The Stupid Literally Burns Like Cigarettes

In Australia, there is quite a furor right now among the chattering classes in regards to a sharp increase in teen tobacco smoking from 2018 to 2023 after over two straight decades of decline.  And one of the things people are blaming is.....wait for it....vaping.  Because reasons.  Or something.  But there is one very glaring problem with this theory.  In Australia, vape products are technically legal, but ONLY if they do NOT contain any nicotine at all, thus kind of defeating the purpose.  That's right, nicotine vape products have never been approved for legal sales in Australia (and probably never will be any time soon), meaning anyone who wants to use them must either smuggle them in from abroad or buy them on the black market.  And interestingly enough, vaping itself also appears to be on the rise as well down under.  Thus, it truly takes a special kind of stupid to not only perversely create a situation where vaping and smoking both increase at the same time, but to then blame the increase in smoking on vaping.

Even more notable is the fact that in Australia, cigarettes have some of the highest taxes (and thus prices) in the world, plus so many other world-leading "best practices" tobacco control polices as well.  This additionally shows that while vice taxes and some other policies may work well to a point, all of these policies inherently have their limits in practice. 

Our working theory:  it is actually the banning of nicotine vaping, combined with the harmful effects of one of the strictest lockdown and Zero Covid regimes in the world, that ultimately snatched defeat from the jaws of victory in the long fight against tobacco smoking, particularly for youth.  And we must stress that while nicotine in any form is far from benign and definitely NOT for kids, banning or unduly restricting vaping (which is still significantly safer than the known deadly habit of smoking that it often displaces) is therefore a net public health loser of a policy.  And a policy like Australia's that perversely increases "dual use" of both is even that much worse still.

One could even argue that their truly massive cigarette black market created by their insanely high taxes, especially combined with their vaping black market from their nicotine ban, actually increased underage (under 18) use of both products since black market sellers typically don't ask buyers for ID.

Note also how the increase did not begin until 2020 (implicating the lockdowns as a contributing cause), and occurred for 14-17 year olds but interestingly NOT 18-24 year olds (putting the lie to the idea that their age limit of 18, as opposed to 21, was in any way related).  Also note that in England, where the age limit is still 18 and vaping is literally promoted by public health authorities, teen smoking continued its long decline through at least 2021.  New Zealand, where the age limit was still 18 (until very, very recently), smoking rates among 15-24 year olds nosedived as soon as nicotine vaping was officially legalized in 2020, despite an even stricter lockdown there.  Thus it seems to be the combination of 1) black markets, 2) vaping bans, and 3) lockdowns that is the cause of the jump in teen smoking in Australia.

But good luck trying to convince the nanny-state zealots to use even a little bit of common sense!

QED

How To Make Tobacco Less Appealing And Addictive Without Banning It Or Reducing Nicotine Below Natural Levels

Here is a "Cliffs Notes" style list on how to make cigarettes and other smokeable tobacco products less addictive and appealing WITHOUT banning it outright, raising the age limit any higher than 18, or even reducing nicotine below natural levels:

• First and foremost, BAN ADDITIVES!  No non-tobacco ingredients should be added, period.
• Adding extra nicotine deliberately should also be banned as well.
• Require the smoke pH to be 8 or higher to discourage deep inhalation of smoke, as it naturally was prior to the 20th century. 
• Phase out the pH-lowering and environmentally unsustainable practice of flue-curing tobacco. 
• Phase out cigarette "filters", which don't really filter, and merely provide a false sense of security to smokers, and inherently creates a major toxic waste littering problem to boot.

If they still want to reduce maximum nicotine levels to a non-addictive level in ready-made commercial cigarettes and little cigars, go right ahead.  But it would be best to do the other things on the list first.

Also, banning the use of radioactive (!) phosphate fertilizers to grow tobacco is really a textbook no-brainer in terms of tobacco harm reduction. 

Additionally, requiring all tobacco products to be sold only in dedicated tobacco stores, or other places where you have to be 18 or older to enter, would really not be a bad idea either.  It would certainly make it less ubiquitous, convenient, and tempting without the constant reminder in grocery stores, convenience stores, gas stations, pharmacies, etc.

So what are we waiting for?

A Better Way To Phase Out Tobacco

California is now seeking to emulate New Zealand, Norway, Singapore, and the Philippines in phasing out tobacco products with a permanent generational ban on the sale of such to anyone born on after January 1, 2007.  Twenty-One Debunked has generally opposed such an idea on principle, as we had discussed previously.   Not only is it inherently ageist, and further promotes black markets, but it will drag it out and take decades to have the desired endgame effect.

Here's a better idea, that the FDA is already currently considering:  Reduce the maximum allowable nicotine levels in commercial cigarettes, and perhaps other combustible tobacco products, to a non-addictive or sub-addictive level.  This idea, or at least some flavor of it, has long been endorsed by many stakeholders and pundits the world over, from the American Medical Association to Robert N. Proctor to Malcolm Gladwell.  And Twenty-One Debunked has endorsed it since 2013, ideally keeping the legal age limit at 18 (which Congress and Trump unfortunately raised to 21 in late 2019, much to our chagrin).

By that, it means reducing nicotine levels by 95% or so from current levels, down to no more than 0.5 mg/g (0.05%) of tobacco.  Crucially, this would apply to nicotine content, not "delivery," as the latter can be gamed and manipulated too easily.

If done smoothly and gradually enough, and leaving noncombustible tobacco and nicotine products untouched, this will dramatically reduce smoking rates for all ages, and thus save thousands if not millions of lives without creating any more of a black market than already exists from high cigarette taxes alone.  Pairing it with a tax hike (within reason) would also increase its effectiveness as well.

Even if the new nicotine limits applied only to the sale of pre-rolled cigarettes and quasi-cigarettes like little cigars, and nothing else, it would likely still have the desired effect.  That is because those are the products that really drive the deadly tobacco epidemic.

It could be done in either one step with some lead time, or a few steps over a period of months to a year or two, for all cigarette manufacturing and importation going forward, plus an additional year to clear out excess inventory.  Doing it in a few steps would probably be better overall we think.  Either way would probably be fine though. 

Banning the use of additives, which are largely all about increasing the addictiveness of the products, would also make sense as well.  Michigan already has an excellent law on the books, that bans any "deleterious" ingredient or anything "foreign to tobacco" being added to cigarettes.  It needs enforcing.

Redesigning the cigarette to have a more alkaline smoke pH of 8 or higher, as it typically was prior to the 20th century, would make it less appealing and harder to inhale at least for new smokers.  Most cigars and pipe tobacco are already like that currently. 

And for the love of all that is good, ban the use of radioactive phosphate fertilizers yesterday!

Another good idea would be to only allow tobacco products to be sold in designated or dedicated tobacco-related stores (i.e. smoke and vape shops) and/or places that one needs to be 18+ to enter.

As for nicotine vapes, capping the maximum nicotine content at current European or Israeli levels (lower than USA levels but still generous) would reduce overall nicotine addiction rates without driving vapers back to smoking cigarettes.

Do these things and the desired endgame can be achieved in a matter of months to years, not decades.  But that would make too much sense, right?

FUN FACT:  Hemp-based, tobacco-free "blunt wraps" are now commercially available, so even the classic use of hollowed-out cheap tobacco cigars for rolling cannabis blunts is now thoroughly obsolete as well. 

UPDATE:  Apparently New Zealand will, starting in 2025, mandate that only very low nicotine cigarettes (VLNC) be sold, similar to what we advocate above.  Also, in 2024 they will sharply reduce the number of tobacco retail outlets by 90-95%, and ban the sale of cigarettes at kiosks, gas stations, or supermarkets.  This will be in addition to their generational ban for anyone born after January 1, 2009.  Thus, the generational ban is completely redundant and unnecessary, given the other two components.  And also the price of a pack of smokes there, $36 NZD, is the equivalent of over $20 USD (that is, more than a dollar per cigarette!) thanks to their already high taxes, making it a very expensive habit as it is.

And vape products would remain unaffected. 

Twenty-One Debunked's preferred plan, in a nutshell, is basically the New Zealand plan MINUS the generational ban and keeping the age limit at 18, plus a few other things above listed above.

UPDATE 2:  Bhutan, the only country in the 21st century that had completely banned tobacco across the board, has failed so miserably in doing so (thanks to the black market and international smuggling, and despite very stiff penalties too) that they ended up reversing their ban in 2021, largely out of fear that rampant cross-border smuggling would.... increase the spread of Covid.  Seriously, you cannot make this stuff up!  This should really be a cautionary tale.

What About Tobacco, Again?

The Biden administration is currently considering two new sweeping FDA rules affecting combustible tobacco cigarettes:  1) banning menthol cigarettes and flavored cigars, and 2) reducing nicotine levels, presumably to a non-addictive level.  Where we stand on these two potential changes is as follows:

The first one, Twenty-One Debunked is on the fence about that, as we can see both sides of that issue, noting that Canada has already banned menthols and the EU has phased them out, while also noting the inconvenient truth of racism and how it intersects with this issue as well.   The flavored cigars we generally lean against banning, while for menthol cigarettes we believe that if they must do it for whatever reason, they should phase them out more gradually and allow existing stocks to be sold well after the designated "quit date" for selling newly manufactured menthols.  Also, possession and consumption of menthols should NOT be banned or punished, and police should NOT go out of their way to target the sale of menthols or "loosies" in underprivileged neighborhoods with people of color.

(For what it's worth, quit rates in Canada have improved significantly since their menthol ban, particularly among formerly menthol-preferring smokers.  That lends credence to the idea that menthol enhances the overall addictiveness of tobacco by making the high nicotine levels less harsh on the throat, which also makes it easier for young experimenters to pick up the habit in the first place.)

The second one, reducing nicotine levels, Twenty-One Debunked has cautiously supported since 2014, and we still do, provided that all of the following are true:

• The phasedown of nicotine to a non-addictive level is done gradually and stepwise over a period of at least a year, in at least three stages.
• The sale of existing domestic stocks of cigarettes above the nicotine cap can continue at least six months after the "quit date" for manufacturing and importing cigarettes above that cap (at each step of the phasedown).  
• The possession/consumption of cigarettes with nicotine levels above the cap is NOT banned or punished.
• The only other tobacco products subject to the same cap shall be little cigars (below a certain size), perhaps all cigars with a smoke pH below 8, and possibly loose roll-your-own cigarette tobacco and/or pipe tobacco with a pH below 8.  Nothing else, period.  We would be fine with, and would actually prefer, if only pre-rolled commercial cigarettes and little cigars (the size of cigarettes) were subject to the nicotine cap.  
• The addition of any harmful or addictive additives to all newly manufactured tobacco products is banned effective immediately as well.  All additives must meet the same standards as for additives to food.  Radioactive fertilizers for growing tobacco must also be banned as well.

While the effectiveness of the flavor ban is a bit questionable at best, the nicotine cap and phasedown would likely greatly reduce the prevalence of tobacco smoking and associated disease and death, simply by making this conveniently deadly product by design far less addictive.  More people would quit fairly quickly, and fewer people would take up the habit in the first place.  And people who miss the old high-nicotine smokes of yore would still be free to use alternative tobacco and nicotine products.

And doing it gradually enough will make it so there is no more of a black market for higher-nicotine cigarettes than there is for incandescent light bulbs.

As for vaping, Twenty-One Debunked does not support such a massive reduction in nicotine levels to that proposed for combustible cigarettes, but rather we support reducing the nicotine content in vape products to the maximum levels permitted in the EU, UK, and Israel.  That would nix the super-addictive ones that notoriously get young people hooked within seven days (JUUL, we're looking at you!) while still allowing plenty of nicotine for adult vapers who are trying to quit smoking.  (Twenty-One Debunked does NOT recommend anyone take up vaping, except as a last-ditch effort for truly hardened and refractory adult smokers who cannot quit any other way.)

Of course, we also think the smoking age should be lowered back to 18, just like we feel about the drinking age and toking age.  We are not called Twenty-One Debunked for nothing, after all.  Raising the age limit to 21 was at best useless, and is an ageist abomination.  In the meantime, though, the above is our nuanced and well-thought-out stance on the latest tobacco-related measures being proposed. 

FINAL THOUGHT:  By the way, the fact that they use the "think of the children!" argument to justify the banning of menthols and flavored cigars, is really just a tacit admission that raising the smoking age to 21 was essentially useless in keeping cigarettes and cigars from "trickling down" to people under 18.

HALF Of America Now Has A Smoking/Vaping Age Of 21

As of July 2019, HALF of the American population now lives in jurisdictions with a tobacco/nicotine smoking/vaping age of 21 now.  It is a total of 18 states as of September 2019, and hundreds (if not thousands) of localities, and given the population distribution it adds up at least half of the population living in such places.  And now Pennsylvania, currently 18 statewide (with none of their localities setting it any higher), but soon to be surrrounded on all sides by states with an age limit of 21, unfortunately looks to join them as well.

That is a shame, since Pennsylvania has seen more progress than the national average in terms of reducing teen smoking (and less of an increase in teen vaping) in recent years, while the increase in teen vaping continues unabated nationwide regardless of the states who raised the age limit to 21 in recent years.  Pennsylvania raised their cigarette tax and implement a hefty vape tax on recent years, so that could be part of their relative success story.

UPDATE:  As of November 27, 2019, Pennsylvania raised their smoking age to 21, effective July 1, 2020.  And New York's hike to 21 has just gone into effect in November as well.  Thus, now MORE than half of the American population (and growing!) lives under a Tobacco 21 regime now.

When It Comes To Vaping, Don't Throw Out The Baby With The Bathwater

In the wake of both the mysterious vaping-related lung illness epidemic, and also the recent increase in vaping among young people (something for which Tobacco 21 laws have apparently done NOTHING to stem the tide, by the way) both the federal government and several state and local governments are beginning to crack down on vaping to one degree or another.  Yes, Houston, we have a problem.  But it is important to keep a cool head and not throw out the proverbial baby with the bathwater.

The FDA plans to ban all flavored vape products other than tobacco (yuck!) or unflavored (meh), as is Michigan.  San Francisco, on the other hand, already passed a ban on ALL vape products regardless of flavor.  The state of New York just passed an emergency executive ban on all flavored vape products other than tobacco or menthol, effective October 4th.  And California's governor announced a crackdown on counterfeit vape products, though he lacks the authority to pass any flavor bans without the state legislature passing it.

Going too far with such bans would only increase the very black market that is the most likely cause of the mystery vaping illness (though with that it is mostly black-market THC products, though some appear to have been nicotine only).  At the same time, while vaping can help some adult smokers quit, it's not like there really is any overarching benefit society from nicotine that comes in fruity, candy, or dessert-like flavors either.  It really is a balancing act.

Twenty-One Debunked once grudgingly supported some degree of flavor bans in the past, mainly as an alternative to Tobacco 21 laws, but in light of current events, we no longer support such bans today.

New York's flavor ban--if there must be one at all--is somewhat more reasonable than the ones that don't even allow menthol.  And clearly counterfeit products need to be cracked down upon, and bad actors and questionable additives rooted out at once.  And capping and reducing nicotine levels of vape products down to European and Israeli levels would also make such products less addictive than they are currently.  But anything more stringent than these things would likely do more harm than good.  (That goes for setting the age limit any higher than 18 as well.)

As for cannabis vaping products, the best way to eradicate the sketchy and janky black and gray market products is to fully legalize and regulate cannabis nationwide, period, with an age limit of 18, strict quality control, and reasonable taxes on such products.  And again, crack down on counterfeit products and products with questionable additives.  But that would make too much sense, wouldn’t it?

So let's be adult about this, shall we?

UPDATE:  Looks like Michigan's emergency executive flavor ban contains a loophole that allows flavored nicotine-free e-liquids and pods, and also allows flavorless nicotine packets one can combine with such e-liquids (albeit sold separately).  So this particular ban is actually far more reasonable than meets the eye, while still having the intended effect of making it somewhat harder and less convenient for people under 18 to vape flavored nicotine.  And it will likely keep vape shops open for business for the foreseeable future, while JUUL will still get a swift kick in the margins now that their ready-made pods will be verboten if they have any flavor other than tobacco.

And at the other extreme, on September 24th, Massachusetts Governor Baker has literally banned ALL vape products for four months by an emergency executive action.  And that will just throw gasoline on the fire by dramatically growing the black market. DERP!  Didn't think that one through, did you Charlie?

Twenty-One Debunked Opposes Most Drug Testing

In light of recent reports of student drug testing now including nicotine in some schools due to the moral panic over vaping, Twenty-One Debunked needs to reiterate our general opposition to such testing:

• We oppose any drug testing that is not strictly to determine current impairment or "fitness for duty" in cases of driving, operating machinery, or working at safety-sensitive jobs.
• We oppose any drug testing that privileges or excludes some people over others, whether by age, socioeconomic status, race, or any other suspect or quasi-suspect classification.
• We oppose schools and employers having any jurisdiction whatsoever over what students and employees do to their own bodies off the clock and off the premises, as long as it does not unduly adversely affect their job or school performance and behavior.
• Even if the above criteria are satisfied, we still oppose any drug testing method that has detection times longer than a day or two at the cutoff used, and/or uses inactive metabolites as a proxy for the main substances being tested.  That excludes essentially everything except blood and saliva tests for most substances.  (Note that SCRAM bracelets and sweat testing for offenders in the 24/7 Program are an exception to this rule.)

Twenty-One Debunked, therefore, opposes the vast majority of drug testing done in this country.  We are the supposed land of the free, it's time to start acting like it!

Do Tobacco 21 Laws Really Work?

One preliminary study seems to think so about California's law that raised the age limit to buy tobacco and e-cigarettes from 18 to 21 as of June 9, 2016.  But the devil is really in the details.  The study did not, I repeat, did NOT, look at actual teen smoking rates, only the degree of retailer compliance as measured by decoys, which did in fact improve since then in terms of sales to people under 18.

The two problems with this logic are 1) it is not necessary to raise the age limit to 21 to discourage retailers from selling to people under 18, as simply better enforcement against scofflaw vendors would do the trick, and 2) survey data do not really show any decrease in teen smoking that can be unambiguously linked to the policy change, whether in California or elsewhere with a Tobacco 21 law.  Teen smoking dropped nationwide from 2015 to 2017, and while it dropped somewhat faster in California, keep in mind that California also raised their cigarette tax significantly during that time, by $2.00/pack, and Pennsylvania saw an even larger drop in teen smoking despite keeping the age limit 18 and a cigarette tax hike of $1.00/pack, only half as large.

As we have noted before based on survey data for the past few years, there is really no robust correlation between a state or local smoking age (whether 18, 19, or 21) and the teen (or adult) smoking rate.  The strongest predictors of both teen and adult smoking are the tax/price of cigarettes and the prevailing social attitudes towards smoking, and in fact prices seem to have a larger effect on young people than adults.  It is practically axiomatic.  Retailer compliance is also inversely correlated with smoking by people under 18, but again it has proven to be entirely possible achieve nearly 100% compliance without raising the smoking age any higher than 18, as long as there is the political will for it.  And it doesn't even require the criminal justice system at all, since the best tobacco-control success stories involved only administrative penalties (i.e. fines and/or tobacco license suspensions) against rogue vendors.  Nor does it require criminalizing young people themselves.

If anything, if NYC is any indication, retailer compliance actually deteriorated following their age limit hike from 18 to 21 in 2014.  This was in spite of heavy crackdowns against contraband tobacco during that time.  In any case, while teen smoking rates declined in NYC following the law change, they did not drop any faster than the rest of the state or the nation as a whole, in fact they declined at a slower rate in NYC compared with the control locations, and teen vaping actually increased despite the fact that the law applied equally to e-cigarettes as well as combustible cigarettes.  If that's "success", we would really hate to see what failure looks like.

Oh, and about Chicago's supposed success, keep in mind that raising their age limit to 21 in 2016 was not the only new tobacco control law passed around that time in the Windy City.  And the cigarette taxes there also went up significantly shortly before the age limit hike to 21 as well.  Thus, there were too many variables to really tease out the effect of the Tobacco 21 law on teen and young adult smoking rates.

And in fact, this also once again calls into question how effective the 21 drinking age (and now toking age in some states) is as well.  Spoiler alert:  not very.  Thus, if there is a silver lining to the recent hike in the smoking age to 21 in some states and localities, it is that re-running this same failed social experiment with a different age-restricted psychoactive substance only to see it fail yet again in more modern times, a fortiori, is probably the strongest evidence against the very concept of such ridiculously high age limits in general.  If you give the pro-21 crowd enough rope...

Tempest in a Vape Pod: Let's Be Adult About This

Just a few months ago, we at Twenty-One Debunked posted an article about the latest moral panic to sweep the nation: teen vaping, particularly Juuling.  Well, that particular moral panic is now at (or approaching) its ultimate crescendo as we speak, with the FDA not only cracking down on retailers who sell to people under 18, but going so far as to give vendors an ultimatum of sorts:  either they come up with a plan within 60 days to tackle youth use of their vape products, or such products will be pulled from the market.  Such fighting words, aimed primarily at JUUL, have been prompted by largely unpublished data showing an alleged "epidemic" of teen vaping.

Wait, what? Oh, they must mean the "epidemic" where a whopping 2.4% of high school students in 2017 (2.0% in 2015) nationally reported daily vaping.  (And that is the total--keep in mind that among never-smokers, such figures are even lower still, at 0.3%)  Or maybe they mean the "epidemic" in which e-cigarettes have become more popular than combustible cigarettes in terms of experimentation and casual use, and regular vaping is making a dent in displacing regular smoking, but regular vaping among never-smokers still remains vanishingly low, and the use of combustible cigarettes has fallen to a record low.

Yes, you read that right.  A record low. Smoking cigarettes is decidedly "uncool" these days.  And by some measures, vaping has already crested and it too has also declined a bit as well since its 2015 peak.

So what should we make of all this?  First, don't panic, lest we continue to fuel a deviancy amplification spiral rather than let this fad burn out on its own.  The good news, we must repeat, is that combustible tobacco consumption is now at a record low among young people, and still falling.  And again, vaping is actually rarely used by teens who have never also tried combustible cigarettes.  If anything, vaping in general (including, but not limited to, Juuling) is displacing combustible cigarettes on balance, and is significantly safer as well--perhaps even 95% safer by some estimates.  The bad news?  Vaping is, of course, not completely safe, as most vape juices (including all JUUL brand ones, even if its users don't realize it) do contain nicotine, which is highly addictive and is even a known neurotoxin, particularly for the developing early adolescent brain.  Other concerns include the relative lack of regulation as to how these things are made and what sort of contaminants may be lurking inside, but again, it still pales in comparison to the dangers of combustible tobacco cigarettes, which contain literally thousands of other nasty chemicals as well as nicotine, including many known carcinogens, mutagens, and teratogens.  So insofar as vaping displaces smoking, it is a net win for public health.

For currently addicted smokers of any age trying to quit, vaping can literally save their lives upon switching, and we must remember that no matter how much of a fever pitch the ridiculous moral panic over teen vaping ultimately reaches.  Seriously.

Secondly, we should note that this apparent fad exists even in states and localities where the age limit is 21 for both smoking and vaping (or at least for buying these things), including New Jersey.  Thus, raising the age limit is unlikely to solve anything in that regard compared with keeping it 18 and enforcing it on vendors the same as with combustible tobacco products.  Keep in mind that until fairly recently there was no age limit at all for vaping devices and liquids/pods in many states and localities.

And finally, there are practical ways of reducing any potential harm from all of this:

• Regulate vaping devices and juices/pods the same as combustible cigarettes (but no stricter), and require strong quality control standards and testing
• Warning labels alerting users about the fact that they contain the highly addictive drug nicotine
• Tax nicotine-containing vape juices/pods by weight or volume adjusted for nicotine content (but much lower than combustible cigarettes)
• Increase the number of nicotine-free vape juices, particularly for JUUL brand ones which currently lack such options 
• Consider banning or phasing out any vape juices/pods that have fruity, floral, or any other non-neutral or non-tobacco-style flavors unless they are completely nicotine-free ones
• Consider capping/reducing the maximum nicotine content in vape juice/pods, as is already the case in the EU and now in Israel as well.
• Educate the public, especially young people, on the truth about vaping, particularly with an eye towards preventing accidental addiction to something that they may not even realize contains nicotine at all
• Social norms marketing to help defuse any deviancy amplification spiral

Most importantly, we need to see the forest for the trees, and stop tilting at windmills already.

And most ironically of all, this moral panic driven by irresponsible yellow journalism is literally the very best (not to mention free) advertising that JUUL and other vape companies could ever dream of.  Despite being founded in 2015, it is unlikely that very many young people (or anyone else for that matter) had ever even heard of JUUL until it became at the center of the scare stories that started in 2017 and especially 2018.  And if the alleged unpublished increase in teen vaping in 2018 relative to 2017 does turn out to be real, well, we really know who to thank for that!

Tobacco, The Ulitmate Dark Horse of Drugs

Almost immediately after posting a recent article about the roundly debunked "gateway drug theory", we at Twenty-One Debunked felt we should post another separate article about the particular case of tobacco, especially in the form of commercial cigarettes. While our organization does not generally view tobacco as a particularly high-priority issue, perhaps it is something we should be revisiting given both recent evidence as well as recent efforts to raise the smoking age to 21.

While the primary dangers of smoking tobacco (i.e. cancer, heart disease, stroke, emphysema, birth defects, etc.) have been well-known for decades, what has been much less appreciated is the neurotoxic properties of cigarettes.  The thing is, nicotine is a known neurotoxin, and it is likely that at least some of the thousands of other chemicals in cigarette smoke are also toxic to the brain as well.  One reported effect of nicotine is that it can "prime" the brain's reward system for addiction in general, including to other substances.  This seems to be particularly true for the early adolescent brain.  While these findings are based primarily on rodent studies, human studies seem to dovetail with this idea far more for tobacco than for cannabis or even alcohol.  Thus, the psychopharmacological aspect of the gateway hypothesis seems to hold true indeed for tobacco, and if there were such a thing as an actual gateway drug (which is a very big "if", if you ask us), tobacco would have to be it, hands down.

Additionally, tobacco is also emerging as a potential "dark horse" in the etiology of psychosis and schizophrenia as well.  This has been informally hypothesized for many years now while being overlooked by most researchers, and is only very recently beginning to be taken seriously by mainstream science.  Perhaps cannabis (which is often mixed with tobacco in many countries, and whose use is often predicted by prior and concurrent tobacco use in general) has been taking a major bum rap in that regard as well?  All while Big Tobacco has subtly and sedulously promoted tobacco smoking as "self-medication" for decades, of course.

That said, Twenty-One Debunked strongly opposes any attempts to raise the smoking age any higher than 18.  Instead, we (along with the TSAP) believe that we should deal with cigarettes the way we would deal with any other defective product such as the historical examples of the Ford Pinto, lawn darts (Jarts), leaded gasoline and paint, DDT, incandescent light bulbs, and old-style refrigerators.  Either 1) require the defects to be sufficiently fixed, or 2) failing that, remove such products from the market.  And yes, commercial cigarettes as they exist today are indeed defective by design in that they addict, enslave, and kill far more people than they have to.  Worldwide, they kill about 6 million people per year, hence the name of Robert N. Proctor's bombshell of a book, Golden Holocaust.

Since 2013, the endgame strategy that the TSAP (and Twenty-One Debunked) currently supports has been to let tobacco phase itself out by gradually reducing the nicotine content of cigarettes to a (relatively) non-addictive level.  Since 2009, the FDA now has the authority to set a legal limit on the nicotine content of tobacco products, as long as the limit is not zero.  Much research indicates that there is a threshold level of nicotine required to create and sustain addiction, and if all cigarettes were to fall below this threshold, smoking rates would plummet precipitously.  In fact, one tobacco executive was quoted as saying, "‘If our product was not addictive we would not sell a cigarette next week."  This idea was originally proposed by Henningfield and Benowitz in 1994, and has been endorsed by the American Medical Association and several other experts including Proctor himself.  Malcolm Gladwell also discussed it in his aptly-titled 2000 book The Tipping Point.   Thus, the TSAP recommends reducing the maximum nicotine content (not delivery) of cigarettes from the current level of 1-2% to less than 0.1% within 5 years, and doing the same for quasi-cigarettes (i.e. little cigars) and perhaps roll-your-own tobacco (but no other products).  That alone would reduce smoking prevalence by as much as 80% within a fairly short timeframe, with further reductions possible in the more distant future.  Alternatively (or in addition), the FDA could require the pH of such products to be raised to 8 or higher to discourage deep inhalation, as is naturally the case for most typical cigars and pipe tobacco currently.

The TSAP and Twenty-One Debunked also recommend that the following measures be taken as well:

• Ban the use of additives in cigarettes, especially those that are harmful or increase the addictiveness of tobacco.
• Ban the use of any radioactive fertilizers or harmful pesticides for growing tobacco.
• Phase-out the practice of flue-curing tobacco, which is a major resource hog and bad for the environment.
• Improve the quality control standards for tobacco products (and electronic cigarettes) to be at least as high as for food.
• End all government subsidies for tobacco farming and production.
• Divest completely from Big Tobacco at all levels of government.
• Vigorously enforce the current age limit of 18 for tobacco and e-cigarette sales to achieve 100% retailer compliance. 
• Continue to allow widespread availability of reduced-harm tobacco and nicotine products (i.e. snus, e-cigarettes, etc.) so that smokers can easily switch to less dangerous alternatives.
• Improve education and smoking cessation programs, funded by tobacco tax revenues.
• Give out free nicotine patches, gum, etc. to any smokers who want to quit.  NYC already does this. 

At the same time, the TSAP most certainly does NOT support outdoor smoking bans or any other policy that treats smokers like criminals or second-class citizens.  Smokers are NOT the villains here, as that dubious honor belongs to the merchants of death known as tobacco companies.  In fact, we have repeatedly pointed out that, far from being a drain on society, smokers actually save society money in the long run since they more than pay their way as far as taxes go.  Cigarette taxes, especially in NYC where they are extremely high, have basically become a "reverse Robin Hood" way to rob from the poor and give to the rich, since smoking has increasingly become a poor man's vice.  And the wide disparity in cigarette taxes across states has led to a serious black market for untaxed/low-tax/counterfeit/stolen cigarettes, with the main beneficiaries being organized crime syndicates and even terrorists.  Thus, we recommend that the handful of states with cigarette taxes higher than $2.00/pack reduce their tax to $2.00/pack or lower, and the states with taxes of less than $1.00/pack raise it to $1.00-$2.00/pack.  NYC should cut its tax in half.  At the federal level, we recommend no further tax hikes, but a national price floor of $5.00/pack including tax to discourage smuggling.

The tobacco industry has basically dug its own grave.  Time to push them in there, yesterday.