Sales data reported by PiperJaffray for the four weeks ending October 20 (when the Massachusetts emergency ban was in effect for 25 of the 28 days) and the four previous weeks (mostly before the ban went into effect) were compared to sales data for the previous year. The PiperJaffray analysis revealed that there has been a substantial shift from vaping to smoking in the state. This indicates that as I predicted, ex-smokers in Massachusetts who were reliant on e-cigarettes to stay smoke-free are now returning to smoking in large numbers.
Nationally, there was very little difference in the rate of decline in cigarette sales between these two time periods from 2018 to 2019. The rate of decline decelerated by 0.3 percentage points (from -7.8% to -7.5%). However, in Massachusetts, the rate of decline decelerated by a massive 5.7 percentage points (from -9.8% to -4.1%).
Another way of expressing this is that in September 2019, national cigarette sales were 92.5% of what they were in September 2018, and in October 2019, they were 92.2% of what they were in October, 2018. Thus, there was little change in the rate of decline.
However, in Massachusetts, while cigarette sales in September 2019 were 90.2% of what they were in September 2018, in October 2019, they were 95.9% of what they were in October 2018, a substantial lowering of the rate of decline in cigarette sales.
The Rest of the Story
What these sales figures mean is that the emergency ban on the sale of all vaping products in Massachusetts has resulted in an increase in cigarette consumption, most likely due to large numbers of vapers going back to smoking.
Because cigarette consumption is roughly linearly related to smoking-related disease and death, this means that unless the state reverses course, the vaping products sales ban is going to result in a substantial increase in disease and death.
The state is justifying causing this known harm to the public's health based solely on pure speculation that although 90% of outbreak cases admit to vaping THC purchased off the black market, store-bought e-cigarettes are causing a substantial proportion of these cases. This assumes that the 10% of case patients who didn't report using THC: (1) know exactly what the ingredients were in the products they used even though the vapes may have been given to them by friends or purchased off the street or the internet; (2) know that the products are not counterfeit or tampered with; and (3) are not under-reporting their THC use even though we know that a huge proportion of youth who present in emergency rooms do under-report their THC use to physicians.
These known negative health consequences are also occurring in the absence of any documentation that a substantial proportion of confirmed case patients who reported using nicotine-only products tested negative for THC in a urine drug screen.
And furthermore, these known adverse health outcomes are occurring without any finding that a single nicotine-containing e-liquid sold by a retail store was contaminated with a chemical that could be causing the respiratory failure observed in outbreak case patients.
The principle tenet of all public health practice is "Do no harm." As a central principle, we try to avoid doing known harm to the public's health. In this case, states that are banning e-cigarettes (or flavored e-cigarettes) are violating this principle because they are knowingly causing substantial harm to the public's health while producing no known benefits in terms of helping to curtail the outbreak. And, on top of this, they are likely going to make the outbreak worse.
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