Actions by anti-tobacco harm reduction advocates and organizations are “outrageous” and “disgusting,” says Ethan Nadelmann, legendary drugs harm reduction campaigner. Why are the lessons learned in the fight to end the war on drugs ignored in the battle to end the war on vaping?
Featuring:
Ethan Nadelmann Founder & Former Executive Director, Drug Policy Alliance
Podcast Host, PSYCHOACTIVE
@ethannadelmann
Transcription:
00:00:03 --> 00:01:03
Brent Stafford: Hi, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV. Across multiple countries, we are witnessing a widespread puritanical movement that aims to ban safer nicotine products without considering the impact on human life and well-being. It's shocking how quickly things are unfolding with nicotine vape bans in the UK flavor bans in Canada and the U.S., and increasingly irrational rhetoric coming from politicians, academics, and non-profit health organizations. This is happening even though teen vaping rates are decreasing and youth smoking rates have cratered. Joining us today to discuss where this might all be going is Ethan Nadelmann, the founder and former executive director of the Drug Policy Alliance and host of the podcast Psychoactive. Ethan, thanks for coming back on RegWatch.
00:01:03 --> 00:01:05
Ethan Nadelmann: My pleasure, Brent. Happy to be back on.
00:01:06 --> 00:01:17
Brent Stafford: Ethan, since the 1980s, you've played a key role in the global battle for drug policy reform. Tell our audience about that battle and the impact of the war on drugs.
00:01:18 --> 00:03:55
Ethan Nadelmann: Sure, Brent. I mean, well, you know, I first got involved in this drug issue 40 years ago when I started, when I initially started studying the internationalization of U.S. international drug control, of U.S. drug control. And did it first as a Ph.D. and it was writing and speaking about as an assistant professor. But that obviously got me very interested in the issue of drug policy itself, which was a backwater issue in the early 80s when I got started. but by the time I had finished my PhD in 87 and started teaching at Princeton, the drug war had become the number one issue in American public opinion, and we were in a drug war craze, what I would call a sort of McCarthyism on steroids, where everybody was getting absolutely crazy about drugs and the drug war for some understandable reasons, the spread of crack cocaine and all of that, but it went far beyond that, and it was both a domestic and international issue. you know, I published some articles saying this is crazy, that the war on drugs is probably doing more harm than drugs itself, and that we need to move down the spectrum away from harsh punitive prohibitionist policies towards policies that embrace public health, harm reduction, decriminalization, science-based policy, and human rights. And at that time, that was a highly controversial opinion and a very polarized discussion. But over the years, things began to evolve, you know, and after, uh, In 1994, I left Princeton and started up an organization called the Linda Smith Center, kind of a policy and research institute. And after a few years, that merged with another organization called the Drug Policy Foundation to become the Drug Policy Alliance, which I built into the leading organization in the U.S., and really the world, advocating for alternatives to the war on drugs. And I think as many of your listeners will be aware, I mean, the war on drugs really is this combination of these hyper punitive policies that involve high levels of arrest and incarceration and long sentences together with an abstinence only ideology that basically says that anybody who uses these drugs needs to be treated as a criminal, needs to either be incarcerated or at best coerced into treatment. That it doesn't matter whether you have a problem with these drugs or not, it doesn't matter what the evidence says, you merit punishment. So those two elements, the kind of hyper punitive criminal justice policies together with the embrace of an abstinence ideology really characterize the drug war, especially in the US, but to some extent globally as well.
00:03:56 --> 00:04:17
Brent Stafford: Now you're one of the godfathers of global drug policy reform with Jerry Stimson, Alex Wodak, Pat O'Hare. And Jerry is one of the founders of the Global Forum on Nicotine and along with Alex Wodak have been on RegWatch many times. How is it that drug harm reduction advocates became tobacco harm reduction advocates?
00:04:17 --> 00:10:48
Ethan Nadelmann: Because it just makes sense, right? I mean, harm reduction, the phrase begins 40 odd years ago, probably in the Netherlands, when people begin to realize that HIV AIDS is being spread by and among injecting drug users, not because needles are inherently causing AIDS, not because drugs do, but because consumers were sharing infected syringes, right? And so the simple harm reduction approach says, look, we would prefer these people just stop using, but until they are able or willing to stop using, let's keep them from contracting this deadly disease for which we have no cure. And that meant clean needles instead of dirty needles. That was the origins of harm reduction. And then it begins to spread more broadly out there in terms of, for example, methadone maintenance, not just in a, in a very strict thing, but in a more inclusive environment, more easy access one. It meant things like safe injection sites. It meant things like heroin prescription programs. It meant doing drug education, like sex education, where you try to keep kids from getting involved, but if they do, you have a fallback to keep them safe. It meant teaching drug users how to inject drugs safely and avoid getting infections. It meant a kind of approach of meeting drug users where they're at. There's traditional drug treatment. It said, we can't help you unless you're willing to stop first, and then we'll try to help you. And harm reduction flipped it around and said, we want to help you get your life together, whether or not you're using drugs. And then let's look at dealing with your drug use in that context. So meeting the user where they're at. Also, the core idea that became more popular is harm reduction gained credence of like an international gathering. So the slogan became, nothing about us without us. That was, I think, chanted by the Act Up activists who were really the pioneers of some early harm reduction. And I think it became embraced in that way. So with all of those reasons, when you look at why Pat O'Hare, who founded, Harm Reduction International, which at its origins in 1990 was known first as the International Harm Reduction Association. When you look at his successor, Jerry Stimson, who was a very distinguished drugs and AIDS researcher at the University of London back in the, I don't know, about the 70s, but certainly the 80s and the 90s when he became Pat's successor. You look at Alex Wodak. I oftentimes joke that, you know, I'm the Alex Wodak of America or he's the East End Edelman of Australia. But, you know, we're kind of the early leaders on drug policy reform and And I'd even probably include somebody from Canada, people like David Sweenor, who had some connection to this issue, or Mark Tindall from Western Canada. It's like, my God, here are people consuming drugs in a very dangerous form, right? So with illicit drugs, it meant using dirty syringes, or using drugs of unknown potency or purity, or using them in unsafe conditions, right? So here, but we also know that harm reduction applied, for example, with respect to bicycles and motorcycles, that wearing helmets when you play contact sports or when you ride a bicycle or motorcycle, that's harm reduction. Seatbelts are harm reduction. All the sorts of ways, teaching sex workers how to deal with problematic clients and how to keep from getting either pregnant or getting disease or getting exploited or physically harmed. all types of harm reduction, all ways of trying to reduce the negative consequences of drug use or any other potentially harmful or risky activity, trying to reduce those harms and risks by and among those people who are unable or unwilling to stop doing so, stop engaging that activity now. And that meant both as a personal intervention, but it also meant as a broader societal intervention. looked at it that frame, tobacco harm reduction was a no brainer. The real challenge was that the amount of harm, you know, for us, harm reduction oftentimes meant in the early years, get people to smoke less, you know, that reducing from one or two packs a day down to becoming, you know, three, four or five cigarettes a day. or to becoming a quote-unquote chipper. You know, chipper is an expression that came from the illicit drug world. It referred to people who used heroin, but were not addicted to it. People used heroin occasionally, which many people thought was impossible, but then it turned out there were many people doing that. And then the same thing turned out to be true with cigarettes. You know, there were a small number of people who are chippers, people who don't smoke every day, but we've seen the evidence show that there's an ever-growing number of people who use cigarettes not on a daily basis, right? Or who may... vape most of the time, but they'll use the occasional cigarette if they're in social environment or who don't even vape, but may do it that way. So harm reduction initially meant to us reducing the amount of smoking. Right. And we were wary when big tobacco, you know, you know, push the whole notion of low of high of low nicotine cigarettes or, you know, because of their sordid history as promoting, you know, low nicotine cigarettes or promoting the filters as major harm reduction things. When it turned out, they really didn't reduce harm and sometimes even made things worse. So we were wary, but that's what it meant. And really the only thing that was out there, to some extent, were the new oral nicotine products, especially Snus from Sweden, which, you know, the nicotine pouch, which had played such a monumental role in Sweden achieving the lowest smoking rate in the world among men, because men were the ones who took it up. So I was aware of harm reduction, and Brad Rodu, an early American researcher, was one of the champions of this, and he had, I think, reached out to me over 20 years ago. So I paid attention to this issue. But if you look at Pat and at Jerry and at Alex, we all just simply got it on an instinctive level. It was like, duh, of course. And then, of course, switching from smoking to snus was a good thing. Of course, these other things, yes, those were good things. And then of course, with the explosion in the number of harm reduction devices available in the last 10 years, and especially as we become much more easier access, the opportunities have grown in a very, very substantial way.
00:10:51 --> 00:11:18
Brent Stafford: Ethan, we spoke with you last in 2021 in London at the Global State of Tobacco Harm Reduction event, but you first appeared on RegWatch at a very auspicious time. It was December 2019, just months after the so-called vaping-related lung illness touched off a disastrous moral panic, not just in the US, but in Canada and other countries around the world. I've pulled some sound bites from that episode. Let's have a listen.
00:11:20 --> 00:12:56
Ethan Nadelmann: We're doing with e-cigarettes right now, right? What happened with all the other illicit drugs in the past with disastrous consequences? I think there's a decent possibility that we could be witnessing the beginnings of the first great drug war of the 21st century. And it's going to be a drug war that is going to start off with e-cigarettes, and then it's going to turn to cigarettes themselves. Once you start banning things, You know, which I mean, that's what we're doing now. When you start banning things and making it illegal to possess or to sell or whatever these things, Inevitably, you have to start enforcing those bans, which means that inevitably the police start to get involved and inevitably the prosecutors start to get involved. And so I think it's a decent chance that we're going to see people not just getting arrested, but even going to jail for violating the laws against vaping. You're going to see people, you know, who essentially are trying to protect their health in a harm reduction way that's proven by science by switching from smoking to vaping. You're going to see those people and the people who supply them and market to them being arrested. And I have to tell you, it reminds me of what happened with needle exchange. where people who are trying to distribute sterile syringes to reduce the spread of HIV, you know, among injecting drug users, were being arrested and incarcerated and prosecuted. I mean, it is from both a public health perspective and a moral perspective, absolutely horrific.
00:12:58 --> 00:13:05
Brent Stafford: When you look at the scope of what's happening today in 2024, how accurate is that prediction from four years ago?
00:13:06 --> 00:16:05
Ethan Nadelmann: Well, I mean, you know, it's hard to say. We're still not seeing a lot of arrests. You know, you see the occasional stories pop up in the news about, you know, some, you know, young people. I saw, you know, some young kids, black kids walking along the boardwalk in Maryland and cop tells them to put out their vape and they kind of laugh and then they get arrested. Or you see other stories like that. I remember a couple of years ago when, um, Duterte was still the president of the Philippines, and they launched a crackdown where they started arresting people for vaping. So you're still seeing occasional things. You're also seeing a lot more punitive policies, I think, happen in schools of young people who are vaping being suspended, being punished in various ways. And that's probably where we're seeing more of the harms result right now. What I don't know is how many people are losing their jobs. Remember, some of this is about the criminal justice system. and the other parts about punitive aspects of what might be called the civil or broader system, like people losing jobs, people being kicked out of school, people being otherwise sanctioned, kicked out of their housing, apartments, what have you. So I think those sorts of things are probably growing around the world. Now, it's also true that when you look, for example, at the bans on selling vapes that are anything other than tobacco flavored in the United States and other countries now. What you're seeing is there's now a huge kind of unregulated market in these disposable vapes, not being produced by big tobacco, being produced by companies, smaller pop-up companies, sometimes not the most reputable credentials with relatively little in the way of enforcement. Reminds me a little bit what's happening in the cannabis market. with all the spread of unlicensed shops in New York and California and a range of other places. So we're going through a phase now of huge gray markets, maybe even illicit markets, where there is not a huge crackdown effort. But it does seem to me only a matter of time until we see those sorts of enforcement approaches and other punitive approaches begin to escalate in the US, in Canada, in a range of other countries. Mexico is another place where most of this stuff is prohibited, but there's very little enforcement to date. But at some point, it starts to emerge. And then those places where police corruption at the low level is much more common, you can see the police start to see it as an opportunity to extract bribes from people they pick up by threatening them with arrest for possessing a vape like they would do with a joint unless the cops get paid off. So I think we're headed down a somewhat slippery slope to greater and greater criminal justice and their putative consequences regarding this market and possession of harm reduction devices.
00:16:06 --> 00:16:45
Brent Stafford: So let's take a look at the UK. They have just, you know, are in the process of implementing a disastrous ban on disposables. No matter what you think of that, the fact is, is that they're the most popular device and they work, you know, to the extent that there's a lot of access, they're ubiquitous everywhere, they have flavors and it's usually high nicotine content. So how is it that a country like the United Kingdom would be able to remove millions and millions of disposables from the marketplace without it completely totaling, exploding into a black market?
00:16:46 --> 00:18:44
Ethan Nadelmann: Well, you know, look, there are black markets where the government gets very involved in enforcement to suppress it, like with heroin, cocaine, things like that, fentanyl. And then there are black markets where they sort of look the other way, at least for a while. So I don't know. I mean, I'm obviously very disappointed that the UK, which has been such a global leader in embracing and advancing tobacco harm reduction and including it in a prominent way among the tobacco control policies, is doing that. Now, that said, I think the world is better off to the extent people are vaping. I think the world is better off, generally speaking, to the extent we're not using disposables, to the extent we're using the rechargeable ones. I think it's probably better and certainly better from an environmental perspective first. Secondly, it's probably that the quality of the rechargeable ones, especially when they're being produced by some of the bigger companies that have to meet the scrutiny of in the US FDA and others are probably of a higher quality in terms of health safety than are some of these disposables. But that said, that means not that we should be banning the disposals, it means ideally that one should be orienting policies towards favoring the non-disposables over the disposables. In the same way that most of us involved in tobacco harm reduction are in favor of having one set of policies for combustible tobacco products, and then having other set of policies with respect to lower taxation, fewer regulation, easier access, for non-combustible tobacco products, nicotine products. Ditto that maybe that's the distinction we should be making between the disposable e-cigarettes and the non-disposable ones. But I think that the UK and other countries that follow this route are setting themselves up for ever-growing and more costly, both in fiscal terms and human terms, disaster.
00:18:46 --> 00:19:13
Brent Stafford: Let me ask you, when we look at this issue, we see a lot of similarities between countries, UK, Canada, the US, even across other countries around the world, that there's a particular type of mentality and tactics that the enemy has, the enemy of vaping. What can you say in terms of similarities and differences that there might be between today's enemy on vaping and the enemy you fought during the war on drugs?
00:19:14 --> 00:26:46
Ethan Nadelmann: Well, I mean, let me just start with a few of the prominent differences, right? I mean, perhaps the most significant one is that when you look at the issue of drug policy reform with illicit drugs, I mean, there are a few elements that are not there with respect to tobacco harm reduction. The first one, of course, is that the drugs themselves have been entirely illegal. I mean, now marijuana is beginning to get legalized. in a growing number of places, and psychedelics is falling behind in a very limited way. But the other drugs are essentially illegal, truly illegal, not just for the trafficking, but even for the possession, except in a limited number of jurisdictions. And at least with tobacco harm reduction, these things are still, they're legal to a greater extent, and tolerated to a greater extent, even when they're unlicensed or illegal. than is true with the illicit market. That's first. Secondly, you don't have the mass incarceration, the mass arrests and mass incarceration, which was a defining element of the drug war in the US and in many other countries as well. We don't have to go through the numbers, but we went from 50,000 people locked up behind bars on drug charges in 1980 to over half a million people by the early 2000s. And the numbers have dropped substantially since then, but it's still very substantial. And meanwhile, the numbers are sometimes growing internationally in that regard. You don't have that yet with respect to tobacco products, with respect to tobacco harm reduction products. The other thing that you had in the drug policy reform area was that the racism and the racial injustice and racial disproportionality in the enforcement of these laws and in terms of the impact was tremendous with respect to illicit drugs, not psychedelics, but the rest of the other drugs, even marijuana. where rates of marijuana use are no higher among black people than they are among white people. And the same might well be true with respect to the other drugs, that rates of use are no higher, only a little bit higher among black and brown people than among white people. So in the tobacco area, You don't really have that. It's emerged as an issue in the whole debate over banning mentholated products. But apart from that, it's not, and you do have higher rates of smoking increasingly among people of color, whether they're Aboriginal people in Oceania or whether it's black people in the US, et cetera, which I think that was higher than the white, I'm not certain, it used to not be. So you don't have that strong element around around racism in this area as yet. Now, in terms of similarities, I mean, the major similarity has been the underlying abstinence-only ideology that drives the opposition to harm reduction. That was very powerful and remains so in the United States and many other countries. The notion that why would you give a clean needle to an injecting drug user to reduce AIDS they need to be absent, they need to be forced into abstinence. The whole notion of drug treatment, that if we're not gonna send you to jail, we're gonna force you into drug treatment, and if you cannot abstain from drugs entirely, we're gonna then put you in jail. That notion, the notion that there's no permissible relationship between a human being, adult or child, and a psychoactive drug apart from non-use, apart from abstinence. So that was a very powerful ideology with respect to illicit drugs, that has now faded a little bit as harm reduction has gained traction. But you see the same thing with the anti-harm reduction forces in the United States, epitomized by the organizations that Michael Bloomberg and his funding entities are supporting. If you look at the Campaign for Tobacco-Free Kids, which was not always dedicatedly anti-harm reduction, but seems to have evolved in that direction. And what you see there is that If you go back to the beginnings of the tobacco control campaigns in the latter part of the 20th century and into the early years of this century, you know, the major focus was to reduce smoking and to reduce the harms associated with tobacco, right? And so both the harm reduction folks in tobacco control and the anti-harm reduction folks in tobacco control were basically one big coherent group, right? But what happened was that with the emergence of all of these harm reduction devices, and also with the significant decline in smoking, what you saw was that the anti-harm reduction forces began to become less and less concerned with the value of harm reduction for current smokers, the 30 million people in the US, the billion one people globally. and more and more concerned with really two things. One was trying to drive a stake through the heart of big tobacco, which paradoxically, of course, their opposition to harm reduction is accomplishing exactly the opposite. It's propping up big tobacco in terms of sustaining their sales of deadly combustible cigarettes, right? And then their second objective really became about abstinence, and abstinence not just from combustible tobacco, but abstinence from all tobacco and nicotine products. It became a form of an ideology as we dealt with in the illicit drug area. And of course the focus then became both to some extent in substance and even more so rhetorically about protecting the kids, everything to protect the kids. If we can save the lives of 10 older smokers by getting them to switch to vaping, but the cost of that will be a handful of adolescents starting to vape and becoming dependent upon vaping. Well, we don't want to make that trade-off. It's all about the kids. And of course, the entire war on drugs was typically justified as one great big child protection act. So in that sense, there's a tremendous resemblance between what we dealt with in the past and what we dealt with now. But what you see so in the resistance to the notion of meeting people where they're at, the resistance to accepting, you know, in policy discussions, nothing about us without us, that the consumers need to be at the table, right? Even as in the harm reduction world, we fought against with some success against the stigmatization of people using these illicit drugs, you know, in the kind of anti harm reduction tobacco world, it's all about stigmatizing people who may use these products. So we see, you know, a tremendous number of similarities as well. And I think also in the sense of seeing the fact that the science overwhelmingly favors harm reduction, both in terms on the individual level, as well as on the broader societal level, But you see the anti-harm reduction folks really kind of cherry-picking the minority of studies that seem to bolster their case and systematically ignoring the overwhelming evidence that says that harm reduction is the way to go if we want to reduce the cumulative negative consequences of tobacco in global society.
00:26:47 --> 00:27:07
Brent Stafford: Has there been a bit of a mind meld or some kind of a switcheroo that's happened, say, between the puritanical conservative right of the 1980s and 90s and the progressive minded person today? Because it seems that it's the progressives that have really kind of lost their marbles.
00:27:08 --> 00:32:12
Ethan Nadelmann: I mean, I will say to you, it's one of my great frustrations, because when I look at the politicians who were my key allies, on legalizing medical marijuana, on marijuana legalization, on needle exchange, on overdose prevention, on harm reduction more broadly, on reducing, getting rid of mandatory minimum drug sentences and providing alternatives to incarceration, even on supporting controversial things like safe injection sites, supporting psychedelics reform. Those are often the same people who have been at the forefront in opposing tobacco harm reduction. And to me, when I speak to some of them in past years about this, they kind of give me a sort of glazed look that essentially what I'm giving them, providing to them is inconvenient knowledge. It's not something that's gonna resonate politically. It's something that's gonna be very risky for them. I think many of them, I think in retrospect, got engaged in supporting harm reduction illicit drugs less because of, I mean, obviously the science, the evidence, the benefits all made a difference. But I think also the racial justice element was so prominent and the reducing incarceration element was so prominent. And the fact that those two elements of over-incarceration and racial injustice play such tiny roles still on tobacco harm reduction, I think that's been less of incentive for progressives to get engaged in this. I think also with the progressives, you know, many of them, you look at where it really got going, the anti-harmonics and stuff was in liberal cities like San Francisco or a range of other places where you had, you know, progressive white, mostly white elite populations who had, you know, that were the adults had either never smoked or if they did, it hadn't been since college. They essentially don't hang out in environments where their peers smoke. The only people, you know, they don't see people smoking unless maybe it's the people working for them and the people working for them aren't going to smoke in front of them. And then meanwhile, they see their kids, you know, coming around and they're vaping these new e-cigarettes and juuling. And the parents are freaking out about this. They're uninformed. They see some of their kids developing a problem, getting dependent upon the vaping. And so they totally flipping out and all of their principles are going out the window. So the way I've sometimes framed this historically, you know, as somebody whose politics are, you know, not far left, but kind of, you know, left center, center left, with a bit of a, you know, center left with a bit of a libertarian streak, I would say if you look historically to 100 years ago in America, probably in Canada as well, that the progressives got half a dozen things right and one big thing wrong. What they got right They got right about child protection laws and food and safety protection laws. They got right about allowing labor unions to stand up for the rights of workers at a point when workers were being terribly exploited. They got right about giving women the right to vote. They got right about the direct election of U.S. senators to office. They got right a whole lot of things, but they got one big thing wrong, and that was their support for alcohol prohibition. Now, mind you, that was a fairly bipartisan thing because you also had the Ku Klux Klan that was deeply involved and a lot of conservatives supporting alcohol prohibition as well. But still, the progressives, by and large, got that wrong. And today, I say the same thing. I think that, by and large, the people who are leaning more Democrat, liberal, progressive, They get it right on key things like on the environment and the need for clean energy. I think they get it right about the need for investing in the infrastructure of this country. I think they get it right about basic rights of minorities, of lesbian and gay people. And they've gotten it right increasingly on drug policy reform. But they've gotten it tremendously wrong on this issue. And I think it's because of the absence of the racial justice piece because of the absence of the mass incarceration piece. And of course, because big tobacco is playing such a major role, is really increasingly becoming the dominant player in tobacco harm reduction. I mean, even as you have all these smaller companies emerging, selling the disposable vapes, at the same time you have The big companies, you know, Altria first investing in Juul, then unloading that when that didn't work, but investing in Enjoy, one of the big companies in the US. You have Philip Morris International buying Swedish Match, which produces snus. So the fact that big tobacco is the major player in this is also something that gets progressives who are instinctively suspicious of big business, big multinationals, and especially big tobacco. I think it gets their backs up as well.
00:32:14 --> 00:32:22
Brent Stafford: Would you characterize what's been unleashed by, I would say the progressives of today, a moral panic?
00:32:23 --> 00:37:35
Ethan Nadelmann: Oh, well, I mean, yes, most definitely. I think that the, what happened around Juuling, you know, as some moral panics get started with almost nothing to get them going. I mean, one of the classics, which is a chapter in the classic book in illicit drug areas, a book called Listen to Illicit Drugs by Ed Brecker and the editors of Consumer Reports published over 50 years ago. And it was a kind of founding classic of drug policy reform and early stage harm reduction, even before it was called harm reduction. And in that chapter, he had, in that book, he had a chapter called On the Glue Sniffing Epidemic, right? And it was about, you know, how, An article appeared in the local press, I think in Denver, about some high school kid sniffing glue and somehow got picked up in the national media and became a national hysteria, even though almost nobody was doing it. And then paradoxically informed millions of teenagers, oh, you can get high by sniffing glue. And so they actually made the story, made the thing worse. So I think what you saw with this thing is, yeah, people, there was a real issue of growing numbers of young people, large numbers of people vaping and, you know, dueling and other vaping. There was a problem which was exaggerated, but still a problem of young people getting hooked on vaping, having a hard time stopping doing it. So there was some substance to the concern, but the magnitude of the hysteria and the reaction and what happened in American media back in 2018, 19, when Juul kind of took off as a phenomenon among young people and a social media thing, And then when you looked at the whole E-Valley scandal, you know, the thing where people were landing up in the hospitals with all this oil splattered on their lungs. And I think a couple thousand people seriously injured and about 70 or 80 people actually died. And it became the CDC, the U.S. Center for Disease Control, called that E-Valley. And where the E stood for electronic cigarette and then V for vaping. And then the API was about the harms. ALI was about the harms. But it became evident from early on that EVALI had either almost nothing or absolutely nothing to do with vaping nicotine. That it was entirely explained by a couple of knuckleheads who were producing illicit THC cartridges for vaping cannabis and who used vitamin E acetate In those cartridges, basically, vitamin D acetate is very safe to drink or to eat, but if you light it up, it can be deadly in the ways that it was proving to be. But then you were using vitamin acetate because it was the same color and same viscosity as THC oil, which meant that if you wanted to sell THC vapes and save money and kind of rip off the consumer, you would use some THC oil and then you would cut it with vitamin E acetate. So that was, and there were articles appearing about this right from the beginning of the epidemic. But the CDC, to some extent the FDA, as well as political leaders around the country jumped on this. And this was both Democrats, it was also Republicans, especially some of the liberal Republicans in the North, the few liberal Republican governors we have in the Northeast and others who jumped on this to ban all vaping. And it was, and then even when it became obvious The CDC has refused to rename this disease from E-Valley to removing the E. Nobody who vapes marijuana says they're taking marijuana and e-cigarettes. They call it vaping. It's only in the nicotine area that you refer to the device as an e-cigarette. So they've persisted with this duplicity because it proved helpful to them in scaring young people away from vaping nicotine, even though it was based on an entire falsehood. So we've seen this hysteria out there. Now, my hope is that some of this will moderate. And especially, you know, we've seen that the nicotine pouches are the fastest growing segment of the market, not in absolute numbers, but proportionally. Because they don't involve inhaling something into your lungs, I think they will be less demonized, less stigmatized, but still being swept up in the whole anti-tobacco harm reduction narrative. So we are dealing with that. And I should also say, although progressives have been the great violators here, you've also had prominent Republicans from one of the people who's now one of the few respected Republicans left in America, that being Mitt Romney, who is adamantly opposed to this, other right-wing politicians. Donald Trump at one point wanted to ban vaping and then swung around. So it has been a bipartisan effort but one in which the Democrats and the progressives have been out front. What's remarkable is that it's still almost impossible to find anybody on Capitol Hill, including Republicans, who will publicly identify with tobacco harm reduction.
00:37:36 --> 00:38:05
Brent Stafford: Yeah, it doesn't seem to be a potentially winning position to have for on either side. Let me ask you, you were just talking about the CDC and the whole Evali issue. Is that example a good example of what you deemed as inconvenient knowledge? So if you try to get to a progressive and say, look, here, CDC, this whole deadly vaping thing wasn't nicotine vaping, they've just got their fingers in their ears.
00:38:06 --> 00:42:06
Ethan Nadelmann: Well, I mean, that's a kind of very outrageous example of inconvenient knowledge. But it's true more broadly, Brent. I mean, you know, you look at, we have hard evidence now that even FDA and CDC, I mean, CDC admits it in the small print if you look at their website, but they don't put up on the front of the website that one of the best ways to quit smoking is by shifting to these devices. You look at the FDA, which has given permission for a variety of harm reduction devices, both pouches and heat not burn and e-cigarettes to be sold in tobacco flavors, but is not trumpeting that fact or letting consumers know that they've done this. if you look at the fact that a majority of Americans and a majority of the population, lots of other countries still believe that vaping nicotine is as or more dangerous than cigarettes, even though the evidence is totally contrary. If you look at the fact that a majority of physicians still believe that, if you look at the fact that a majority of people in my country and many others believe that nicotine causes cancer where it basically doesn't, it's the the combustible matter that's burnt that is causing most of the damage there. So the fact of the matter is oftentimes the politicians themselves are uneducated. They have no incentive to look at the evidence. Politicians are not typically known as leaders. I mean, it's a bit of a misnomer to call most politicians leaders. They're oftentimes followers. you know, the definition of politician is he who leads most loudly from the back of the crowd. So it's not as if they're seeing anybody pushing them from their base, you know, to get involved in this. So to me, I think the problem is even less about the politicians and it's more about the fact that there's no base mobilized behind that. And that has to do with the fact that there's been, I mean, one of the facts is that, A, people who smoke it's not like people who are dying of HIV 40 years ago, where there was a true sense of crisis, right? So there's not the crisis of imminent death or imminent contracting of a deadly disease that will kill us when we're still young. With respect to tobacco and nicotine, it's more about a deadly disease that will kill us when we're quite a bit older. So there's not that sense of urgency, right? Which is one issue. And then secondly, there's not the funding available. You know, the role that I played 30 years ago you know, when I was teaching in Princeton in 92 and got a phone call from George Soros, the famous philanthropist and financier, although he was not famous back then. And when we hit it off that, you know, that resulted in his becoming more or less the singular, you know, funder of harm reduction in the U S and around the world for many years with me is basically the, the principal gatekeeper of that funding for the first half dozen years and a key advisor for many years thereafter as then other very good people came in to manage all that. But you don't have that. The only major philanthropic funding in this area is coming from Bloomberg and a few other like-minded foundations, and they are radically anti-harm reduction. And the only funding coming in to support tobacco harm reduction was ever available either directly or indirectly from the big tobacco companies, right? From Philip Morris or from the Foundation for the Smoke-Free World, which had received money. from Philip Morris International, but it has disconnected itself from where the big tobacco doesn't have influence over their doings. But one way or another, the fact that they have accepted money from this source, even though they're fighting for good, even though they're fighting for public health and human rights, the Bloomberg-funded folks can hold that against them and discriminate against them, ban them, use that to discredit them. And whereas in fact, if there were philanthropic funding, if there were a George Soros who had no connections to the tobacco industry, who was funding tobacco harm reduction, that would make a huge difference.
00:42:08 --> 00:42:26
Brent Stafford: Ethan, I know you'll be attending the Global Forum on Nicotine again this year for the annual conference on safer nicotine products and tobacco harm reduction. GFN 24 runs from this June 13 to 15 in Warsaw, Poland. Let me ask you, why is an event like GFN important?
00:42:28 --> 00:48:05
Ethan Nadelmann: Well, I mean, the first reason I can give is very personal. You know, when Jerry Stimson, who I've known since the 1990s, when he invited me to give the Rolston Oration in 2016. I was still running Drug Policy Alliance and I wasn't able to go, but I went there the following year, shortly after I stepped down. And for me, it was an incredible way to meet a whole new world of people involved in this area. So I would say that, and it resulted, it played a major role in my devoting a, you know, not major, not insubstantial either part of my time now, you know, with no compensation to this cause of tobacco harm reduction, because I believe in it. So, you know, in that sense of being introduced to a world that includes academics, that includes consumer advocates, that includes folks from industry, that sometimes includes government officials, I just think, you know, that gathering of GFN, which I went to in Warsaw back in 2017, which I'm going back to again this year, as well as the ESIG Summit, the event that's put on in London and New York each year by Amanda Strange. I just think those events are immensely valuable because it's a place where people who already know one another can get together, exchange information, see one another. It's a place where first timers can come and be introduced to a whole new world and learn about the cutting edge stuff and build those sorts of personal relationships. The other interesting institute in the U.S., is FDLI, FDLI, the Food and Drug Law Institute, which is I think the only place that we have in the US where you have people coming from across the political spectrum, where you have not just are the people coming from tobacco harm reduction welcome, but it's also a place where the people coming from the anti-harm reduction world feel obliged to participate as well. And so that's valuable in terms of creating a place where you have people from across the spectrum all together. which is otherwise fairly rare in this world. One reason it's rare, of course, is you have something that's happening in the tobacco control world that I almost never encountered in the illicit drug policy world, which is people being banned from conferences because they have one or another connection to the tobacco industry, or even I think the e-cigarette industry at times. And people, academics having their articles rejected, not on the merits, but by editors who say, we will not even consider your article. We will not put it through the peer review process because you are exhorting some compensation in one way or another, or have some association. with big tobacco or an affiliate. There's the old norm, the norm that has existed in virtually every area of science, is that if you have a potential conflict or even something that might be seen as a conflict, that the cure for that is full disclosure. You have to disclose to the editor of the journal, I have this relationship with the government, this relationship with the big tobacco company or whatever. It's full disclosure, right? But you have a peer review process. It's about science. But the tobacco control area, and I'm not sure if this is unique to the tobacco control area, but it was not happening in the illicit drug area. I mean, there were small elements of it, but nothing like this. Basically, the peer review process survives intact and people can go to conferences. They're not banned. They may not be invited, but they're not banned from attending. So I look at what just recently happened with Cliff Douglas. I mean, Cliff Douglas, who has, you know, 40 years experience in tobacco control, a huge reputation for opposing big tobacco, you know, a very moderate guy who's worked at, I don't know if it's the Cancer Society or Lung or Heart Associations, a variety of those organizations. He's now succeeded Derek Yak as head of the Foundation for a Smoke-Free World. right, which got its start with money that came from the tobacco from Philip Morris. Well, Cliff persuaded Philip Morris to hand over all of their remaining financial commitment, I think $150 million or something, Right. In a one big check. So Philip Morris has no connection anymore. Right. He also, you know, has gone public that he will never, ever seek funding from Big Tobacco or even for that matter, this may be going too far, but or even from the harm reduction companies, e-cigarette companies. Right. I mean, this is a guy with a pristine reputation. in terms of tobacco control, assuming the leadership of what could be the most, which will very quickly be the most important tobacco harm reduction organization out there, given its funding levels and its independence. But he was just recently banned from a meeting of SRNT, the Society for Research on Nicotine and Tobacco, the major academic gathering, notwithstanding his 40 years reputation, simply because he has taken on this new position. I mean, that is a form of, I mean, that's the kind of thing you see in anti-democratic societies. It's the type of things you see in highly ideological societies, the type of things that you would expect to see in Russia or China or other countries which don't tolerate these levels of debate. So I'm just disgusted with the excesses at which this anti-harm reduction stuff has gone in organizations that call themselves academic or intellectual or science-based organizations.