When used—and regulated—appropriately, she argues, e-cigarettes are a form of harm reduction, just like 1980s exchange programs that allowed injection drug users to swap dirty needles for clean ones and reduce their chances of contracting HIV through shared needles. At the time, critics worried that providing free needles would endorse drug use or make it easier for children to get hooked. The end result, though, was that infection rates dropped precipitously. “The known harms of HIV were so great that the policy decision was made that this was a risk worth taking,” says Fairchild. “The same calculus is at work here.”Cigarettes kill nearly 500,000 Americans every year, and the Centers for Disease Control estimate smoking costs the US more than $300 billion annually in medical bills and lost productivity. These risks are well known, while the long-term health consequences of vaping e-cigarettes are not as well understood. E-cigarettes certainly aren’t harmless; they still contain nicotine, which is highly addictive, and they can also include toxic flavorings, heavy metals, and carcinogenic chemicals. “There is no question that e-cigarettes are not safe,” says Fairchild. “But it’s a question of proportionate risk.” Instead of waiting for a perfectly safe product to replace cigarettes, these experts suggest, let’s allow smokers to choose the lesser of two evils.
“We’d rather everyone quit nicotine completely,” agrees coauthor David Abrams, a public health expert at New York University. “But if they’re going to use it, I’d much rather they use a less harmful product.”Abrams points to research including a 2019 study conducted in the United Kingdom that found e-cigarettes were more effective than other methods at helping people quit smoking. E-cigarettes deliver nicotine efficiently, so they meet people’s cravings better than lozenges or medications. That addictive quality actually helped smokers stick with the vape instead of going back to regular cigarettes. Users also enjoy the flavors, which make the experience more enjoyable than smoking.But those same attributes are also what have made e-cigarettes so attractive to teenagers. While teen smoking rates are at record lows, teen vaping is soaring. The 2019 National Youth Tobacco Survey found more than five million teenagers use e-cigarettes, often daily. It’s a Catch-22, says Abrams: A really appealing, high-quality e-cigarette is going to be a more effective substitute for combustible cigarettes—but it’s also going to be more addictive and appealing to teens.