R.I.’s harm-reduction hypocrisy harms public health

Government decisions and inconsistency tend to go hand-in-hand. Unfortunately, Rhode Island is not immune to this problem. That’s particularly true with harm reduction policy. Harm reduction is about minimizing the risks associated with certain behaviors, such as drug use, rather than insisting on policies that prohibit substances or only abstain from them.

Simply put, Rhode Island lawmakers are adopting laws that “meet people where they are” regarding cannabis and opioid use – but are taking a retrograde prohibitionist approach to nicotine use. By limiting people’s access to reduced risk nicotine products (RRPs) – such as Electronic Nicotine Delivery Systems (ENDS) which includes e-cigarettes and vapes – lawmakers are unintentionally contributing to more people smoking combustible cigarettes, and dying as a result.

Recent research from the R Street Institute highlighted this mind-blowing inconsistency. Rhode Island, to its credit, is on the cutting edge of harm reduction policy for opioids and other illicit drugs because it treats the issue primarily as a public health concern rather than a law-enforcement one.

The state was an early adopter of policies to authorize syringe service programs shown to dramatically reduce infectious disease transmission among drug users. It has also legalized drug-checking equipment to help individuals test for adulterants like fentanyl and xylazine, substances which greatly increase overdoses. The state was the first in the country to adopt a statute authorizing overdose prevention centers, which provide a safe space for people to use illegal drugs – purchased elsewhere – under medical supervision.

If Rhode Island raises the cigarette tax, will smokers quit? Not really.

Even though the state has been slower to adopt policies reducing harms associated with cannabis, it has made positive progress by legalizing medical cannabis in 2006, and recreational cannabis in 2022. Legislators understand that abstinence isn’t a viable strategy for many users of opioids and cannabis and that these individuals need access to tools and resources to protect their health. However, this same mindset doesn’t extend to smokers, whose access to RRPs like e-cigarettes has been continuously limited.

To put it plainly, Rhode Island has failed to embrace tobacco harm reduction, and it’s advancing proposals that undermine efforts to shift smokers towards RRPs. In 2020, the state banned flavored tobacco products. That serves also as a de facto ban on vaping given that almost all vaping products use flavors.

This session, H 7225, includes provisions that would impose the current 80% tax on wholesale price for e-cigarettes. Also, the bill would ban all ENDS flavors besides tobacco. While this is promoted as advancing public health, it undermines adult smokers’ efforts to quit combustibles for safer alternatives by decreasing flavor options and increasing the costs to obtain them.

Compared to smokers who inhale 7,000 chemicals and over 70 toxic carcinogens when using combustible tobacco, e-cigarettes lack these chemicals and are 95% safer than traditional cigarettes. It’s foolish to keep the most dangerous products legal while limiting access to safer ones.

Rhode Island legislators should follow the lead of public health officials including the National Academies, U.S. Food and Drug Administration, Public Health England, and Royal College of Physicians who assess nicotine products based on risk. Combustible cigarettes impose the highest degree of risk – and non-combustible products like vapes, and oral nicotine pouches carry much less risk. Moreover, these products are safe and effective options for smoking cessation. Reports indicate they are even more successful at curtailing smoking than the nicotine patch or gum.

Additionally, research has found that flavored vapes help more people quit smoking. Flavor selection is crucial for adults attempting to switch to e-cigarettes. Flavored ENDS help smokers disassociate from the tobacco flavoring, which assists them in quitting.

Rhode Island legislators risk increasing smoking-related healthcare costs, which are already $640 million annually. The data is clear: Using harm reduction to mitigate traditional cigarette use will save lives and reduce health-related costs. History is rife with examples of prohibition being a failure–why not try something different and allow adults to make informed decisions that impact their own bodies? It would be a consistent policy to undertake.