to cigarette smoking. E-cigarettes work by vaporising nicotine-filled fluid that can then be inhaled, while heated tobacco products are supposed to “heat-not-burn” the tobacco inside, in theory leading to fewer harmful emissions. Vaping devices can also be used to consume other drugs, namely cannabis or its active ingredient THC.

The FDA is set to issue its first major regulations concerning the industry by September 9, which will include its final decision on millions of applications from e-cigarette companies. The agency has said that it will deny products that fail to show they are “appropriate for the protection of public health.” In recent weeks, it has already pulled over 55,000 flavoured products from three small companies from the market, perhaps signalling that very few of these products will survive the cull.

In a new study published in BMJ Open, researchers in France and Switzerland decided to poll public health specialists around the world about their opinions on the future of e-cigarettes and heated tobacco products. They used a method known as a Delphi survey, which uses a series of detailed questionnaires and feedback to help determine a consensus among experts on a specific topic (in other words, the survey isn’t intended as just a simple question-and-answer poll).

They conducted two rounds of the survey, with the first involving 92 experts and the second involving 55. These participants came from 15 countries, including the UK, Sweden, Finland, France, and the U.S., and they all had experience in tobacco control or smoking cessation research.

For e-cigarettes, the team found consensus (at least 70% agreement on yes-no questions, for instance) that all ingredients of an e-liquid should be listed on the product; that there should be a maximum concentration of nicotine in an e-liquid; and that products should come with a warning label noting the limited evidence on their long-term outcomes, including their safety and addiction potential.

E-cigarettes, they also agreed, shouldn’t be sold at general stores, only at specialised vaping stores or other places where tobacco products are sold, like pharmacies with sale restrictions for minors. Heated tobacco products should considered as addictive as traditional cigarettes and should come with the same warnings and taxes attached to cigarettes, the surveyed experts said.

A majority of experts did agree that e-cigarettes are safer than cigarettes and less addictive than heated tobacco products, and that vaping should be offered as one of many cessation aids for quitting smoking. But most also believed that people are more likely to use e-cigarettes and cigarettes at the same time, rather than use vaping as a way to quit cigarettes permanently. The majority similarly agreed that neither e-cigarettes nor heated tobacco products should be allowed indoors in public spaces and that they shouldn’t be advertised to non-smokers.

The study, while meant to be the first international survey of its kind, does have its caveats. Namely, the low response rate, with only 34% of eligible participants responding to the initial survey and only slightly more than half returning for the second round. So the findings may not be generalizable to all relevant experts around the world, the researchers warn.

They also noted that the second round of the survey took place after the epidemic of lung illness among some vaping users in the U.S. in 2019, which could have affected some people’s opinions (the crisis, while used as justification by some states to further crack down on the industry, was traced to black market THC products, not legally sold e-cigarettes).

Some countries, particularly the UK, seem to have a much more favourable opinion of e-cigarettes than others. Public health experts there widely support its use as a cessation aid for smokers, and its leading public health agency argues that vaping is at least 95% less harmful than smoking. There are also some scientists in the U.S. who have been very critical of their fellow vaping researchers and who have argued that policies like banning flavored products could be counterproductive and actually increase the risk of teen smoking.

The authors of the new study do point out the ongoing debates over vaping and the “passionate responses” expressed by experts on various sides. But they also hope that their results “may be useful for health authorities, decision makers and researchers of the tobacco use and cessation field.”