E-Cigarettes: Matching Risks With Regulations
Cet article fait le point sur les risques pour la santé et les enjeux réglementaires du vapotage aux Etats-Unis
In 2019, e-cigarettes captured public attention as never before, with more than 2,600 cases of e-cigarette or vaping product use–associated lung injury (EVALI) and at least 57 U.S. deaths by early 2020. Local and state governments responded with bans on flavored e-cigarette sales. The U.S. Food and Drug Administration (FDA) later announced restrictions on sales of flavored e-cigarette cartridges. Yet these responses conflated the epidemic of youth e-cigarette use—largely attributed to flavors—with the EVALI outbreak driven primarily by the use of informal or illicit vaping products that contained vitamin E acetate and, often, tetrahydrocannabinol, marijuana's principal psychoactive chemical. They also reveal a common oversight in e-cigarette policy: users’ ability to acquire substitutes or mix their own e-liquids. Specifically, e-cigarettes are devices that turn a substance (the e-liquid) into an aerosol to be inhaled. Whereas closed-system e-cigarettes use prefilled e-liquid cartridges, vapers can refill open-system e-cigarettes manually with any desired substance. Many vapers mix or modify their own e-liquids to obtain specific flavors or nicotine concentrations for use in open-system devices. Thus, although banning flavored e-liquids may reduce their accessibility, vapers can acquire close substitutes through informal channels, including those implicated in the EVALI outbreak. Vaping's health risks depend on the substance and device used. To identify key regulatory challenges and opportunities, decision makers must first disentangle the risks of vaping 3 types of substances: nicotine, flavors (with nicotine), and black-market or user-modified substances.