There’s more elephants in the room or on contemplating the new user red herring.

Forgive the proliferation of other life forms in this title (and post) but it seems that whenever nicotine or tobacco are discussed, we end up wading knee deep through a bog of misinformation and ANTZ (thank you again Kristin Noll-Marsh for this most appropriate acronym for anti-nicotine and tobacco zealots). So we end up talking of caffeine and automobiles and unlike most other health related topics having to dress the discussion in children’s clothing so as not to enrage or offend.

Some time ago, Elaine Keller wrote in these pages about the nicotine as self medication elephant. But it is just one out of this herd thundering about and for the most part ignored by diligent and blinkered prohibitionists. One of the other pachyderms is that nicotine use is just another human behavior and a particularly popular one if history is a guide (and shouldn’t history constitute better evidence than utopian (or is it dystopian) fantasies?). But the tusker today is one that even many pro-THR activists and vaping communities are not talking about.

This elephant is the likely increase in the numbers of never before nicotine users trying snus or vaping.

From the ANTZ side this seems worse than smoking. After all, the promise of low risk nicotine use can only result in more people trying it and more people staying with it. Once health risks are no longer a sticking point, it won’t matter if the nicotine using proportion of the population goes up or down (as Carl Phillips has pointed out time and again, the economics of the case are that when you lower the cost of something, in this case the health risks, consumption will increase).

From their point of view nicotine use is intrinsically bad and any associated health risks are a side issue. We know this because if they did care about health risks they would be agitating for THR on every street corner.

But to the point at hand.

The central hope of THR is that low risk nicotine use supplants smoking. Currently more smokers than ever are switching and this is good. Every survey of vapers seems to come back with a result that implies that almost every vaper is an ex-smoker or a smoker trying to quit. Snus users (outside of Sweden) seem to be more of a mixed bag but the proportion of switchers seems to be getting larger there as well.

And if there is one thing both camps agree on, nicotine is not for kids.

But here’s the thing. The presaging of victory will be when we see more would be nicotine users starting with these products. ANTZ will be up in arms but if we accept that nicotine use is with us for the foreseeable future then only once initiation is typically with low risk products will that future be a better one.

Right now, vaping is almost considered as a post-smoking activity. While it is great that smokers have switched, isn’t it a little odd that smoking be thought of as a precondition for vaping? Should you be allowed only to vape or snus if you have first exposed yourself to a high risk nicotine delivery system? Should we only let you use seatbelts after driving for a while without?

No.

When you think that very little smoking will expose you to the same total risk as a lifetime of low risk nicotine use, you should be glad to see an uptick in new users. It is the only way that the transition to low risk nicotine use being dominant will occur.

And that is why, and we have already discussed this point often enough, low risk alternatives need to be at least as accessible as cigarettes. If someone (old or young) is about to try nicotine for the first time, that choice should not be weighted, as it now is, toward the one choice that might have serious consequences. As we have already seen in Sweden, once safer alternatives are both accessible and socially acceptable, cigarettes can become the less favoured option. The would be smoker turning instead to snus or e-cigarettes is not only virtually eliminating any health risks but is also making it more likely others will do the same.

We need to reach that tipping point.

(Just a note for the ANTZ: you can only ignore elephants for so long. Once you factor in the size difference, safety in numbers no longer applies.)

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Comments

  • TK  On October 13, 2011 at 12:32 pm

    Excellent post

  • Thad Marney  On October 13, 2011 at 12:52 pm

    Even if e-cigarettes someday become popular among never-smokers, there is no reason for a non-smoker to use nicotine unless you are suggesting that there are some BENEFICIAL effects of smoke-free nicotine? ANTZ insist that nicotine is not beneficial and that people who think otherwise are just junkies trying to justify their addiction…either they are lying or there is absolutely no reason that a never-smoker would use e-cigs with nicotine. Either way, without the habit forming MAO inhibiting alkaloids in whole tobacco, there is no evidence that nicotine-only products like e-cigarettes and NRT can cause addiction.

  • Kristin Noll Marsh  On October 13, 2011 at 1:21 pm

    True, Thad, nicotine has the same or more benefits as caffeine – another brain altering chemical that is more socially acceptable. If one low-risk chemical is ok, why isn’t the other? Of course, the other day I read that some are trying to say caffeine is a possible gateway drug to cocaine or amphetamines! (Will they ever stop??)

    When confronted with the concern that “kids will try these and get hooked on smoking,” all I can say is that any kid (or other current nicotine non-user) interested in these would most likely have been otherwise interested in traditional cigarettes, so eliminating e-cigarettes would leave them only the more dangerous option!

    Additionally, arguing that e-cigarette use will lead to smoking actual tobacco would only make sense if e-cigarettes were made to taste just as foul and make you feel just as lousy! If I had started vaping my sweet, Mochaccino-flavored e-cigarette before smoking, I couldn’t imagine it leading to nasty-tasting tobacco anymore than someone drinking Mogen David would suddenly have the desire to drink cooking sherry! (Unless they banned the Mogen David or made it 10x more expensive than the cooking sherry!)

    Then again, the ANTZ are now saying there’s a risk that Pepsi drinking will lead kids to free-basing crack, so how do you deal with that kind of logic??

  • westcoast2  On October 13, 2011 at 2:17 pm

    Vapers certainly do not allow elephants to stomp around. Over at UKV we had a lively discussion on this (http://ukvapers.com/topic/2268-vaping-for-non-smokers/)

    At one point I asked the question “Are you suggesting we need to wait until someone has become a smoker to then be able to suggest vaping to them? ”

    Some still said “yes” though recognised it was not as straight forward as it seems.

    Nicotine itself may have benefits. The problem, of course, for the neo-prohibishionists is that once that is admitted it undermines the anti-tobacco/nicotine campains.

    It does seem the neos are slowly being exposed for there lack of concern about health.

    From my standpoint I believe that presenting people with acurate information is far more beneficial than coercion or denormalisation.

    • Paul  On October 13, 2011 at 2:27 pm

      Thanks for that link which has already given me a few ideas for a followup post!

      When talking to the not-ex-smokers considering vaping, vapers are almost in the same position as parents who used to do drugs (and loved it) answering their kids questions. You know that for you it was the right choice, your life is the richer for it but it seems kind of strange to just say “go ahead”.

  • Jim Rothenberger  On October 13, 2011 at 9:37 pm

    Thank you Paul. I have been stating that fact, once in a while, very tentatively when comments are made about banning their use by minors. If I had a child that decided to use tobacco, I’d certainly be encouraging them to either not or to try just about anything other than smoking. Once they start, it may be years or decades before they stop. It’s still about peer pressure, convenience and price in the beginning and cigarettes win in a lot of the scenarios.

    I’ve seen little luck in getting 20 somethings to select anything other than cigarettes as their tobacco products. They my try an e cig for a bit, but generally move back to smokes fairly quickly. Hopefully the hardware will improve and become more affordable to encourage the switch earlier.

    • Paul  On October 13, 2011 at 9:51 pm

      Exactly. I was thinking of adding a little aside about preferring my daughter if she should decide to try nicotine that she would be as likely to use snus or ecigs, The big problem is that any attempt to make these alternatives competitive in the interests of better health is interpreted as marketing to kids.

      Once people decide to use a substance they tend to use whatever is available and affordable and only when those conditions are met do they start thinking about which one is healthier.

  • Alan Selk  On October 14, 2011 at 1:01 pm

    Something forgotten in this is that in Sweden, where snus is readily available, there are many people who start by using snus and never smoke. Availability has a lot to do with it, but also the public at large is better educated as to the risk factors of snus verses smoking, though even Sweden has their ANYZ. I would assume there are a few kids in the US experimenting with the bastardized (I mean americanized) snus, and getting some benefits from it they are liking. So be it. Either we get rid of all tobacco (not going to happen except in some ANTZ fantasy world) or we educate the public as to the risk of different types of tobacco/nicotine. It’s for the individual to decide what they want to do with the information.
    Of course a rational taxation policy would also be a big help. I live in Wisconsin that has the highest smokeless tobacco tax rate in the country. As far as money goes I might as well smoke.

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