Snuffing Out Vaping and Smoking Cessation Programs

In the news reports about the deluge of government personnel cutbacks, it would be understandable if you had not noticed that support by the Federal government for vaping and smoking cessation programs has been almost entirely eliminated. While most of the actual services are delivered by state organizations, these activities are heavily dependent on resources supplied by the Federal government. Two Federal agencies have been responsible for providing these resources:

1. Described as “the lead federal agency for comprehensive tobacco prevention and control,” the Office of Smoking and Health (OSH) at the Center for Disease Control and Prevention (CDC) has been abruptly abolished! Its origins go back to 1965 when the National Clearinghouse for Smoking and Health was established to put into practice the observations and recommendations of the 1964 Surgeon General’s Report that linked smoking tobacco to lung cancer and heart disease. 

OSH has played a central role in one of our country’s great public health success stories. The 1964 Surgeon General’s report followed by subsequent reports contributed to reducing the prevalence of smoking by adults from 42% to the current rate of 11%. As a result, since 1990, lung cancer deaths have declined by 59% for men and 34% for women.

2. The Center for Tobacco Products (CTP) at the Food and Drug Administration (FDA) has been eviscerated and its leadership replaced. CTP was established in 2009 to implement the Tobacco Control Act which gave the FDA authority to regulate tobacco product. Spurred by concern about an epidemic of vaping by youth, the FDA authority was extended to e-cigarettes in 2016.

In this post, I will focus on the impact of the changes at The Center for Tobacco Products on e-cigarette regulation. One of the responsibilities of CTP is to assure that e-cigarette devices, and the e-fluids they contain, do not present unacceptable danger to consumers. This protective role is a challenging one, given the high volume of new products appearing on the market. Nevertheless, at a presentation by the Center director, Dr. Brian King, that I attended last year, I was impressed by how well his organization was performing this daunting task.

This already difficult situation is intensifying. My patients who use e-cigarette tell me of an explosion in the varieties of available vaping devices – to venture into a specialty vape store and try to sort out the options can be a disorienting experience. Technological advances are leading to an enhancement in the delivery of nicotine to the lungs, and from there to the blood and brain. Small screens are being added to vaping devices so that video games can be incorporated. These games are designed to incentivize increasing the number of puffs. Overall, I expect these developments to increase the already substantial tendency of e-cigarettes to create physical dependence on nicotine.

Now would therefore not appear to be the best time to reduce these regulatory activities, but that is exactly what has happened – Dr. King and the rest of the leadership of CTP has been replaced. In the wake of this change, I read of complaints from convenience stores about the vigorousness with which CTP executed another one of their responsibilities – monitoring the sale of e-cigarettes at commercial outlets, such as convenience stores, to ensure that they are not being sold to underage youth. 

My concern is that the new leadership will not be as energetic in their regulatory efforts, resulting in negative consequences for public safety. The lack of an explanation of the rationale for this change intensifies my concerns. I have written about the clinical complexities of the e-cigarette issue in a previous post. This administrative development adds another level of complexity.

The degradation of these two important agencies makes me concerned about how far the attack on substance use disorders is going to proceed. As yet, the National Institute on Drug Abuse (NIDA) has not been a target. At the annual Tuerk Conference in April, I had the pleasure of introducing Dr. Wilson Compton, the NIDA Deputy Director, for his plenary presentation about the problematic role played by nicotine for many people with other substance use disorders. He made clear to the audience that NIDA was still looking for good research ideas to fund and encouraged submissions.

Furthermore, Dr. Nora Volkow, the esteemed Director of NIDA, resumed her blog this month, after an unusual and worrisome 3-month hiatus. I was heartened to see that her focus was on long-term recovery – a time frame that gets comparatively little attention compared to crisis issues such as overdose deaths. I found it remarkable that there is progress on identifying a possible neurobiological infrastructure for such important clinical issues as retention of patients in treatment.

The lack of transparency about the thinking and planning behind these actions is alarming to me. I will continue to monitor new developments and report on them in this space. In the meantime, the Triple Track treatment program continues to be available to those of you who would like to quit vaping or smoking. The first step would be to get in touch with us by clicking on this link.