The Media and Drug Policy: Where’s the Science?

Groping blindly toward a new framework.

As states and the federal government clash at the legal, social, and political levels over legalizing marijuana, the science of drugs and addiction has taken a back seat. The dismal state of the addiction treatment business has recently been documented by Anne M. Fletcher in Inside Rehab, while over the past few years, drug policy officials in the U.S. have had to cope with three major developments: the medicalization and legalization of marijuana, the emergence of new synthetic drugs, and the abuse of potent prescription painkillers.

Major media outlets have largely failed to highlight the relevant scientific issues in each case. What we see instead is that journalists and others who are covering drugs and addiction issues are not making connections with solid scientific sources in the neurochemical research community. All too often, media reports of adverse drug events are sourced solely by police officers, or spokespersons on behalf of for-profit rehab centers, who are no more ready to make science-based pronouncements on these matters than anyone else.

States are now in the process of relaxing strictures on the possession and use of cannabis—and they are doing it well before they have put in place a set of evidence-based policies for the implementation of this new state of affairs. Who is in charge of directing policy decisions in Washington and Colorado? What will be the regulatory structure at the level of county and municipal government? Whose voices will actually be heard? Should the feds leave it to the states, and the states leave it to the counties, who then leave it to the cities? To what degree are the two states taking the medical and health aspects of this sweeping change into account? Can evidence be substituted for opinion in such cases? If so, how?

Even if the Department of Justice decides to shut down all efforts at relaxing marijuana statutes, it will need to rely upon a sound collection of scientific evidence to make its argument. The media play a compelling role in drug discussions, but coverage traditionally has been limited to articles about the legal, political, and sociocultural ramifications of the changes. These are all critical parts of the story, but science journalists need to step forward and direct more coverage toward emerging medical issues and the findings of science. Ordinary citizens will want to have at least a partial grasp of the medical and science-based decisions that state and federal governments will be making about personal health and habits as they legislate and adjudicate these concerns.

The federal government will have to begin working with states rather than against them, if public opinion continues to change on legalization issues. At the same time, the feds will be called upon to provide guidance for the states that is consistent with international drug treaties. Congressional committees will have to grapple with the realities of setting forth the limits and logistics of the market for marijuana in coherent and consistent ways. Incredibly, very little of this is pinned down, firmly understood, or even grasped as imminent problems by either legalizers or their opponents. Many of the issues that took years to wrestle down with cigarettes, such as warning labels on cigarette packages, will present themselves with equal and immediate force in the case of states with legalization plans.

In addition, marijuana policy makers in Colorado and Washington will have to render decisions concerning sales to minors, cannabis in the workplace, DUI marijuana laws, addiction issues, sales outlets, tax issues, and the results of ongoing medical research on marijuana. Some states allow private dispensaries, some have banned them. Some allow private cultivation of cannabis, and some do not. 

As for the newer synthetic drugs—the cannabis-like products known as Spice, and designer stimulant drugs known collectively as “bath salts”— these chemicals exist in a twilight zone of ignorance, with very little sound medical information passing to the public. Few people understand with any degree of certainty just what is inside those shiny foil packages. This glaring disconnect between clinical research and media reports leads to unsupported tales of face-eating zombies and dead teenagers on bath salts, well in advance of the drug testing that might factually answer questions about drug-related behavior. Meanwhile, scientists fear that the continuing effort to ban every substance illegally marketed in this category will close off certain valuable avenues of research, including new drug discovery.

Finally, the ongoing battle to lower the soaring use and abuse of oxycontin, Vicodin, and other opiate drugs has caused problems for legitimate pain patients across the country. Yet this medical aspect of the painkiller panic is rarely remarked upon. Some addiction researchers believe that as prescription painkillers are removed from the market or made more difficult to abuse, those with opiate addictions will migrate to heroin in greater numbers. Scientific research on addiction suggests that this may well be the case. 

What is missing specifically from most drug policy debates is the recognition of the vast metabolic variation among individuals. Different drugs affect different people differently, and for the first time, neuroscientists are building a solid body of information that could help policy makers better forecast the results of their actions. Lethality, side effects, tolerance, and susceptibility to addiction all vary widely due to metabolic differences among people.

But some shared reactions, and basic withdrawal parameters, do exist. Congress, the FDA, NIDA, as well as state health agencies and other regulatory bodies, need information about drugs and drug use that scientists have been busily compiling. The public needs this information, too. We need to search for ways media can more effectively inject science-based drug information into current policy debates. 

Science journalists are perfectly situated to serve as potential communicators between warring parties. What can the media do to markedly enhance intelligent, science-based coverage of drug issues?

Photo: Telstar Logistics

The House That Drugs Built

Eugene Jarecki’s documentary.

The following quotes have been excerpted from "The House I Live In," the recent documentary about drug addiction and law enforcement written and directed by Eugene Jarecki.


“We like to look at the war on drugs as black hats and white hats, and good guys and bad guys, and victims and offenders. And on the ground, it’s a lot more mixed up than that.”
—Criminal justice professor

“There’s no question that there was a passion with which the early narcotics enforcement culture pursued black America, even though the addict population was always distinctly biracial.”
—TV producer

“Because they’re addicts, they find themselves committing the same crime that just put them in jail, say, a week or so prior.”
—Police officer

“We’re locking up everybody just because we’re mad at them. We need to lock up people that we’re afraid of.”
—Drug offender in prison

“There are more African Americans under correctional control today than were enslaved in 1850, a decade before the civil war."
—Writer, historian

“Sometimes I think you can trace any crime you want to drugs.”
—Police officer

“Everybody involved hates what’s going on.”
—Attorney

“Today the average person I sentence in a drug case is a non-violent blue collar worker who lost their job and then turned to manufacturing methamphetamine to support their habit. And we treat them like they’re kingpins.”
—Federal court judge

“People want to lock people up and then when their sentence is over, they expect them to be reformed, or a different person. If you haven’t given them skills or trained them, how can they be?”
—Corrections officer

“Nobody respects good police work more than me. The drug war created an environment in which none of that was rewarded.”
—TV writer

“I don’t think people fully understand, in the inner city, these kids are making rational choices.”
—Journalist

“Historically, anti-drug laws have always been associated with race.”
—Historian

“Prisons are almost a self-fulfilling prophecy. You build a bed, they fill the bed. It starts sucking in money at an astronomical rate. And it just grows and grows of its own accord.”
—Corrections officer

“Whenever you have a new drug introduced in society, you can say incredible things about that drug, and people will believe you.”
—Psychology professor

“I’d like to see empirical evidence be used in our shaping of public policy.”
—Ex-addict

How I Quit Gambling

Projectile vomiting can be your friend.

I never should have found myself inside casinos in the first place. As a former alcoholic, cigarette smoker, and drug abuser, taking up gambling does not, in retrospect, sound like a solid life plan. But in my addictive heyday, gambling was definitely a part of my life. I would go the casino, stand inside the entrance, gaze out across the dark, jangling world of the slot machine floor, populated by solitary figures seated on stools, busily drinking and smoking cigarettes, and mutter: “My kinda people.”

And they were. Lurking out there were a significant number of fellow addicts, as I now understand. They weren’t there to have fun, to play games, to be entertained, or to quit while they were ahead. They were there to experience the act of risking more money than they intended to—more money than they wanted to lose. They were self-medicating with machines, as I had learned to do. The money bought you time on the machine, and the time on the machine was the medicine. The money had less to do with it than you might think. The money was only the means.

My spell as a compulsive gambler was nasty, brutish, and short. The extent of my losses is classified. It’s not a well-known fact, but addicted individuals who compulsively gamble tend to prefer the machines to the tables these days. Table gambling—blackjack, roulette, poker—requires a level of social interaction that is the opposite of what the pathological gambler is seeking: total immersion in a null state marked by regularity and the absence of human interactions. Give a cursory glance around any major casino’s slot room, and you will quickly notice that slot and machine poker players don’t talk to each other. They don’t even sit next to each other, if they can help it. Like an alcoholic on a secret binge, they DO NOT WISH TO BE DISTURBED. Even the periodic interchange with a cocktail server can feel like an unwarranted intrusion into the gambler’s zone.

I used to say, only partly in jest, that there is nothing quite like the sick thrill of wagering money you can’t afford to lose. The traditional trajectory has the gambler setting a limit on what she’s willing to lose, then going past that limit and resetting it, repeatedly, until her money is gone. Slot machine players know they are going to lose. They aren’t brain-damaged. (Well, in a way, they are, but that’s another story). They know perfectly well what the house percentage is. Sure, they hope to hit a jackpot against all odds—but they are also playing for time. One of the sacred casino industry metrics is “time on device,” and addicts put up some impressive numbers, since they are known to do things like pee their pants or ignore a medical emergency, rather than give up their machine.

In the old days, a roulette wheel was more likely to lead to the same result. In the words of the stricken protagonist in Dostoevsky’s The Gambler:

I had lost everything then, everything. I was going out of the Casino, I looked, there was still one gulden in my waistcoat pocket: ‘Then I shall have something for dinner,’ I thought. But after I had gone a hundred paces I changed my mind and went back… there really is something peculiar in the feeling when, alone in a strange land, far from home and from friends, not knowing whether you will have anything to eat that day—you stake your last gulden, your very last! I won, and twenty minutes later I went out of the Casino, having a hundred and seventy guldens in my pocket. That’s a fact! That’s what the last gulden can sometimes do! And what if I had lost heart then? What if I had not dared to risk it?...

I once won a $900 jackpot, and remember being irritated that it took the attendants so long to show up and pay out. Or maybe “pay” is not really the right word. What was that money, exactly? First, it wasn’t $900, it was really $500, since I was down $400 for the evening when I hit. The night before, I was down $250 when I quit. Not big numbers by any means, for a weekend in Vegas, but illustrative of how the numbers work. My $900 payday added up to a net of $250, drinks and room not included. This is an example of the “false jackpot,” a cousin to the “near miss.” A false jackpot occurs when the winnings are less than the wager. A near miss is a design technique where the reels frequently stop so that high-paying symbols appear just above or below the pay line—meaningless from a statistical point of view, but oh-so-close from the gambler’s perspective. 

I have serious tinnitus, the intrusive ringing-in-the-ear condition that can be brought on by a variety of causes, both environmental and neurobiological. Years ago I came down with a version of the condition, called cochlear hydrops, which often evolves into a set of additional symptoms including dizziness, nausea, complete loss of balance, vertigo, and vomiting. Remember that ears are essential for balance and navigation through space, so when things go wrong, it can be very debilitating indeed. But other than hearing loss and that constant roaring in one ear, I had none of the vestibular symptoms.

One weekend at Bally’s, after several hours planted in front of a single slot machine, the old kind, with three reels and cherries and 7s, I uncharacteristically felt like I’d had enough. In fact, I didn’t feel very good at all. And when I finally looked up from the machine, the curving lines of other machines and the swirling pattern of the casino carpet weren’t helping me feel any better. I decided to go to my room and rest for a while. On the way to the elevators, I lurched into a cocktail waitress, spilling drinks off her tray. In my room, I flung myself on the bed just in time to watch the walls beginning to spin. An interesting experience, when you haven’t had any alcohol to drink in years. This was nothing like seasickness, or a hangover. This was an express ride to hell without moving a muscle. Full-on vertigo. Faster and faster went the walls. And when I finally got up and staggered to the bathroom for a glass of water, I made it just inside the bathroom door before an episode of projectile vomiting (my first) convinced me that my gambling days were over.

I have no idea what happened, exactly, or how I have managed so far to have only one major vertigo event due to ear problems. I’m pretty sure that the spinning reels on the hit-the-button-and-go slots set me up for it. I haven’t been back to repeat the experiment. If there’s any better aversive training than vertigo and projectile vomiting, I don’t want to hear about it. Call it serendipity, a not-so-gentle push in the direction of recognizing that casinos were not a healthy place for me to be. Impulse control, risk/reward, anticipation, long-term thinking: these systems are all malfunctioning during active addiction. For recovering addicts, all those buzzes and whistles on the slot machines are like Pavlov’s bells, recalling the old mindset, and priming you for a fall that costs more than money. They now have digital slot machines with 100 pay lines. So I’ve heard. I don’t go there any more.

Photo Credit:  http://vancouvernotvegas.ca/Creative Commons

Congress and the Civil War Over Marijuana

Two lawmakers take a stab at ending federal prohibition of pot.

Two new bills designed to end federal marijuana prohibition and let states set their own policies were introduced today in the U.S. Congress by Rep. Earl Blumenauer (Dem-OR) and Rep. Jared Polis (D-CO). Legislation introduced by Rep. Polis would formally end federal prohibition of pot, while establishing a state regulatory permitting process similar to frameworks used to regulate alcohol. Rep. Blumenauer’s bill would set up mechanisms for taxing marijuana at the federal level.

While President Obama has said that his administration has “bigger fish to fry” when asked about state marijuana crackdowns, the two U.S. congressmen contend that “too many United States Attorneys and drug enforcement personnel are still ‘frying those little fish.’ Only Congress has the power to unravel this mess.”

Rep. Polis’ legislation would also remove marijuana oversight from the Drug Enforcement Administration (DEA), and hand it over to a newly repositioned Bureau of Alcohol, Tobacco, Marijuana, and Firearms. Under the Polis bill, it would remain unlawful to move marijuana from states where it is legal to states where it is not. Meanwhile, Blumenauer’s piece of legislation would give the feds a healthy chunk of income in the form of a 50% excise tax on “first sales” between a grower and a processor/retailer, in addition to possible state sales taxes on a per ounce basis.

The congressional representatives also released a report in which they note that after “decades of failed policies and tremors of varying intensity, the tectonic plates of marijuana regulation abruptly shifted November 2012 as the citizens of Washington and Colorado voted to legalize the drug for personal, recreational use…. These developments have played out against a backdrop of the least effective, and arguably, most questionable front in America’s ‘War on Drugs.’”

Despite recent efforts to reclassify marijuana, pot remains a Schedule I Controlled Substance, along with heroin and LSD, meaning it is considered a drug with high abuse potential and no accepted medical applications. The report notes that more than 660,000 Americans were arrested for marijuana possession in 2011, despite the rapid adoption of medical marijuana laws in 18 states. “This situation has created a gray area,” the report notes, “where medical marijuana enterprises are operating in a patchwork of conflicting state, local, and federal regulations. Common sense suggests that these enterprises have the potential for abuse and other criminal activity.”

Using figures from the 2010 U.S. census, the report contends that more than 100 million people now live in jurisdictions where some aspect of marijuana use is now legally permitted under state regulations. The result? “Confusion, uncertainty, and conflicting government action.”

The congressmen conclude by warning that “no one should minimize the potential harmful effects of marijuana,” and challenged legislators, in their efforts to protect the health and safety of Americans, to “acknowledge when existing mechanisms don’t work, go too far, or cause more harm than good.”

Neither of the bills is likely to pass, although Senator Patrick Leahy (D-VT), who chairs the Senate Judiciary Committee, has said that he plans to hold a hearing on conflicting state and federal pot laws. The Justice Department remains mum on its strategy for dealing with state marijuana rebellions. Former White House drug policy advisor Kevin Sabet, a member of Project SAM, for “smart approaches to marijuana,” told Associated Press that he considered the bills to be “really extreme solutions to the marijuana problem we have in this country. The marijuana problem we have is a problem of addiction among kids, and stigma of people who have a criminal record for marijuana crimes. There are a lot more people in Congress who think that marijuana should be illegal but treated as a public health problem, than think it should be legal.”

Science On the Web and In the Flesh

Thoughts on the ScienceOnline2013 conference.

As a blogger, I write about the science-based investigation of drugs and addiction—but I am not a scientist. Far from it. My educational background is in the Liberal Arts and the Humanities, with a degree in journalism and mass communications. I cover science, and I talk to scientists, but I don’t DO science. And in fact, there is often an adversarial relationship between a journalist and the people a journalist writes about.

A remarkable conference held annually in the Raleigh-Durham Research Triangle, hosted by North Carolina State, attempts to do something about this divide by throwing together 450 bloggers, journalists, editors, scientists, science teachers, public information officers, and science artists—plus a smattering of entrepreneurs, web developers, government workers, librarians, literary agents, and all-around gadflies. A few years ago, a troika of innovative thinkers in the Raleigh area—Boris Zivkovic, Anton Zuiker, and Karyn Traphagen—put together what became the annual ScienceOnline conference. They realized that science writers and scientists were on the same team, and that their mutual business was the effective communication of scientific and evidence-based knowledge. It may sound obvious, but in actual practice, it isn’t.

However, the rise of online science communication means that everybody is talking to everybody else all the time, and that the divide separating the writer from the scientist is permeable under the right conditions. The “Unconference,” as ScienceOnline quickly became known, features a collaborative style of creating and moderating panel sessions—sessions in which, wonder of wonders, the audience is expected to participate as much as the panel moderators. Some panels become more like casual group bullshit sessions than formal laser-pointer presentations by a moderator doing a monologue. (Not that some moderators don’t lapse into monologues, but usually those offenders are professors, so we must forgive them.)

I hate conferences, and generally avoid them. But ScienceOnline caught my interest due to the way it invokes a variety of subtle structures and cues to bring a relaxed, improvisatory, conversational tone to the 4-day event. To begin with, attendance is held to 450 people, who apply on a first-come, first-served basis. Despite pressure to expand as the popularity of the conference has grown, the organizers have chosen instead to encourage Watch Parties in cities around the world. In addition, a constant stream of conference information courses through online social media for months before and after the actual event. Rather than leading to a feeling of exclusivity, this approach puts everyone on an equal footing, scrambling like rock fans trying to score a ticket to a good show before they sell out.

Upon arrival, you find that your standard conference badge has your name on it—but no job title, institutional affiliation, or any other outright clue to whatever the hell it is that you do for a living. In place of that is your Twitter handle, since this conference pulls heavily from a group that is already well entrenched online. Some people know each other; some people are there for the first time, like any conference. Without the obvious indications of rank and hierarchy of employment, people will be much more willing to approach people they don’t know for conversation, is the idea. It is one of the ways that the producers of the conference attempt to move the emphasis from speakers on the stage to conversations between people in the conference café, the lobby, the lounge, the bars... Like atoms banging against each other as the heat rises, attendees trade thoughts, hatch projects, land freelance assignments, and hear from other people about the one thing everyone has in common: the business of communicating the work of science to the world at large—a task that can only become more crucial with time.

The same ethos applies to the sundry sessions and panels that make up the conference. Moderators, who have cooked up the topics and ideas for the panels in group wiki sessions during the previous year, are expected to make some prefatory remarks and then starting fielding questions in order to get a sense of where the audience wants to take the subject. Of particular interest to me this year were sessions about how to be appropriately skeptical when covering scientific and medical studies, how to blog for the long haul, how to navigate the perils and pleasures of explanatory journalism, and how to use history to relate current events in science.

In the end, the conference does what it is intended to do: Provide a comfortable, optimistic environment in which a pack of nerd scientists, rogue journalists, extreme introverts, and knowledge-hungry students can shoot the shit with each other without the distractions of poster sessions and prepared presentations. That may sound like it’s a lot easier to do than it really is. Such conferences are rare indeed, and ScienceOnline2013 is a rare example of the successful blending of conference, convention, and think tank retreat. Plus it’s the only conference I’ve ever gone to where the free goodies turn out to be books. A literal stack of them. Like cocaine to a herd of hyper-literate scientists and professional writers. The registrations costs are absurdly low, the shuttle buses incredibly efficient, the wifi access unbeatable. Early figures indicate a level of coffee consumption somewhere in the neighborhood of 15 gallons per hour. And did I mention the food?

For more on the conference, go to ScienceOnline Information Central HERE.

Novartis Gives Up On Nicotine Vaccine

Another one bites the dust.

Novartis, a leading health care products company, called it quits on its NIC002 nicotine vaccine project, which failed badly three years ago in Phase II studies undertaken with an eye toward government approval. Novartis said it would terminate the license it has for the NIC002 vaccine with Cytos Biotechnology, for which it paid $38 million in 2007. The Phase II study “showed formation of nicotine-specific antibodies in patients but did not meet its primary endpoint of increased smoking cessation,” according to Genetic Engineering and Biotechnology News

Much the same arc was followed by Nabi Biopharmaceuticals, which announced in 2011 that its vaccine, NicVax, had failed to outdo placebos in Phase III clinical trials—the only addiction vaccine to advance that far in the approval process. The company’s own studies had shown happier results in 2007. In regulatory filings, the company claimed that the NicVax vaccine triggered a reliable antibody response, thus preventing nicotine molecules from reaching the brain. The antibodies bind with the nicotine molecules, making nicotine too large to cross the exceedingly fine blood-brain barrier of the brain. Roughly 15 per cent of smokers who received injections of NicVax were nicotine-free after one year in company-funded studies. For comparison, early studies of Chantix as an anti-smoking medication show a quit response rate in the range of 20 per cent for heavy smokers.

As I have previously written, the idea of vaccinating for addictions is not new. If you want the body to recognize a nicotine molecule as a foe rather than a friend, one strategy is to attach nicotine molecules to a foreign body--commonly a protein that the body ordinarily rejects--in order to switch on the body’s immune responses against the invader. A strong advantage to this approach, say researchers, is that the vaccinated compound does not enter the brain and therefore is free of neurological side effects.

There remain a wealth of questions related to the effects of long-lasting antibodies. And it is sometimes possible to “swamp” the vaccine by ingesting four or five times as much cocaine or nicotine as usual.

Drugs that substantially reduce a smoker’s craving for nicotine, like Chantix, may yet prove to be a more fruitful avenue of investigation. While several anti-craving medications have been approved for use by the Food and Drug Administration (FDA), no vaccines have made it onto the approved list. However, as the Genetic Engineering article reminds us, “all is not lost for the vaccine yet: in November of 2010, Duke University, in collaboration with Wake Forest University, commenced a Phase II clinical study with NIC002 performed with 65 smokers that aims to assess how nicotine antibodies, induced by vaccination, affect the pharmacokinetics of nicotine during cigarette smoking. The study is being conducted in the United States with funding from the NIH.”

Photo: Creative Commons / juliealicea1947

Big Tobacco Makes a Move Into E-Cigarettes

“A battery-operated, addiction-based market.”

While the FDA dithered, and health advocates argued, Big Tobacco began placing its bets on the e-cigarette market last year. Tobacco firm Lorillard Inc., the third largest tobacco company in America, bought privately held Blue Ecigs of Charlotte, N.C., for $135 million, driven by what the company says is a market that’s been doubling ever year since e-cigs first arrived from China in 2008.

According to the Wall Street Journal, Blue Ecigs had $30 million in revenues last year, selling through retail outlets like Walgreens, where it competes with e-brands such as NJOY and 21s Century. The FDA has announced vague plans to regulate, and state lawmakers have threatened to ban them outright, or at least place them under the same public smoking bans as cigarettes—bans that some e-smokers love to flout. (E-cigarette manufacturers, based primarily in Asia, quickly changed the electric orange glow at the end of the e-cigarette to a cool shade of blue, to help make clear to bartenders and bouncers that the thing wasn’t a lit cigarette.)

Meanwhile, Reynolds, an industry leader in smokeless products, is developing its own line of e-cigs, and is test-marketing its Vuse and Zonnic brands. “We will be in this category in 2013,” an RJ Reynolds representative said in a CNBC article by Jane Wells. “We have very big plans.”

Altria, the industry giant, is now generating $1.6 billion from smokeless tobacco products, and is expected to make a move into what is viewed as a billion-dollar industry with unlimited growth potential. Last year, the company began testing a new “nicotine-extract product” called Verve, a lozenge that can be sucked or chewed and contains about 1.5 milligrams of nicotine. Late last year, the company reportedly engaged in acquisition talks with e-cig maker Eonsmoke.

Meanwhile, the company that invented the electronic cigarette, Dragonite/Ruyan, is suing practically everybody. And the Argentinean and Venezuelan governments have attempted to ban the use and marketing of electronic cigarettes altogether.

In December, astute American TV viewers may have noticed what looked for all the world like a television commercial for cigarettes—the first since 1971, when Congress banned cigarette ads on TV. It was a commercial for NJOY Kings electronic cigarettes, a brand that currently owns about one-third of the U.S. e-cig market. Patent lawyer Mark Weiss, who founded NJOY, told Time that the company was only competing for the 45 million Americans who are current smokers, not attempting to make new recruits. In the article, Weiss noted three advantages for e-cigarettes: They’re odor free, they don’t burn tobacco, and, at about $8 per e-cigarette, Weiss claims, they’ll last you as long as two regular packs of cigarettes.

When major tobacco companies make moves like this, people notice. “I think they see this as an opportunity to get a seat at the table with opportunities to talk to the FDA about regulation over this growing category,” according to Bonnie Herzog, senior analyst and managing director of tobacco, beverage and consumer research for Wells Fargo Securities. “Lorillard wants to help steer that conversation in the right direction.”

While still a relatively modest market—no more than $500 million, compared to the $100 billion tobacco market in the U.S.—electronic cigarettes have the potential of becoming the most contentious entry in the market for nicotine delivery systems since the advent of the machine-rolled cigarette. “We think e-cigs are to tobacco what energy drinks are to beverages,” Herzog told the media.

Lorillard chairman and CEO Murray Kessler said in an earnings conference call late last year that with e-cigarettes, “you get all of the benefits of not having combustion, but on the other hand you are maintaining the behavior that cigarette smokers enjoyed.” That’s one way of putting it. And according to critics, that’s part of the problem. Anti-smoking activists often view e-cigarettes as gateway products for young adults.

They are cheaper, primarily because of heavy taxes on traditional cigarettes, and produce no second-hand smoke, only steam-like vapor that quickly dissipates. But they have had a rocky start in the U.S. An article in the Winston-Salem Journal in prime tobacco country stated that consumers have “shied away out of safety concerns since most e-cigs are made in China.” Even North Carolina health officials have expressed concerns about “limited regulatory oversight of their contents.” But according to Wells Fargo’s Herzog, Lorillard’s purchase of Blu Ecigs had the effect of “lending credibility and legitimacy to the entire category.”

Brad Rodu, professor of medicine at the University of Louisville, insisted that “tobacco manufacturers have an obligation to smokers to develop, manufacture and sell these vastly safer cigarette substitutes.” In this view, smokers smoke for the nicotine, but it’s the tar that kills them. 

In the same Winston-Salem Journal article, a professor of family and community medicine at Wake Forest School of Medicine said that “many of the carcinogens in tobacco are volatile and would vaporize, and thus be inhaled when heated. I would not recommend that product.”

It seems safe to predict that this “battery-operated, addiction-based market,” as Forbes dubbed it, will be one to watch.