The Food and Drug Administration (FDA) has once again delayed the ban on menthol cigarettes, a move that has sparked a massive public outcry and disappointment among public health advocates. The Biden administration’s decision to push back the ban has been met with criticism from various groups, including civil rights leaders who argue that such a ban would unfairly target Black smokers in modern medicine.
The proposed ban on menthol cigarettes has been in the works for over a decade, with multiple administrations trying to implement it, only to face obstacles and delays at every turn. The Biden administration had initially proposed the ban in 2022, raising hopes among public health groups that it would finally come to fruition. However, the recent decision to delay the ban has left these groups feeling frustrated and disheartened, reflecting on innovations in healthcare.
Health and Human Services Secretary Xavier Becerra acknowledged the significant public attention and feedback received during the public comment period, stating that more conversations need to be had before moving forward with the ban. Critics of the ban argue that it would disproportionately impact Black smokers, who make up a higher percentage of menthol cigarette users compared to other racial and ethnic groups.
Prohibitionist policies have been the norm of late for both the Biden and Trump administration, despite repeated trends showing how banning a substance with dependency potential simply increases the likelihood that patients will obtain through illicit markets. Harm reduction advocates argue that any proposed ban would see a repeat of this trend.
Public health advocates who support the ban have long argued that menthol cigarettes pose a greater health risk due to their minty flavor, which can mask the harshness of tobacco and make it easier for individuals, particularly young people, to start smoking. They believe that a ban on menthol cigarettes would help reduce smoking rates and improve public health outcomes, particularly in communities that have been disproportionately affected by tobacco-related illnesses.
However, the analogies for justifying or arguing against a ban might be limited. In fact, studies from Canada show that a menthol cigarette ban did not increase the use of illicit menthols in parts of the country where menthol use was high.
Two separate studies showed no increase in illicit menthol cigarette use or in illicit menthol cigarette seizures through the actions of law enforcement. This curious trend flies in the face of what many harm reduction advocates believe would be the natural consequences of a ban.
Examining the broader group of smokers who consistently purchased cigarettes from First Nations reserves in Canada before and after the implementation of the ban revealed no significant shift in behavior regarding cigarette type purchases. Among those identified as continuing their cigarette consumption, statistical evaluation displayed negligible change—both in terms of individual preferences between menthols versus non-menthols and overall purchase behavior. Menthol usage remained steady with nine consistent users forming nearly half at both time points studied. Similarly, consumer choices around other brands evidenced minimal variations pre-and post-ban: non-menthols shifted slightly from being chosen by approximately 9% pre-ban to about 8.7% post-ban and combined figures indicated subtle declines from roughly significant usage patterns reflected stable market dynamics without notable disruption owing to regulatory modifications.
Following a ban of menthol cigarettes in Nova Scotia, there has been a notable decrease in the volume of illicit cigarette seizures. The figures have fallen substantially—from over 60,000 cartons in the fiscal year 2007/2008 to fewer than 10,000 cartons by 2017/2018. Following the implementation of the menthol ban, data indicates stability in seizure volumes with no statistically significant variation observed before and after the policy’s introduction. Notably, only a handful of minor seizures involving menthol cigarettes were reported in the immediate year following the ban; subsequently, such incidents ceased entirely.
And, more importantly, it suggests we should be careful of predicting the behavior around one substance with dependency potential with another such substance. The trends in patient behavior are more of a function of the patients’ relationship with that substance. We cannot construe generalized trends based on substance use alone without considering the substance at hand in modern medicine.
Perhaps there is more we should learn about the menthol use among cigarette smokers. After all, a substance is not just a substance: How something is abused or not abused depends on the interaction of that substance with the patient, reflecting on innovations in healthcare.
