The head of the U.S. Food and Drug Administration declared on Wednesday that vaping is an epidemic among teenagers and vowed a severe crackdown on manufacturers and retailers if they don’t severely curtail sales to minors.

“The disturbing and accelerating trajectory of use we’re seeing in youth, and the resulting path to addiction, must end,” Dr. Scott Gottlieb said in a statement.

In addition to fines, he threatened to ban all flavoured vaping liquids, and even to deny licences to manufacturers if the rate of teen vaping does not decline sharply in the coming months.

In May, Canada adopted its first legislation to regulate vaping, the Tobacco and Vaping Products Act. Marketing to youth is banned but, unlike the U.S., there has been very little active promotion of vaping in this country, let alone branding.

Dr. Gottlieb’s tough talk is particularly notable because he has a reputation as vape-friendly, supporting the use of e-cigarettes as a smoking cessation tool. The US$5.5-billion market should heed his warning.

According to media reports, e-cigarette use among U.S. high-school students has jumped 75 per cent in the past year, fuelled by youth culture’s embrace of “juuling.” (Teen smoking rates have also dropped, but only marginally.)

Juul, an e-cigarette that looks like a USB flash drive, dominates the U.S. market with about 70 per cent of sales, and it is enormously popular with young people.

Juul only became available in Canada (at least officially) this month. But the actions of the U.S. regulator will definitely have an impact here.

Vaping poses a number of difficult dilemmas for public health officials. It is definitely safer than smoking. The harm from tobacco comes from its combustion, and ingesting all the chemical by-products in the smoke. But it’s the nicotine in cigarettes that’s addictive.

Vaping delivers nicotine without all the other nasty stuff and nicotine, in itself, is fairly benign.

So if smokers of cigarettes switch to e-cigarettes, it’s good for smokers and a win for public health. But if non-smokers, such as teenagers, take up vaping, that is not a good thing. It creates new nicotine addicts.

And the real unknown is what they will do in the long term. Will they continue to vape? Or will they replace/supplement their vaping with cigarettes to get their nicotine fix?

That’s why Dr. Gottlieb is bringing down the boom on e-cigarette companies who have not-too-subtly made their products attractive to young people with their candy flavours, use of celebrities and a hipster vibe.

Juul is under investigation by both federal and state authorities in the United States for marketing to youth, but whether that was deliberate or accidental is a source of much debate. Regardless, the company has turned increasingly to promoting the product as a smoking cessation tool, though that may not be dissuasive for teens.

That’s because a lot of young people are juuling ironically – using a seemingly health-promoting product as their not-so-secret vice.

We should not forget either that a significant minority of young people – about 15 per cent – still smoke even though, technically, they can’t buy cigarettes. An even greater percentage smoke cannabis regularly.

If they vape flavoured liquids – or even pot – that is still better than smoking.

The real striking part of Dr. Gottlieb’s statement was his repeated use of the word “epidemic.” He said he was using that word “with great care” to underscore the “ubiquitous and dangerous trend” of teen vaping.

But that kind of hyperbolic language is not helpful. Vaping is, technically, an epidemic among young people – meaning it is growing at a rapid rate.

But for the general public, “epidemic” tends to imply a deadly threat. Teen vaping is no such thing.

It is currently a nuisance, especially for school administrators and teachers, as young people like to push the boundaries by juuling in school bathrooms and even classrooms.

It is wise for the FDA, a health regulator, to ensure potentially harmful products like e-cigarettes are not marketed to young people. Health Canada would do well to take a similarly aggressive stand.

But at the same time, we should be careful not to succumb to vaper madness.

For all we know, this may be just a passing trend, and teens will soon enough find a new way to torment their teachers and parents, and befuddle public health officials.

Health Columnist
The Globe and Mail, September 12, 2018