Public Health

California Is Forcing Smokers To Buy More Dangerous Products

Banning less harmful tobacco alternatives is not a way to improve public health.


I consider myself a rational person, someone who is swayed by solid data and persuasive arguments, yet every afternoon after my work is done, I jump on my three-cylinder Triumph motorcycle and take an exhilarating ride along country roads, city streets and freeways. The statistics suggest that this is a very bad idea.

Based on vehicle miles traveled, motorcyclists are 37 times more likely to die in a collision than the occupants of passenger vehicles, according to National Highway Traffic Safety Administration data. Those are sobering numbers. Even air-bagged vehicles pose a significant risk. Around 39,000 Americans die each year in car and light-truck crashes.

On a personal level, I have three ways of dealing with the incongruity between my love of riding and its dangers. First, I can stop riding, which will dramatically increase my odds. Second, I can refuse to worry about it—and make besides-the-point excuses to justify my choice. Did you know that 400,000 Americans die each year because of unhealthy eating?

Finally, I can embrace a policy of "harm reduction." In other words, I can minimize my risks through training, careful riding (no intoxicating substances or speeding) and, of course, wearing serious protective gear. The government has taken this approach by mandating motorcycle helmets and automobile airbags rather than, say, forbidding the use of dangerously fast vehicles.

From a policy standpoint, the government can embrace one of two public-health approaches in all areas—Prohibition or harm reduction. The former got a bad rap from 1920 to 1933, when the feds embraced an insane policy—pushed by religious zealots and progressive up-lifters—that tried to force Americans to give up booze.

The latter has become popular in the context of prostitution and drug use, which still are subject to government prohibitions. "While harm reductionists may differ on the extent to which stopping illicit behavior should be the goal of the interventions, most focus on client-centered efforts, such as needle exchange…that meet clients 'where they are at,'" according to the Open Society Institute.

California's progressive lawmakers have been on the cutting edge of such efforts. Instead of treating prostitution mainly as a law-enforcement matter, they've tried to help sex workers embrace safe-sex practices and get tested for HIV. The thinking is sound. It acknowledges that we're unlikely to end the "world's oldest profession"—so it's better to limit the spread of disease.

In 2019, the state passed the California Harm Reduction Initiative, which earmarks $15 million toward supporting local syringe exchange programs, so that people who use drugs can do so in a way that limits overdoses and hepatitis. The latest efforts involve pilot programs where people inject themselves at a "safe injection site." Drug use is destructive, but this might reduce its ill effects.

Love these ideas or hate them, but it's clear that our political leaders have embraced harm reduction and rejected prohibition. Voters largely are aligned on those points. In 1996, they approved Proposition 215, which legalized medical marijuana (with a doctor's note), and in 2016 approved Proposition 64 legalizing recreational cannabis.

Prop. 64 hasn't lived up to its promises (ending illicit sales and reducing harm by assuring oversight of the supply) largely because California imposed so many new regulations, fines and taxes that it was easier to keep buying weed from a neighbor or cousin. Nevertheless, it signified a move forward. You're not going to find any major California Democrats calling for a return to prohibitionist marijuana policies.

But at the same time that our politicians are championing their forward-thinking approaches to these matters—and chastening red states that prefer to sic cops on drug users and sex workers—they are going all in on another form of prohibition. That involves tobacco use. In 2020, Gov. Gavin Newsom signed Senate Bill 793, which imposes a ban on the sale of flavored-tobacco products.

The federal Centers for Disease Control reports that, "Cigarette smoking remains the leading cause of preventable death and disability in the United States, despite a significant decline in the number of people who smoke." It attributes 40,000 deaths annually in California alone to cigarette smoking—multitudes more than die by driving.

Flavored tobacco includes vaping products, snus and non-tobacco pouches that contain pharmaceutical-grade nicotine. Virtually all of those products have added flavors. The go-to statistic, from the top British healthcare agency, is vaping is 95-percent safer than combustible cigarettes. Sweden has the lowest cancer rate in Europe because snus is the nicotine-delivery device of choice.

Unless voters overturn that rule in a referendum in November, California's smokers will no longer be free to buy reduced harm products—but can still buy the most dangerous ones. It's like the government allowing me to ride a motorcycle but forbidding me from wearing a helmet. If state officials insist on being nannies, they at least should promote rules that won't kill us.

This column was first published in The Orange County Register.