Thursday, 27 June 2013

E-cigarettes and a new culture of intoxication?

I've talked about e-cigarettes before, and they still fascinate me as a case study in intoxication, whether it's the comparison with alcohol and the idea that there might be a 'complex', 'premium' aspect to the product beyond the nicotine, or the comparison with medicines.

One of the ongoing issues with e-cigarettes is the possible 'gateway effect'.  That is: if they're not properly regulated, young people will be able to easily get their hands on them, and then they might develop a nicotine addiction and graduate to the hard (harmful) stuff, 'real' tobacco.

Clive Bates has challenged this idea on his blog, and I'm inclined to agree with much of what he says.  However, it led to an exchange on Twitter with Andrew Brown, who pointed out this brand of e-cigarettes, which particularly plays on the connection with 'real' cigarettes.  The packs look like cigarette packets, even down to mimicry of the paper seal you sometimes get, and the e-cigs themselves look almost exactly like 'real' cigarettes, with a 'filter' and a white main section.  The tastes and strengths are described by direct comparisons with certain brands of cigarettes, the word 'smoke' is used right across the website and branding, and the advertising slogan appears to be it's "OK [to] enjoy smoking again".[1]

Andrew has posted very promptly on this, following another Twitter exchange today.  Because he's sensible, thoughtful, and expresses himself clearly, he's careful to note that he's not actually sure what the right action might be.  I'm going to have a go at pinning down what I think, as the next step in what could hopefully be a helpful debate, but as a result this has been dashed off quite quickly, so apologies if it's not as neat and clear as it might be.

The issue here, placing ourselves in the position of all-powerful regulator, is working out what we might want e-cigarettes to do - and what we might not want to see.  So, one of the advantages to making e-cigarettes look like 'real' cigarettes is that they might be more attractive to current smokers, hopefully shifting them to what is generally understood to be a less harmful pastime.  However, the flipside of this is the fear about the 'gateway': if they're so similar, what stops someone (generally understood to be younger) shifting the other way?  And, regardless of age, there's concern from organisations like the BMA that e-cigs, particularly if 'vaped' indoors and in public, will re-normalise smoking, unravelling the apparent effect of the smoking ban that has made smoking seem abnormal.  I can see how this could be the danger with a poster that might seem to say it's OK to smoke again.

You'll probably have noticed by now that I keep referring to 'real' cigarettes, when I could have used a word like 'conventional' or 'traditional'.  This is deliberate.  If e-cigs are seen as a replacement, then the possibility is that they're forever be understood as an imitation, an echo, a shadow of the 'real' thing.

Attending the Under Control conference last weekend got me thinking about the pleasures of drug-taking.  (Well I did drink some ether and plenty of beer.)  So did reading this book chapter by Steve Wakeman about novel psychoactive compounds (NPCs) or as they're more commonly know, legal highs.  The point is, there's pleasure potentially associated with lot of aspects of taking what's seen as an intoxicating substance: the social aspect; something approaching a 'pure' intoxication; conversely an ability not to feel intoxicated; perhaps the frisson of doing something illicit, or frowned upon, or dangerous.

Few people will find the final of these thrills as important as Wakeman's participants, one of whom decided that there wasn't much of a buzz in highs that were legal, and so decided to snort them off his dashboard while driving (though he waited till he was stopped at traffic lights - safety first, kids!).  However, as I've said before, there can be something of a frisson in smoking, knowing that it might kill you.  This could be particularly powerful when combined with the sense of invincibility of youth that means you don't really believe it'll kill you.

This idea of cigarettes as attractive in part because they're dangerous would, I'd suggest, only be strengthened by the view that they are the 'real' thing, in contrast to bowdlerised e-cigs.  Of course, if e-cigs are a nicotine replacement therapy, as the UK Government seems to think, then this is precisely the view that must be taken.  According to this view, and following Ingrid Walker's presentation at Under Control[2], the medicine (e-cigs) is likely to be presented as involving choice and health, compared to the destruction and failure of the tobacco.  (We're going back to Sarah Wollaston's strange claim that tobacco only brings bad breath, disease and death.)

I'd suggest that this perspective - whereby e-cigs are simply there to wean people off smoking - is one that governments can feel comfortable with.  This gives a reason for having an intoxicant on the market - it's there to divert people from another.  However, if we're serious about getting people to move away from tobacco, I'd suggest this dynamic of real/fake isn't helpful.  To some extent, OK-cigs know this, and that's (paradoxically) why they've gone out of their way to mimic traditional cigarettes: they want people to feel that their product is somehow real.

But my point would be that the mimicry can only go so far.  I think it would be more powerful to be able to say:

"Here's something - not a cigarette - that does the same thing, but better.  It gives a high, but without so much danger - and also with more choice of what the device looks like and what the vapour tastes like.  There's much more choice, and less danger."

OK, you lose some of the James Dean frisson, but you can present e-cigs as positive and something worth doing in their own right, rather than a healthy, diet, responsible version of smoking.  You'd also cut down the dangers of re-normalising smoking or offering a gateway to cigarettes.  It is clear that this is in the minds of some people who are currently selling e-cigs, with the shop in Camden quoted in this article sounding like it's trying to carve out a particular niche for the market.

This approach would also have positives in terms of resolving the Wetherspoon's issue.  At the moment, regulating indoor 'vaping' is difficult.  If device manufacturers stepped away from conventional mouldings (maybe branching out into something like these) then that would make it easier.  Perhaps there could be special categories for different types of e-cigs: if you wanted to go down the medicine route, fine, you could make the device look like a traditional cigarette; if you wanted to market it as a new nicotine product, then you have to deliberately move away from mimicry.  Of course, there'd be difficulties in setting down guidelines like this clearly, but there'd be some merit - and it does happen in the field of BB guns, which can't look too much like 'real' guns.

Of course the reason the Government wouldn't feel comfortable with this is that it would be licensing something that could be labelled a new intoxicant.  Although I can't go into it here, I see a general reluctance to countenance the pleasure of intoxication in itself by government, and in this case there's also the additional factor that the drug (nicotine itself, not found in tobacco) cannot be dressed up as 'natural'.  However, in the context of 'legal highs', which governments around the world have struggled to regulate for, there's the possibility that these sorts of debates will be forced to move to new ground.  E-cigarettes are a much easier target than Benzo Fury or the latest NPC, but it's hard not to see the inconsistency in the situation.

Caffeinated drinks offer an interesting comparison.  Coffee or tea might be constructed as 'natural', but Red Bull and Relentless are not.  They are presented in the 'hit' or 'kick' formula that's familiar from the alcohol industry's response to rave culture.  I have heard youth workers and those involved in drug treatment express concern that these could be the next major issue for the substance misuse sector.[3]  And yet they are legal.

There are all sorts of other issues involved in this debate, which I don't have time to discuss here.  Most notably: first, the involvement of 'big tobacco', which I think could actually potentially be a positive thing (imagine if those interests were shifted to selling something less harmful); and second, the nature of addiction and free choice within a market.  However, I'm happy to leave this post with this question: why shouldn't e-cigarettes operate a little like energy drinks, carving out a market niche distinct from their traditional (natural) forebears?  There's plenty of possible challenges to this position - perhaps most powerfully something thinking about addiction - but I'd suggest it's an interesting alternative starting point for thinking about the issue, rather than seeing e-cigs as re-packaged nicotine inhalers.

[1]Alasdair Forsyth has made the interesting point that this approach might be in breach of a code or law, as the e-cigs don't actually produce any smoke...

[2]I should say that I might be mis-representing this as I'm getting it second-hand - I couldn't go as I felt I ought to think of the day-job and go to presentations (which were themselves fascinating) about methadone maintenance and safe injecting rooms.

[3]I think this is somewhat overstating the case, with there still being plenty of heroin use across the country, not to mention ketamine and mephedrone.

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