Vaping and Gaslighting

The Washington Post recently published an editorial expressing concern about vaping.

This should not be surprising.

Public health efforts to reduce smoking have been aided by regulation and social norms that limit the times and places that smokers can smoke. Further, those regulations and norms not only limit tobacco use, but also make it less pleasant by isolating smokers and putting them outside, often in cold, hot, or wet weather. Additionally, the nature of smoking makes it very difficult to do inconspicuously in places it might be prohibited or discouraged. (None of this even considers the effects of cost increases attributable to taxes.)

When I started working in addiction treatment, most treatment admissions consumed 1 to 2.5 packs per day. Today, anecdotally, the norm is more like 0.5 packs per day.

On the other hand, vaping is often done constantly throughout the day. The minimal odor of many varieties allows it to be done in bathrooms, restaurants, meeting spaces, etc., with limited risk of detection or confrontation.

This means that nicotine addicts who had previously been limited to smoking a few times during a work day, or who had to go outside at home, are now able to vape all day every day.

Additionally, vaping allows for previously unseen concentrations of nicotine and levels of potency.

My kids are 19 and 17, and they have been reporting out of control vaping since middle school. My daughter reports that the bathroom is referred to as the vaping room, and that’s pretty much what it is. She also reports kids vaping in class when the teacher has their back to the kids.

I imagine we’re going to see levels of nicotine addiction we’ve never seen before.

What does that kind of nicotine addiction look like? I don’t know. It could be no worse than what we’ve previously known, or it could be a whole different animal.

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Another area of concern is the innovation of vaping.

I am reminded of a talk by Bill White on drug trends. Someone asked about emerging and future major drugs of misuse. He responded by saying something like, “I can’t tell you what the major drugs problems of tomorrow will be, but I can tell you that they are already here. Someone will come up with a new way to prepare or consume them and it will transform the relationship between the user and the drug.”

To illustrate his point, he pointed to the impact of the syringe on opioid use. Prior to the syringe, opium was a consumed by chewing, smoking, or tinctures. Then the hypodermic syringe was developed. Then people figured out how to prepare morphine and heroin for injection. This transformed the relationship between users and the drug.

The other example he offered was cocaine. Prior to the 1980s, cocaine was thought of as an expensive weekend party drug. Freebasing was method with the highest risk of chronic and problematic use, but the complexity and dangers of that method, along with the cost, limited its adoption. Then, people figured out how to prepare and sell it as crack cocaine, offering a cheap and easy freebase experience available to large numbers of users.

These innovations transformed drug use and the public health landscape for more than a century in the case of the syringe, and decades in the case of crack.

Will vaporizers, as a technological innovation, play an important role in future drug crises? I don’t know, but I suspect the chances are pretty good that vaporizers will play a role in some substance becoming a larger and more serious problem.

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So . . . where does “gaslighting” come in?

Since vaping was introduced, concerns about vaping have been met with condescending scorn by public health advocates and others. The argument is that vaping is safer than smoking, and may provide a path to smoking cessation.

I have little doubt that vaping is safer than tobacco AND smokers switching to vaping probably represent a minority of people presently vaping.

To be sure, there are people who hype and distort the risks and bring a drug war mentality to an issue like vaping. These people should be challenged and their misinformation should be corrected.

Yet, I see routinely see people confidently assert that vaping is, on balance, good for public health and that any significant regulatory or statutory intervention is likely to do more harm than good. To me, this seems unknowable, and I’m suspicious of anyone making these claims.

The gaslighting comes in because people who express concern are often caricatured as operating from ignorance and (often unconscious) puritanical desires to control others and deny pleasure.

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Maybe vaping is a fad that will fade away. Maybe it’ll stick around and have few lasting public health consequences. Or, maybe it’ll produce a new kind of nicotine addiction with earlier onset, higher dosing, higher potency, and unusual levels of habituation. OR, maybe this period is functioning as R & D—developing the tools for a future drug crisis.

I don’t know. And, I don’t know what the best policy responses might be. But, I believe it’s worthy of serious discussion.