Massachusetts will place a four-month ban on all sales of vaping products, the state’s governor announced Tuesday, ushering in the most extensive state-level crackdown on e-cigarettes after a mysterious illness has afflicted hundreds and killed nine people.

The move is the latest response from policymakers to growing alarm about the popularity of e-cigarettes among young people and fears that the products, which have yet to be vetted by the Food and Drug Administration, pose unknown health risks.

Bans on sales of flavored vaping products took effect this month in New York and Michigan, and the Trump administration said it plans to enact a similar regulation at the federal level. Flavored products have attracted particular scrutiny from policymakers who say they are getting children hooked on nicotine.

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But Massachusetts would go beyond a flavor ban to also temporarily eliminate tobacco and marijuana e-cigarettes from the market. Officials say the halt will allow time to properly investigate a crisis that’s expanded to 530 cases in 38 states as of last week, according to the Centers for Disease Control and Prevention.

“The purpose of this public health emergency is to temporarily pause all sales of vaping products so that we can work with our medical experts to identify what is making people sick and how to better regulate these products to protect the health of our residents,” Massachusetts Gov. Charlie Baker (R) said in a statement.

San Francisco became the first major U.S. city to effectively ban all e-cigarette sales this summer by targeting products that have yet to gain FDA approval. But San Francisco’s policy will not go into effect until early next year, while Massachusetts’s new rules take effect immediately — and on a much larger scale.

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The state’s new policy drew swift criticism from e-cigarette advocates and companies that have long argued their products help rather than hurt public health by offering smokers an alternative. Some public health officials, too, have promoted vaping as a tool to reduce smoking among adults — notably in England, where vape shops sit on the grounds of some hospitals.

Sixty-one potential cases of vaping-linked illness have been reported to the Massachusetts Department of Public Health as of Tuesday, the governor’s office said. Official investigations nationwide have connected many of the illnesses to marijuana products bought off the street, but no one item has been linked to all cases. And some patients have reported vaping nicotine, though health professionals note people may be reluctant to admit to using marijuana.

As The Washington Post has previously reported, the illnesses are largely affecting young people:

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An investigation by state health departments in Illinois and Wisconsin traces the first signs of illness among 53 tracked patients to April. The victims — mostly young men with a median age of 19 — overwhelmingly ended up in the hospital, many under intensive care. A third went on respirators.
Patients typically experienced coughing, chest pain or shortness of breath before their health deteriorated to the point that they needed to be hospitalized, according to the Centers for Disease Control and Prevention. Other reported symptoms include nausea, vomiting, diarrhea, fatigue, fever and weight loss.
Many victims have ended up with acute respiratory distress syndrome, a life-threatening condition in which fluid builds up in the lungs and prevents the oxygen people’s bodies need to function from circulating in the bloodstream.

While the illnesses have given new urgency to long-brewing concerns over vaping, lawmakers explaining new e-cigarette restrictions in other states have focused on the broader threat of teen addiction.

Michigan Gov. Gretchen Whitmer (D) announced her state’s flavored e-cigarette ban Sept. 4 as state health officials declared youth vaping a public health emergency, highlighting research on nicotine’s harm to developing brains and on substances in vaping products with unclear long-term health effects. Michigan’s health department also cited evidence that youth who use e-cigarettes are more prone to take up smoking, which most experts believe to be more dangerous than vaping products.

A 2018 government-funded study found that the percentage of U.S. high school seniors who report vaping nicotine within the past month doubled over just a year, sparking a new wave of alarm that e-cigarettes are reversing decades of decreasing youth tobacco use. E-cigarette use among teens has risen faster than any product tracked in the survey’s 40-plus years of existence, researchers say.

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Preliminary results from this year’s version of the National Institutes of Health-funded study indicated another jump in student vaping, and researchers expressed particular concern over their finding that about 1 in 9 teens vapes nicotine near-daily.

Massachusetts is no exception when it comes to vaping’s popularity among young people. More than 40 percent of the state’s youth reported trying e-cigarettes in 2017, and 1 in 5 said they used the products regularly, according to the governor’s office. High school students’ usage rates are six times as high as adults', the office said.

While Massachusetts officials focused Tuesday on a need to investigate illnesses, they said that they, too, are concerned about youth vaping.

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“Vaping products are marketed and sold in nearly 8,000 flavors that make them easier to use and more appealing to youth,” Lt. Gov. Karyn Polito said in a statement. “Today’s actions include a ban on flavored products, inclusive of mint and menthol, which we know are widely used by young people.”

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The Massachusetts governor’s office seemed to anticipate concerns about smoking alternatives Tuesday, saying it will devote more resources to programs that encourage people to quit smoking and increase the capacity of the Massachusetts Smokers’ Helpline.

Opponents still blasted the move as counterproductive.

Austin Finan, a spokesman for leading e-cigarette manufacturer Juul, warned Tuesday that bans on the sale of vaping products will encourage a black market of products with “unknown ingredients under unknown manufacturing standards.” He added that bans will affect adult smokers’ ability to quit and push former smokers back to old habits.

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Gregory Conley, president of the nonprofit American Vaping Association, called Massachusetts’s halt on sales of nicotine vaping products “absolutely absurd,” emphasizing evidence that links the vaping-related illnesses to illegal and contaminated THC cartridges.

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“We agree with the FDA — if you don’t want to die or end up in the hospital, stop vaping illicit marijuana oils,” he said.

The tough new regulations also dismayed small-businesses owners facing steep losses. Jonathan Lau, who runs two vape stores in Brighton, Mass., said he and other vape shop owners — part of the retail industry’s fastest-growing segment over the past decade — were “blindsided” by the governor’s announcement.

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With vaping products making up close to 90 percent of his shops’ sales, Lau said, he will probably have to close down.

Employees have been told to show up for work Wednesday, but Lau does not think his stores will open.

“Basically, it’s a death sentence for small businesses in the vape industry,” he said.

Officials around the country have warned people to stop using e-cigarettes altogether while investigators try to get to the bottom of the illnesses and deaths.

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An executive order from California Gov. Gavin Newsom (D) last week directed the state’s Department of Public Health to launch a $20 million public awareness campaign about the risks of vaping both nicotine and cannabis substances. California health officials on Tuesday also joined the calls for consumers to stop vaping while the cause of vaping-linked illnesses remains unclear.

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Other states are signaling interest in following Michigan, New York and now Massachusetts’s lead in taking a tougher stance on e-cigarettes.

“We’re seeing more and more states exploring what emergency powers they have,” said Michael Seilback, assistant vice president for state public policy at the American Lung Association.

Seilback would not express an opinion on Massachusetts’s choice to suspend all vaping sales, telling The Post only that states are being “forced to make hard decisions” and emphasizing his group’s support for the bans on flavored vaping products that other places have adopted.

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He’s eager to see the Trump administration’s proposed ban on flavored vaping sales come to fruition.

“We think that strong federal action would prevent a piecemeal approach where different jurisdictions are looking at these products differently,” he said.

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