Are E-cigarettes the new Methadone?

Lawmakers and regulators, from Albany to Washington, are debating whether to let people feed their nicotine addiction in a relatively clean way with e-cigarettes, in order to stop them from polluting their bodies in a clearly very dangerous way with traditional ones.

Public health professionals are divided, with loud voices on both sides, and several of them gathered recently at Columbia University’s Mailman School of Public Health to confront each other with medical and ethical arguments.

On one side, Nobel Prize-winning neuroscientist Dr. Eric Kandel stood up for the precautionary principle – the idea that if you do not know what a substance can do, you should keep it out of your body.

“Everything that we’ve looked at indicates this is extremely dangerous – not only in itself, but in its likelihood of leading to more dangerous drugs,” Kandel said.

On the other side, ethicist Ronald Bayer touted the importance of harm reduction – the idea that steamed nicotine from e-cigarettes is a lesser evil than smoked tobacco.

“It a little bit reminds me of the early days of the battle over methadone, when people said, ‘What do you mean you’re going to give an addictive drug to junkies?’” Bayer said. “And the answer was: Oral methadone is better than injectable heroin.”

Kandel's wife, social scientist Denise Kandel, argued e-cigarettes could set back the war on tobacco by lessening the stigma around smoking.

“We made tremendous success over the last 20 or 30 years in reducing the rates of smoking in this country,” Kandel said. “What will happen to that effort in light of the spread of e-cigarettes?”

Her husband detailed the effects of nicotine to the brain, delving into what really happens when nerve pathways get addicted to chemicals. The chemistry lecture was challenging to a public health audience generally more comfortable studying populations and policy, rather than molecules and cells. Graduate student Lorraine Fei was one of many audience members whose head-nodding suggested greater sympathy for the harm reduction approach over the absolutes of “Just Say No.”

“It really does remind me of methadone, or even of abstinence versus condom usage,” Fei said. “And I think that’s a pretty convincing argument.”

Outside the academic building, a woman who would only give her name as Karen was vaping an e-cigarette, while waiting for her elderly father to emerge from a medical appointment. She said being able to ‘vape’ is helping her cut back from a pack-a-day to five cigarettes – but she doubted e-cigarettes would help her completely quit.

“I would like to think so,” she said. “But I hate to say it: there’s something about a cigarette, when you’re an addict.”

For now, Karen can vape in restaurants in the suburbs, just not in the city, where the indoor smoking ban includes e-cigarettes. Legislators in Albany have proposed extending this ban statewide. Their bill was put on hold earlier this year, but they are expected to try again in 2015.