The Vaping Lung Illness Mystery Has Been Solved

Looks like the "mystery" vaping lung illness (now called EVALI) has been largely solved.  And the primary culprit is indeed the same one that Twenty-One Debunked and many others had long suspected several months ago:  Vitamin E Acetate, a common additive found almost exclusively in black-market and counterfeit THC (and probably some gray-market CBD) vape cartridges.  Though harmless when ingested orally or applied topically, when inhaled it is apparently a different story:  this "thick and greasy" oil, and perhaps also its byproducts upon heating it to high temperatures, can indeed cause serious lung damage, and quickly.  It certainly does NOT belong in the lungs at all!  And both samples of vape cartridges as well as (more recently) samples of lung fluids taken from EVALI patients now confirm such suspicions, as noted recently by the Centers for Disease Control (CDC).  But we could have told you that a while ago.

The illness was apparently quite rare before June 2019, when the epidemic apparently exploded, peaked in September, and sharply declined thereafter.  In other words, this was not a trend, this was an event.  Something had clearly changed about vaping between 2018 and the first half of 2019.

Prior to 2019, Vitamin E Acetate was not widely used in THC vape products, whether legal or illegal, and according to cannabis industry insiders it first emerged as a cutting agent for products made in late 2018 at the earliest.  It may very well have been used before that, but if it was it was too rare to be of any concern or on anyone's radar.  But then, the black-market and counterfeit THC vape product purveyors discovered that this cheap additive can be used to dilute (or "cut") the expensive THC distillate oil while (unlike with other, thinner cutting agents) still maintaining a thick enough consistency to fool unsuspecting buyers into thinking it is purer than it really is, and thus greatly increasing the profit margins.  Yes, you read that right--for filthy lucre.  And they now have a ton of karma to answer for.

And while there apparently have also been some bad actors in the legitimate cannabis market that used this additive here and there, the fact remains that it has been quite rare overall.  And there is still no evidence that Vitamin E Acetate was ever used in any nicotine-containing vapes, whether legitimate or counterfeit.  (Note that those EVALI patients who reported "only nicotine" vaping and not THC may not have been entirely honest.)  In other words, it is fundamentally a black-market and counterfeiting problem that is best solved with legalization and sensible regulation, not blanket prohibition or overregulation.

There may very well have been other additives to blame as well, along with heavy and hard metals leaching from the heating coils of janky devices.  And perhaps some statistical flukes thrown in for good measure.  But these other minor culprits are basically sideshows compared with Vitamin E Acetate, and again the best solution is legalization and regulation of such products and devices, not prohibition.

Of course, that would make too much sense.  But truth is always the first casualty in any moral panic.

And really, SHAME on anyone (politicians, pundits, regulators, and activists) who cynically and disingenuously used the horrendous and hellish suffering of the over 2500 EVALI victims (and over 50 deaths) as a ploy to push their hateful and regressive prohibitionist agendas, while essentially hiding or denying the real cause of the illness for several months, before finally admitting it well after the epidemic had peaked.  You had a chance to save so many lives and prevent so much suffering, but you chose to sit on it, because reasons.  You now have just as much blood on your hands as the aforementioned bad actors that chose to adulterate their products with questionable additives for filthy lucre.  What you did was unforgivable in our view, but you now have a chance to make amends (albeit belatedly) to keep your karma from getting any worse.  So what are you waiting for?  Legalize and regulate yesterday!

JANUARY 2020 UPDATE:  The latest CDC report confirms yet again that the vast, vast majority of EVALI patients, among those for whom data is available, reported obtaining THC vapes from "informal" sources.  And while the anti-legalization lobby seized upon the finding that 16% of those reporting THC vaping reported obtaining their products from "commerical" sources, keep mind that that figure also includes unlicensed pop-up shops that may appear legitimate but are not, and there is always the possibility of recall bias when more than one product is used or shared.  Again, the real solution is to legalize, regulate, and root out the bad actors, not to categorically ban cannabis or vaping.

Though relatively rare, Vitamin E Acetate  has recently been found in some legal THC vape cartridges on the shelves of licensed dispensaries, including medical dispensaries upon testing, at least in Michigan.  A product recall was rightly issued.  Another state that bothered to test for it, such as Massachusetts had found none of that additive in their legal products, but had temporarily quarantined their products in November so they could be tested before reaching consumers.  This is how the system of quality control is supposed to work, and far better than the black market, which has ZERO quality control.

(For those who are interested, the hypothesized underlying chemistry of how exactly Vitamin E Acetate can cause EVALI can be found here and here.  Once thought to be lipoid pneumonia based on a handful of case reports, it turned out to be more like chemical burns in the vast majority of cases.)

Pennsylvania Raises Smoking Age To 21

It's official, Pennsylvania just raised the legal age limit for tobacco products from 18 to 21, effective July 1, 2020, making them the 19th state (and counting) to do so.  And the new law also expands the legal definition of tobacco products to include vaping products as well, since apparently they didn't even have an age limit for vaping products at all (though the federal age limit of 18 applied by default from 2016 onwards).

The part about including nicotine vapes in the definition of tobacco products is totally reasonable.  But raising the age limit to 21 is really not justified at all.  And Pennsylvania had been seeing so much progress in reducing teen smoking and vaping already, mainly due to tax hikes on both.  It would really be a shame to risk derailing such progress now with such an utterly illiberal and ageist law.

Yes, there is an exception in the new law for active military and veterans, who only need to be 18 or older instead of 21 to buy tobacco products.  But that one silver lining does still not make it OK to deny adult rights to otherwise legal adults over 18 who are legally old enough to join the military, regardless of whether they are actually in the military or not.  Thus, the exception does not actually resolve the inherent ageism and hypocrisy of this otherwise bad law.

I like to joke about "the other Tri-State Area", where NY, NJ, and PA all meet.  Port Jervis, NY, Montague, NJ, and Matamoras, PA are all right next to each other, and Matamoras is basically "come for the fireworks, stay for the cigarettes", since fireworks are legal in PA to sell to nonresidents, cigarettes are cheaper in PA, and the age limit in PA for tobacco has been 18 (until July 2020) while it is 21 in NY and NJ.  Looks like the tobacco part of that equation will no longer be true, at least the age limit part, and the price difference is also narrower now for cigarettes, and reversed for vape products, due to the tax hikes.  And gas is also more expensive now in PA than either of the other two states, while NJ gas is almost as pricey as NY now.  Thus the whole microeconomic dynamics of "the other Tri-State Area" are fundamentally different now, except for the fireworks of course.

In The UK, Cooler Heads Still Prevail When It Comes To Vaping

With all of this mass hysteria going on in the USA over vaping, we should keep in mind that our friends across the pond in the UK are generally NOT freaking out about it.  So what is so different over there?

First of all, regulation of advertising and promotion of vaping products is stricter in the UK.  Also, the nicotine content of such products is capped at a level significantly lower (as much as two-thirds lower) than the average of today's leading brands in the USA.  Even when those very same brands, most notably JUUL (aka "may their name and memory be forever blotted out"), are sold in the UK, they have to reduce their nicotine levels to be able to sell them there.  That, of course, is an EU-wide regulation, binding on all member states including the UK (at least until Brexit, just to Regrexit, if finalized).  The dose makes the poison, basically, and capping it greatly reduces (though does not eliminate) adverse side effects, not to mention the chances of young experimenters becoming addicted to nicotine so disturbingly quickly.

Also, the age limit is 18 over there (strictly enforced on vendors, just like regular cigarettes and alcohol), and there are no flavor bans either.  If anything, they seem to have an even wider variety of flavors.

Public Health England (PHE) certainly does NOT recommend that non-smokers ever take up the habit of vaping, but they do encourage current adult smokers to switch to vaping if they can't quit nicotine otherwise.  And they caution vapers not to vape any illicit or homemade products or add anything to the legitimate pods or liquid. Overall, authorities and the public health community keep a cool head about vaping, and guess what?  In the absence of moral panic, there does not seem be any real vaping epidemic among young people over there, and while there have been occasional reports of adverse reactions in general, there so far have not been any reported cases of the mystery vaping-related lung illness that the USA is currently grappling with.  (Of course, as we have already noted before, that mystery illness is primarily due to unregulated black-market vape products, especially THC ones, which often contain very questionable additives.)

That’s not to say that nobody is freaking out over there at all.  Every country has its share of that it seems.  But over in the UK at least, it currently seems to be confined to the tabloids for the most part.

We can really learn a lot from our friends across the pond.  So let's be adult about this, shall we?

Calling It QUITS

There is a new bipartisan bill in Congress now, called the Quell Underage Inhaling of Toxic Substances (QUITS) Act.  And to be honest, it is a mixed bag overall.  It would:

• Ban flavored e-cigarettes (i.e. vape products) and other flavored tobacco products, including menthol.
• Increase the federal cigarette tax from $1 per pack to $3 per pack.
• Create a tax on e-cigarettes equivalent to $3 per pack.
• Increase annual funding for the CDC's Office of Smoking and Health from $210 million to $500 million.

The first item on the list, the flavor ban as we have noted before, is too broad and largely due to the moral panic around vaping these days.  Throwing out the proverbial baby with the bathwater is likely counterproductive, and slopes are slipperier than they appear.  other items on the list are overall a good idea though.  At least all of these also apply to, and does not ignore, the real elephant in the room:  combustible cigarettes and other combustible tobacco products, which kill over 480,000+ Americans per year, while vaping has killed eight people so far in all of its history, and even then, mostly via black-market THC products rather than legitimate ones.  And while even one such death is one too many, compared to combustible cigarettes, that's essentially a mere rounding error in statistical terms.

Another strength is that it does not raise the age limit for tobacco or vaping products at the federal level.  And that, Twenty-One Debunked is happy about.

So what can be added to the bill to improve it, while also removing or narrowing the flavor ban?  Here are some of our ideas:

• Cap and reduce the maximum allowable nicotine content of vape products down to current European and Israeli levels. 
• In fact, while we're at it, cap and gradually phase down the maximum allowable nicotine content of combustible cigarettes down to a non-addictive level as well.
• Tax vape products in a manner that is directly proportional to nicotine content.
• Enforce better (targeting vendors) the current federal age limit of 18 for both vaping and combustible tobacco products.
• Restrict advertising of vape products, similar to how it is for combustible tobacco products.
• Actually REGULATE the vaping industry, and require quality control testing.
• Crack down on black-market and counterfeit vape products, and root out any bad actors in the legitimate market as well.
• Legalize and regulate cannabis at the federal level, and implement strict quality control standards as well for both cannabis as well as tobacco/nicotine products.
• Require ALL vape products, whether nicotine, THC, CBD, or otherwise, to transparently disclose all ingredients, and immediately ban the use of questionable additives believed to be linked to the outbreak of the mystery vaping illness.

Let's be adult about this, shall we? 

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?

New Tobacco 21 Study Leaves Us With More Questions Than Answers

A new and very preliminary study of recently-passed Tobacco 21 laws appears to find that such laws significantly reduce tobacco smoking (both recent smoking and current and established smoking) by as much as 39% among 18-20 year olds.  The study looked at survey results of 1869 18-22 year old young adults in 2016-2017 in 48 states and DC (excluding New York and Massachusetts), and compared those in states and localities that raised the tobacco age to 21 versus those that did not, and further compared 18-20 year olds versus 21-22 year olds, after adjusting for potential confounders such as cigarette taxes as well as demographics and parental and peer smoking.

However, there are still reasons to be skeptical of these findings:

• Correlation is not causation, and there may still be selection bias, reporting bias, and residual or unmeasured confounding.
• Only a few states and localities had an age limit of 21 for tobacco in 2016-2017, especially when New York and Massachusetts are excluded.
• In some of these few Tobacco 21 states/localities, the number of individuals surveyed was in the single digits.
• Even if these results are 100% due to the hike of the age limit to 21, the study may only be measuring short-term effects since the laws are so recent and only data from 2016-2017 were used.  More longitudinal data are needed.
• Such "early-adopter" effects may not be generalizable or durable, as we saw with the 21 drinking age according to Miron and Tetelbaum (2009).
• Data were collected from November 2016 through May 2017, and yet New Jersey was listed a Tobacco 21 state even though their law didn't go into effect until six months later in November 2017.  Thus, we noticed at least one potential coding error.
• California raised the cigarette tax significantly as of April 1, 2017, within the period of the study.  And Illinois and Chicago have raised their cigarette taxes several times in the years before and after Chicago's Tobacco 21 law that was implemented in 2016.
• Smoking was already on the decline nationwide long before any Tobacco 21 laws were passed, and the data are not adjusted for pre-existing trends.
• Vaping was not examined in this study, and in any case all of the data was from before the JUUL craze came on the scene.
• And most importantly, the study did NOT look at people under 18 at all.

Thus, these results are preliminary at best and need to be taken with at least a grain of salt, if not a whole pound.  Especially since, as we previously reported, according to the YRBSS data there is really no robust correlation between high school smoking or vaping rates and whether the smoking/vaping age is 18, 19, or 21.  And even in this new study of 18-22 year olds, the effects were limited to only those who had already tried cigarettes before, and that typically occurs well before 18.  But wait, isn't the strongest pro-21 argument that Tobacco 21 laws would reduce smoking (and vaping) among people under 18?

And for what it's worth, there is no evidence that Tobacco 21 laws (all of which now apply equally to vape products, by the way) have done anything to reduce the JUUL craze that began in very late 2017 and apparently continues unabated to this day in all states and localities regardless of the age limit.

Also, it just so happens that yet another recent and preliminary study was done, this time longitudinally using BRFSS data of 18-20 year olds from 2011-2016 compared to 23-25 year olds, and comparing the local tobacco age limits by metropolitan/micropolitan statistical area (MMSA).  This study, which was driven by even earlier adopters (mainly city and county-level Tobacco 21 ordinances), did find statistically significant reductions in current established smoking by 18-20 year olds that were not found for 23-25 year olds.  But the devil is really in the details, since the effect size was rather small (1.2 percentage points, and at most 3.1 percentage points in some models) for practical purposes, and may still have been driven by reporting bias, selection bias, and/or differential sensitivity by age to tobacco tax hikes at the same time.  And given how effect sizes for later adopters of any given policies tend to shrink over time compared to earlier adopters, these results do not look particularly encouraging.  Especially since a cursory look at the trendlines in the study finds that the slight divergence in smoking rates that emerges in 2014-2015 re-converges and essentially disappears by 2016, suggesting that the findings are likely driven by short-term effects rather than longer-term effects.

Bottom line:  it looks like the supposed benefits of raising the smoking/vaping age to 21 were, shall we say, all smoke and mirrors, at least for people under 18.  The supposed success of Needham, MA, for example, was likely a statistical fluke and/or a result of endogeneity, much like the "early adopter" effects of the first few states to raise the drinking age to 21 creating that particular mirage in the 1980s.  Or perhaps increased enforcement in general relative to neighboring towns did the trick regardless of the age limit, like it did in Woodridge, IL and several other communities the 1990s with an age limit of 18.  Studies show that whenever vendor compliance exceeds 90-95%, there is indeed a dramatic drop in teen smoking regardless, by as much as 50% compared with previously weak enforcement and low compliance rates, especially for the youngest teens.  More recent research bears this out as well, for teen smoking as well as vaping.   And keep in mind that those who make it to 18 without smoking are far less likely to take up this deadly habit later on.

This all should be food for thought for policymakers debating not just the age limit for tobacco, but also for alcohol, cannabis, or anything else for that matter.  And even if such benefits of the 21 age limit were real, we at Twenty-One Debunked would still not support an age limit any higher than 18, on principle alone.  Old enough to fight and vote = old enough to drink and smoke.  'Nuff said.

What Does Big Tobacco Really Hate? Hint: It's NOT Tobacco 21 Laws

Clearly, Big Tobacco (including the quisling JUUL Labs who sold out to them) does NOT oppose raising the age limit for tobacco and vaping products to 21.  In fact, they now openly support Tobacco 21 laws, including the latest attempt at the federal level.  It appears to be a cowardly, treacherous Trojan horse to scuttle and pre-empt any laws that they oppose.

But what laws and regulations DO they really, really vehemently oppose these days?  That is the real question here and the answer is:

• Higher tobacco taxes of any kind, especially on cigarettes but also on other tobacco and vaping products as well.
• Flavor bans of any kind, whether menthol cigarettes, flavored cigars, or fruity and candy flavors for vape products.

And it is very telling indeed that they oppose those laws so vehemently.  Additionally, as far as age limits go, they also historically have preferred purchase-use-possession (PUP) laws over sales-to-underage (STU) laws, since the former put the onus on young smokers/vapers themselves while the latter put the onus on vendors, and Big Tobacco really HATES the latter even if they pay lip service to it. This has been true with an age limit of 18, and probably will still be their quasi-official stance under an age limit of 21.

Given what we know about what Big Tobacco likes and dislikes, it should be pretty obvious how to combat them effectively.  Don't take the Tobacco 21 bait, Congress!  Keep it 18, and enforce it better by strengthening the Synar Program for retailer compliance checks, ban kid-friendly vape flavors, consider banning menthol cigarettes, cap nicotine levels of vape products down to European and Israeli levels, phase down nicotine levels in cigarettes to a non-addictive level, and raise the taxes on tobacco products (and add a more modest vape tax too).

To sum up Big Tobacco's thought process:

• Raise cigarette or other tobacco or vape taxes?  HELL NO!
• Flavor bans?  HELL NO!
• Restrictions on nicotine content?  HELL NO! 
• Raise the age limit for tobacco and vaping products to 21?  HELL YEAH!

Remember, anything that Mitch "Awkward Turtle" McConnell (and Big Tobacco) supports has to have some sort of sinister ulterior motives.  Twenty-One Debunked opposes raising the age limit any higher than 18 on principle, regardless of why they want to do it.  But now add in this sinister Big Tobacco dimension and it only becomes all the more repugnant overall.  It truly must be opposed.

Awkward Turtle! Mitch McConnell Wants To Raise Federal Tobacco And Vaping Age To 21

In 2019, there seems to be one thing that Big Tobacco, JUUL Labs (which sold out to Big Tobacco), most anti-tobacco groups, Sen. Elizabeth Warren (D-MA) and Sen. Majority Leader Mitch "Awkward Turtle" McConnell (R-KY) can all agree on.  And that thing is a federal Tobacco 21 law that raises the sale age limit for all tobacco and vaping products to 21 nationwide.  Politics certainly does make some very strange bedfellows indeed!

This would require an act of Congress, of course, as the FDA is explictly denied (as they should be!) the authority to raise the federal age limit any higher than 18.  And unlike the drinking age where the feds had to make an end-run around the Constitution to coerce states to raise their drinking ages to 21, this time they will not have to do so and can simply set a federal age limit of 21.  They already set a federal age limit of 18 as of 2009, so that law can very easily be amended.  Crucially, this law  only applies to the age limit for sales, and only sellers are targeted and penalized (unlike the drinking age in which public possession by young people is an offense), so this is still within Congress’s authority.  

Except, of course, for the substantive due process and equal protection argument invoking the 14th Amendment, since the age limit would be higher than the age of majority, but that is a separate issue from state's rights and the 10th Amendment.  And that can potentially be challenged in court, albeit as a VERY uphill battle.

Thus, this bill is likely to pass, unfortunately.  Write your Congresscritters and convince them to oppose it.  And point out all of the other things they can do instead:

• Raise the federal cigarette tax, apply it to the producer level, and set a national price floor to discourage interstate smuggling.
• Create a federal vape products tax on all nicotine-containing vape juices and pods, ideally proportional to nicotine content.
• Ban fruity and candy flavors in any nicotine-containing product.
• Cap the nicotine content of vape products down to European and Israeli levels.
• Give out free nicotine patches, gums, inhalers, etc. to any smokers who want to quit (NYC already does this.)
• Consider gradually phasing down the maximum allowable nicotine content of combustible cigarettes to a non-addictive level.
• Consider gradually phasing out menthol cigarettes like Canada did and the EU is in the process of doing.
• And last but but not least, enforce existing laws better in terms of the current 18 age limit for tobacco and vaping products.  In fact, amend the Synar Amendment and Program to raise the passing grade for retailer compliance checks from the currently low bar of 80% to 90% and then 95%, and include vape products.  

But do NOT raise the age limit any higher than 18.

We Hereby Excommunicate JUUL Labs

(Editor's Note:  Twenty-One Debunked has never been affiliated in any way, shape or form with JUUL Labs or any other vaping, tobacco, alcohol, or cannabis company.  And we never will be, either.)

Dear JUUL Labs,

Since you were founded in 2015 as a spinoff from Pax Labs, you have always presented yourselves, at least publicly, as the underdog saving the world in the fight against the evil Big Tobacco.  Little did America know that you were about to pull the wool over everyone's eyes and make fools, and then cynics, of us all.

Why do we hate thee, JUUL?  Let us count the ways:

• You loudly proclaimed yourselves as the enemy of Big Tobacco, but you began to copy their playbook awfully quickly in terms of advertising to young people and cynically attempting to implement your own "anti-vaping" progams in schools. (You claimed that was just an oversight.)
• You chose a much higher nicotine level for your products than other vape brands, by far.  That was most likely to try to edge out the competition, and it worked--at the expense of a new generation of nicotine addicts, that is.
• You lowered your nicotine content when selling in the European Union and Israel (who by law set the maximum allowable nicotine content of vape products much lower than the American version of your products), but curiously still do not offer such reduced-nicotine products in the USA, or any nicotine-free products.
• Until very recently, you failed to adequately warn users that your products contain nicotine and are addictive.  Many young people did not even know that all JUULs contain nicotine, let alone such a high level of it.
• When the FDA finally blew the whistle on you, you responded in the most cowardly way possible.  You decided to throw young adults under the bus by calling for the age limit for vaping products to be raised from 18 to 21, and you banned 18-20 year olds from your website.  And you still made no significant changes to your highly-addictive products, save for the removal of a few flavors.
• And worst of all, you literally SOLD OUT to Altria Group (aka Philip Morris), whose name is literally synonymous with Big Tobacco.  You know, the evil industry you once claimed to be fighting against?  Your deal with the devil may have made you richer and bought you some temporary protection, but everything comes with a price, and your day will come very soon.

Thus, in light of the above grievances, we hereby excommunicate you.  Here is your bell, book, and candle, you cowardly quislings.  Now go take your crack nicotine and shove it!

What's The Best Way To Reduce Teen Vaping? Teens Already Know The Answer

As bewildered chronological adults wring their hands and scratch their heads on how to best fight the teen vaping "epidemic", a recent article came out in Utah that actually asked teens themselves how to do it.  The answer was simple:  tax the hell out of it to make it more expensive.  Gee, who woulda thunk it?

Notice they did not say anything about raising the age limit, by the way.   America's experience with combustible cigarettes has shown that raising the price, via taxes or otherwise, seems to be the most effective and cost-effective way to do it.  And while it works for all ages, the effect size is larger for young people since they are more price-sensitive overall.

Of course, if vape taxes are raised, care must be taken to also raise combustible tobacco taxes so as not to inadvertently steer young people back to smoking.   And as long as vaping remains an available alternative, cigarette taxes can go much higher than they are now (except New York) without creating too much of a black market.   Thus vape taxes should go up, and cigarette taxes should be even higher still.  And only nicotine-containing vape juices and pods should be taxed significantly, ideally proportional to nicotine content.  (Hardware devices themselves should only be taxed modestly, if at all.)

Other effective measures we have noted include capping and reducing the nicotine content of vape products down to European and Israeli levels (JUUL, we're looking at YOU), strictly enforcing the 18 age limit on vendors for all tobacco and nicotine products, and perhaps also removing kid-friendly fruity flavors of nicotine-containing vapes from the market.  But raising the age limit any higher than 18 should quite frankly not even be considered.   Too bad Utah is now the latest state to NOT heed that last bit of advice.