In a brand new perspective article within the New England Journal of Medication, Amy Fairchild, PhD, affiliate dean of educational affairs and professor within the Division of Well being Coverage and Administration on the Texas A&M Faculty of Public Well being — along with Ju Sung Lee, a doctoral scholar at Texas A&M; Ronald Bayer, PhD, from Columbia College; and James Curran, MD, dean of the Rollins Faculty of Public Well being at Emory College — underscore the significance of recognizing not only a continuum of threat on the subject of merchandise that ship nicotine, however a continuum of hurt discount methods. In 2017, the U.S. Meals and Drug Administration (FDA) introduced a brand new plan on tobacco and nicotine regulation, pushing the date for setting guidelines on digital cigarettes to August 2022 to present researchers and policymakers time to completely think about the position e-cigarettes would possibly play.

Of their paper, Fairchild and colleagues discover that hurt discount proposals fall throughout a continuum between techniques that, whereas permitting for the sale and use of e-cigarettes, place strict limits on availability and insurance policies that give people who smoke simpler entry to digital cigarettes as an alternative choice to smoking. Extra restrictive insurance policies embody limiting entry solely to present people who smoke and limiting the sale of digital cigarettes to pharmacies. Such restrictions prioritize stopping younger folks and non-smokers from utilizing digital cigarettes. On the other finish of the spectrum are insurance policies recognizing that some folks utilizing nicotine won’t cease, and thus the purpose ought to be to reduce well being dangers for present people who smoke. Many proposals — age restrictions, taxation and public consciousness campaigns in regards to the dangers of digital cigarettes — occupy the center floor. One of many keys for taxing digital cigarettes is to discover a taxation degree that’s excessive sufficient to place them out of the attain of younger folks however low sufficient that, for people who smoke, they’re nonetheless less expensive than flamable merchandise.

Insurance policies relating to digital cigarettes will proceed to evolve with additional analysis, and the selections of organizations just like the FDA will play an important position sooner or later. Fairchild and her colleagues state that many of those insurance policies maintain uncertainties, which might make it troublesome to resolve which path to take; nonetheless, given the character of the well being dangers concerned with smoking, policymakers might want to act even within the face of uncertainty. The important thing shall be figuring out how a lot insurance policies cut back hurt and whether or not they discover the correct steadiness of restriction.

No matter how restrictive the strategy policymakers take relating to digital cigarettes, there shall be a necessity for ongoing monitoring of well being and security, each for hurt discount and as a client safety concern.

“Policymakers will must be keen to vary their approaches to make sure that they really cut back inhabitants hurt,” Fairchild mentioned. “This not solely signifies that a hurt discount measure would possibly must be rolled again if it hurts extra folks than it helps, but it surely additionally signifies that simply because a tactic is by definition referred to as hurt discount, that it truly works to cut back hurt. A very restrictive strategy to hurt discount that leaves doubtlessly disruptive merchandise onerous to acquire and use could also be hurt discount in title solely.”