The Daily Briefing 6.18.2020

Michigan Governor Gretchen Whitmer was an early advocate last year of banning the sale of flavored vaping products that are responsible for fueling a teenage nicotine epidemic. But courts continually blocked her efforts after the vaping industry filed a legal challenge that eventually left the measure in limbo. Now the state Senate has passed a bill that would specifically allow individuals to sell flavored vaping products, opening the way for legally sanctioned sales.

The bill also imposes an 18 percent sales tax and increases the age requirement for buying tobacco and vaping products to 21 from 18. Republicans backing the bill say it would offer adults a choice whether to use the products. But it does nothing to regulate the vaping industry’s targeted marketing of flavored devices to underage consumers. This has led to a surge in teenage nicotine use, with about 20 percent of high school students saying they vape.

Meanwhile, Texas might be moving toward acceptance of legalized recreational marijuana, due to a huge budget deficit and economic losses caused by the corona virus lockdown. Marijuana decriminalization and legalization area increasingly popular in the state, and are receiving even more attention because of the financial crisis as well as the criminal justice reform movement.

Supporters say opening cash-strapped Texas to retail sales of pot could provide a new source of income for the state. But missing from the discussion are the increased costs of healthcare—and the negative impact on young people—that are likely to result.

The Daily Briefing 6.17.2020

Teenagers coping with drug addiction face daunting challenges, yet there are fewer and fewer specialized facilities that cater to their specific needs. One encouraging trend, however, are high schools designed for students in recovery, including Heartland in Ohio, a state with the second-highest rate of drug overdose deaths in the country. Heartland is the first such high school in Ohio, offering personalized learning, daily mindfulness lessons and group sessions.

Recovery high schools, which have existed since the late 1980s, have grown rapidly since the early 2000s in the wake of the opioid epidemic. Studies show the schools can significantly reduce students’ substance abuse and improve mental health, in part by providing a welcoming, highly structured and supportive environment for teens struggling with addiction.

Meanwhile, an article in Vox looks at methadone—one of the most studied and successful forms of drug treatment—and how its high cost is unmanageable for many patients. Those quoted in the story say they like methadone treatment but that either insurance won’t pay for it or the clinic doesn’t accept their insurance. A 2019 study found that in recent years, coverage for addiction treatment has gotten worse, relative to physical healthy services.

While methadone in its generic form is relative cheap, it costs more as part of addiction treatment largely due to legal requirements for staffing, storage, security and other services. Many of these rules were relaxed during the COVID-19 pandemic—making it easier to both prescribe and distribute drugs such as methadone—which should be studied to determine effectiveness.

The Daily Briefing 6.16.2020

A task force advising presumptive Democratic presidential nominee Joe Biden on drug policy is pushing for him to adopt a broader call for nationwide marijuana legalization. Now, Biden’s official stance includes decriminalizing cannabis possession, federally rescheduling it, expunging prior records, legalizing medical use and letting states set their own policies on recreational.

While that approach covers many of the bases for marijuana reform, some members of the task force say this more moderate position is insufficient and untenable—and perhaps more importantly, would not likely garner support from the progressive wing of the party, which is regarded as crucial for Biden to win the election. This has become more apparent in light of the movement to accelerate criminal justice reform and policing policies, which in the past have led to disproportionately high incarceration rates for drug offenses among people of color.

Racial disparities in drug enforcement have long been a problem, and some believe that treating such offenses as a public health issue—rather than a justice one—is the best way to redress past policies. As Biden formulates his policy on marijuana, he will have to balance calls for criminal justice reform—including marijuana legalization—with the reality that easier access to pot poses risks and dangers of its own, especially for adolescents and young people.

The Daily Briefing 6.15.2020

Drug treatment centers across the country are facing a financial crisis as the corona virus pandemic cuts patient enrollment and threatens funding. Many facilities are seeing fewer patients, due to social distancing regulations, and are concerned about looming state and federal budget cuts due to the economic downturn.

A large percentage of centers have already furloughed or laid off employees, and are running short of cash reserves, while also having to invest in new technology for tele-health services that enable them to treat patients remotely. The crisis comes as drug use and overdose deaths surge during the pandemic lockdown, raising the risk of backtracking on progress fighting the opioid epidemic.

Meanwhile, a new University of Pennsylvania study finds that few patients in Philadelphia receive critical follow-up care after a drug overdose. Only 1 in 6 were in treatment within 90 days of an overdose, although services such as rehab, medications and counseling are deemed essential to help prevent relapse.

There were also racial disparities in Philadelphia—a city with one of the highest opioid-related death rates—as Black patients were half as likely to receive treatment as non-Hispanic whites.

And finally, the vaping industry is looking forward to a post-pandemic summer sales boom as consumers return to “enjoying” nicotine and marijuana vaping products. The execs told Forbes their products are safe, despite the outbreak last year of vaping-related illnesses and deaths and links to worsening symptoms and outcomes for those who contracted Covid-19. There was also no mention of the partial federal ban on flavored products targeted to teens, and accusations the industry has fueled a nicotine epidemic among young people.

The Daily Briefing 6.12.2020

There are growing concerns about mental health issues, including suicide and substance abuse, among the millennial generation born at the start of the 1980s. Facing economic upheaval in the post 9/11 years, and now weathering the global corona virus pandemic and job losses, the Millennials face increasing stress, anxiety and despair, with a resulting 20 percent spike in mortality rates since 2008 for those ages 20 to 34.

Drug-related deaths for this age group more than doubled from 2007 to 2017, while alcohol-related deaths rose by 69 percent and suicides by 35 percent. The uptick is particularly pronounced for young people with less education, who face more financial strain and unemployment with the decline of manufacturing, leading to what is known as “deaths of despair.”

Meanwhile, as debate rages about much-needed criminal justice reform, some Congressional Democrats argue that nationwide marijuana legalization should be on the agenda. The lawmakers believe that eliminating the prohibition on cannabis—and the selective enforcement of cannabis laws in communities of color—would be an important step to promote racial justice. While decriminalization of pot is a sensible goal, the representatives fail to mention the health risks and dangers posed by marijuana to all communities.

And finally, police in Detroit have busted a $41 million opioid ring involving doctors, nurses and pharmacists who had distributed nearly 2 million prescription pain pills. Despite a crackdown on such practices, and increased prescription drug monitoring, the criminal dealings that fueled the national opioid epidemic are still operating—and contributing to the ongoing drug crisis.

The Daily Briefing 6.11.2020

Michigan legalized medical marijuana 12 years ago for certain health problems and allowed adult use for any ailment in 2018. What has happened in that time period? According to a new University of Michigan study, past-month pot use climbed 60 percent—especially among young adults ages 18-25—and one in 30 pregnant women use the drug. The number of fatal car crashes involving a driver under the influence more than tripled to 23.4 percent.

In addition, hospitalizations and emergency department visits increased—with teens and young adults accounting for the largest share of cases. Meanwhile, in Colorado, public perceptions about pot and driving are lagging behind statistical evidence highlighting the risks. A report from the state’s department of transportation says many Coloradans don’t believe that marijuana can impair driving, even as the number of drivers involved in fatal car crashes in the state who tested positive for pot rose sharply each year since 2013, more than doubling since 2018.

The department now wants to build an awareness campaign about the dangers of pot and driving—long after Colorado legalized marijuana. And finally, Ohio’s medical board has rejected proposals to add autism and anxiety to the list of 21 ailments that can be treated with medical marijuana. Opponents of including autism and anxiety said there was not enough data showing the benefits of pot for these patients, adding that such as a move would negatively impact the health and well being of thousands of children.

The Daily Briefing 6.10.2020

The impact of the coronavirus pandemic and lockdown on mental health—including an greater risk of suicide, alcoholism and substance abuse disorder (SUD)—continues to make news. A new report from the Meadows Mental Health Policy Institute points to the link between unemployment and substance abuse, noting that an estimated 10 percent of unemployed adults have a SUD involving an illicit drug, including opioid use, compared to a 3 percent rate for employed adults. In addition, the report says that estimates for the impact of Covid-19 on mental health could be conservative, due to the extreme isolation, fear, psychological distress and job losses it has caused.

Meanwhile, the race for the Democratic Party’s Senate nomination in Massachusetts between Sen. Ed Markey and Rep. Joe Kennedy is heating up over the issue of marijuana legalization. In the not too distant past, both candidates generally opposed legal weed—but now both tout their pro-pot credentials. In a recent debate, each candidate made the case they were quicker than the other to evolve from staunch prohibitionist to endorsing adult-use legalization. For his part, Kennedy noted that his past opposition was related to concerns about youth and adolescent exposure to marijuana, while today he is focusing on the issue of criminal justice reform.

And finally, a federal task force is for the first time recommending regular screening of all adults over 18 for illicit drug use. The new guidance was issued after the U.S. Preventive Services Task Force concluded that there is now sufficient evidence to suggest regular screening, and that testing tools were highly accurate in identifying unhealthy drug use.

The Daily Briefing 6.9.2020

The coronavirus pandemic has stretched hospitals and staff to the limit as they care for a massive influx of patients, including those with symptoms that require ventilators. And with that surge has come exploding demand for injectable opioid painkillers that are used to sedate patients with severe distress in order to complete intubation.

Yet the structure of the opioid market has made it extremely difficult for many hospitals to find these drugs—largely due to the opioid epidemic. Instead of focusing on low-margin injectable opioids for hospital use, pharmaceutical firms have instead catered to more lucrative, high-profit opioid pills, thereby helping fuel the opioid crisis and overdose deaths.

Another issue is the old, and fragile supply chain for injectables compared to the more reliable production and distribution of painkiller pills. As hospitals put in place strategies to cope with future pandemics, it’s time to close the gap between these two applications of the drug to ensure healthcare facilities are always prepared.

And finally, the legalization of medical marijuana has led to numerous theories about its effectiveness treating an assortment  of diseases, including Parkinson’s. But a recent analysis of existing research found that pot doesn’t do much for these patients. In fact, many of the typical side effects of marijuana can exacerbate symptoms of Parkinson’s such as diminished balance and sudden drops in blood pressure, which can be especially dangerous. Pot also amplifies muddy thinking and hallucinations, the report concluded.

The Daily Briefing 6.8.2020

One of the most effective ways to fight the ongoing opioid epidemic is medication-assisted treatment, MAT, a strategy that combines withdrawal medications to reduce cravings with behavioral therapy and social support including peer-based counseling. Yet while MAT has been shown to cut the risk of fatal overdose by as much as 50 percent, only a fraction of the 2 million Americans estimated to have an opioid-use disorder receive such therapy—mainly because not enough doctors are authorized to use it. 

In fact, 40 percent of U.S. counties still have no clinicians permitted to prescribe one of the drugs, buprenorphine, which requires a doctor to take an eight-hour training course. Only one in 10 of the nation’s physicians have done so, even though around 68,000 Americans die every year from drug overdose, the majority opioid-related. To close the treatment gap—especially in rural areas of the country—some advocates propose requiring all medical residents to receive training in treating addiction, in order to integrate treatment into clinical practice.

In addition, they suggest easing the rules for nurse practitioners and physician assistants to prescribe withdrawal medications (they can currently do so but only with a physician’s supervision). All of these proposals warrant close study as we continue to address a national opioid crisis that has killed more than 400,000 over the past two decades.

The Daily Briefing 6.5.2020

More people are taking anti-anxiety medications and antidepressants during the pandemic lockdown, raising fears of long-term addiction and substance abuse of these drugs. The stress, worry and anxiety over becoming infected, as well as fears about jobs, money and economic hardships, are impacting mental health and fueling a spike in prescriptions for these ailments.

Prescriptions for anti-anxiety med rose 10.2 percent in March, while prescriptions for antidepressants increased by 9.2 percent. Some companies have reported even bigger rises: Express Scripts said prescriptions for anti-anxiety drugs rose 34 percent between mid-February and mid-March. Mental health professionals say the increase is worrying, as people can develop a psychological dependence on these drugs that might continue after the lockdown eases.

Meanwhile, as Massachusetts resumes recreational marijuana sales—including more convenient curbside pickup to reduce the spread of corona virus—the state’s cannabis commission has made a very sensible ruling that kids can’t be in the car when the transaction takes place. That would violate the law prohibiting anyone under 21 from being on the premises of a marijuana store, while also raising serious public health concerns.

And finally, Mexican police announced a major drug haul in the border city of Tijuana. The cache included two tons of meth, 8 tons of pot and 131,000 pills containing the powerful synthetic opioid fentanyl. Police said the drugs appeared to be destined for the United States

The Daily Briefing 6.4.2020

The legal landscape surrounding marijuana continues to shift as cities, states and the federal government adapt to ongoing legalization of the drug and its impact on society. In New York City, for example, a new lawthat took effect in May prohibits employers from requiring prospective employees to submit to a drug test for THC, the psychoactive component of marijuana.

The law describes such background testing as an “unlawful discriminatory practice,” but wisely makes exceptions for continuing testing for jobs in law enforcement, childcare and any position requiring a driver’s license. Meanwhile, a recently submitted House bill takes up the issue of impaired driving while under the influence of marijuana, which is emerging as a problem in states where pot is legal.

The bill, introduced by Democratic leaders in Congress, requires legal marijuana states to promote education about the dangers of driving while under the influence of the drug and programs to curb such behavior, to reduce injuries and deaths. A 2019 CDC report found that 12 million Americans said they had driven under the influence of weed in 2018, and urged public health officials to develop standards and toxicology tests for drivers who are high on pot, which do not yet exist.

And finally, doctors are prescribing fewer opioid painkillers to injured workers than they were years ago, according to a workers’ compensation study. Instead of highly addictive opioids, physicians are turning to  non-addictive painkillers, alternative therapies including exercise and massage—or no meds at all. The decline is the result of efforts to curb overprescribing, one of the main drivers of the opioid epidemic. Despite the decrease, however, the report noted that opioids are still the most frequently used painkiller in 10 of 27 states surveyed.

The Daily Briefing 6.3.2020

Lawmakers have asked the Food and Drug Administration to ban sales of the  fast-growing e-cigarette brand Puff Bar, which has become the vaping device of choice among young people through aggressive marketing targeted to that vulnerable age group. Puff Bar gets around the partial FDA ban on some flavored vapes because it is a disposable device—used once and then thrown away—and thereby falls outside the regulations.

Banning sales is critical because Puff Bar blatantly exploits young people with flavors such as pink lemonade and watermelon, and its latest ads appeal to teens stuck at home during the pandemic lockdown. Puff Bar is so popular—with sales of more than 300,000 sticks per week—it is becoming “the new Juul,” the brand that started the vaping boom with its sleek products and slick ads. The call to ban Puff Bar is part of a continuing effort to curb the teen vaping epidemic and e-cigarette use, which has more than doubled among high schools students over the past two years.

It comes amid ongoing concerns over vaping-related illnesses and deaths, and the negative impact of vaping on Covid-19 patients who have severe respiratory complications. It’s time for the FDA to take a more pro-active stance against vaping, especially products deliberately designed to hook teens.

And finally, one purported benefit of marijuana legalization was supposed to be ending the black market for pot. But in California, that hasn’t been the case. In fact, with illicit sales of $8.3 billion compared to $3.1 billion for legal weed, the state is now considering hiring more cannabis cops to patrol the illegal market.  

The Daily Briefing 6.2.2020

There is troubling news from Alaska: a new study by the state health department finds a sharp rise in vaping and suicide among high school students. The report shows one in four students currently using e-cigarettes or vaping products, up from one in six in 2017.

The Alaska results match national surveys on vaping use among teens, an age group that is extremely susceptible to flavored vaping products and targeted advertising. The federal government has implemented a partial ban on some flavored vaping pods and nicotine, but that hasn’t stopped vaping companies continuing to pursue  younger consumers.

Meanwhile, drug overdose deaths are spiking in Canada during the coronavirus pandemic, following a similar pattern in the U.S., as substance users face difficulties accessing treatment and critical medications, and travel bans have disrupted the flow of illicit drugs. And finally, cannabis real estate companies—which lease warehouses for the cultivation and processing of marijuana—are booming, thanks to strong demand for the drug during coronavirus pandemic. Pot sales surged despite the lockdown after most states deemed them to be essential services—alongside pharmacies and grocery stores—and pot enterprises ramped up production to meet pandemic-related demand.

The Daily Briefing 6.1.2020

There is more troubling news about the negative impact of the coronavirus pandemic on drug addiction and overdose: the number of both fatal and nonfatal overdoses in Chicago has skyrocketed over the past five months. There have been at least 924 confirmed or suspected overdose deaths in Cook County during this time—more than twice as many compared with the same period last year. Similar spikes have been reported in many cities and states, as the lockdown has increased anxiety and stress and economic hardships, disrupted drug treatment, and made it more difficult for emergency services to reach individuals in need of medical attention.

Some of these issues are being addressed through changes in federal regulations—for example, easing delivery of medications and access to counseling via telemedicine—but more must be done even as the pandemic hopefully starts to wind down. Meanwhile, with more Americans using pot products while sheltering in place, some analysts say this will push states and the federal government to accelerate marijuana legalization. The states, for their part, need tax revenue to make up for the economic downturn, and are looking to legalization to help close budget gaps.

What they are not counting on, however, is the increased costs legalization will bring for law enforcement and healthcare as a result of wider use. And finally, some strong evidence that banning the sale of flavored e-cigarettes, which are targeted to young people, does in fact curtail use: Finland stopped such sales a few years ago and the rate of teen vaping has dropped dramatically. Vaping is declining among those aged 14 to 17, with under 1 percent of high school students using e-cigarettes, compared to 21 percent in the U.S., where only partial flavored vaping bans have been introduced.

The Daily Briefing 5.29.2020

As the U.S. economy slowly starts to reopen, including the legal cannabis industry, reports say sales are a mixed bag. After an initial surge at the start of the pandemic lockdown, businesses in states where pot is legal—either medical or recreational or both—have reported a subsequent drop off in purchases. While consumers may have simply stocked up on enough weed to relieve shelter-in-place anxiety, analysts say the slowdown in tourism was partially to blame for the slump in states including California, Washington and Oregon, where sales had initially been robust.

Most states allowed pot stores to stay open during the pandemic as "essential" businesses. For pot shops that are struggling, however, don’t expect any help from bankruptcy protection laws. The Justice Department says it will prevent struggling cannabis businesses and the nearly 250,000 workers in the industry from accessing bankruptcy and its financial safety net to weather the coronavirus-related downturn, because that would be a violation of federal criminal law.

And finally, health officials across the country are voicing concern about the appearance of a new “designer” opioid that is circulating among substance users, and might be the cause of a spike in overdose deaths. The drug—which is pressed into counterfeit opioid pills—is derived from a powerful analgesic opiate that has been detected in the blood of people who have died, where it was mixed with cocaine.

The Daily Briefing 5.28.2020

Drug overdoses and deaths are spiking in many regions of the country during the Covid-19 pandemic, less than a year after the Trump administration touted progress in decreasing opioid-related fatalities. Preliminary data from six states show fatal overdoses rising 11.5 percent for fatal overdoses and 18.6 percent for nonfatal cases, as cities including Milwaukee and Memphis report higher numbers.

Meanwhile, the federal government has approved New York City’s program to deliver methadone by mobile vans, easing the way for substance users in quarantine to receive their withdrawal medications without risking contracting the corona virus at crowded drug treatment facilities, where they where obliged to pick up their drugs.

And finally, a rally in pot stock shares fizzles after the debunking of a news report that marijuana and CBD could be a treatment or cure for Covid-19. The erroneous report was based on a preclinical paper that was blown out of proportion by the media. For the record, there is NO scientific evidence showing that any kind of marijuana or CBD product is effective against the corona virus.

The Daily Briefing 5.27.2020

The thousands of opioid lawsuits pending before courts have largely focused on the roles played by prescription painkiller manufacturers and drug distributors to fuel the opioid crisis. Now, a new legal front has opened against large pharmacy chains such as CVS, Rite Aid, Walgreens and Walmart, which had previously eluded scrutiny. The new filings, made by two Ohio counties, assert that pharmacies are also liable because they distributed tens of millions of pills to patients and contributed to the deaths of more than 400,000 people over the past two decades.

The pharmacy chains rarely sounded alarms as a tidal wave of pills landed in small communities, including Ohio’s Lake County, which received nearly 64 million doses of oxycodone and hydrocodone, or about 290 pills for every man, woman and child.

The drug stores, it is alleged, also dragged their feet in setting up monitoring protocols at regional distribution centers, and rewarded pharmacists for churning volume rapidly and never refusing a doctors request. Thousands of opioid-related lawsuits are wending their way through the courts, and these new allegations shed light on how pharmacies must also be held accountable for the suffering and death caused by the epidemic. Meanwhile, the New York Times explores the long and winding road that led to the first FDA-approved, CBD-based drug for a rare form of epilepsy, and how that also spawned a booming market for bogus products with CBD, the non-psychoactive component of marijuana.

While the epilepsy drug was deemed safe and effective, CBD companies used that certification to tout all kinds of fake products and make fraudulent claims that CBD is a cure-all wonder drug—without any scientific validation. And finally, public health officials say they are worried about the growing number of people who are smoking pot while under lockdown to ease anxiety. In fact, smoking or vaping marijuana could leave consumers with irritated, inflamed lungs—and perhaps raise their risk of severe complications if they catch Covi-19. Doctors also suggest people ignore patently false claims that marijuana could ward off the coronva virus.

The Daily Briefing 5.22.2020

There’s nothing like a pandemic to change political thinking about marijuana legalization. That’s what is happening in Pennsylvania, as some Republican legislators are having a change of heart about legalizing recreational marijuana in order to plug a hole in the state budget that has been ravaged by the corona virus-related economic downturn. The lawmakers, who until recently had opposed such a move, are looking at an estimated $4 billion in tax losses, and see that other states—including Illinois, Colorado and California—are reaping a tax windfall from pot sales, spurred by a surge of panic buying during the pandemic.

While experts agree that tax revenue from marijuana alone would not solve Pennsylvania’s budget problem, the extra funds would of course be helpful. Still, what legislators are not counting is the extra cost to healthcare and law enforcement that legalization is likely to incur. While the pandemic continues to impact state government finances and operations, rushing through recreational marijuana legalization to help lower the budget deficit is not sound reasoning—and could in the long run have a negative effect on communities and public health.

Meanwhile, an appeals court in Michigan has upheld an injunction against the state’s ban on flavored vaping products, making the order unenforceable for the time being. Gov. Gretchen Whitmer’s public emergency declaration in September against flavored vaping products was aimed at stopping the surge in teen nicotine use and addiction, but the judges described it as “government overreach.” It’s not clear if the state will continue to litigate the issue in the courts, allowing vaping companies in the meantime to continue luring young people with flavored products.

The Daily Briefing 5.21.2020

Massachusetts is starting to reopen its economy, and that includes recreational marijuana dispensaries that were shuttered during the corona virus lockdown—a controversial decision by Governor Charlie Baker that generated much debate both in the state and nationwide over what constituted “essential” services. Baker stuck to the order, saying he didn’t want tourists flocking to Massachusetts to buy pot and spread the virus.

But now that the ban has been lifted and weed shops resume selling recreational marijuana, the state is easing rules on salesand delivery in the name of public health and safety. That includes allowing online and phone commerce as well as curbside pickup, in order to maintain social distancing and other protective measures, but which will make it easier to access cannabis and perhaps encourage consumers to flout age and other restrictions. Hopefully, the state will revisit the regulations once the pandemic has eased, also in the interest of public health and safety.

Marijuana commerce is also the subject of a commentary in the L.A. Times, by a mom in California who is dismayed by the in-your-face advertising and marketing she sees on a tour of marijuana shops and simply driving around the city. As she notes, pot is promoted on every street corner and by every social influencer with appealing ads aimed at luring susceptible young people. The ubiquity of pot shops and how cool they look and their pervasive promotion can feel disturbing, she concludes, sending the wrong message to susceptible teens and influencing their choices.

The Daily Briefing 5.20.2020

Within a few weeks of the first cases of corona virus being diagnosed in Wuhan, China, real-time data collection concerning the disease was available. Public health officials, scientists and healthcare workers could easily monitor the spread of the virus and its effects, with the data helping to determine health policy and responses. Yet when it comes to the opioid epidemic—which has killed more than 400,000 Americans over the past two decades—we are lagging behind by up to two years in the collection and dissemination of real-time data, and that is having lethal public health consequences, a commentary in STAT argues.

When figuring out addiction policies, and allocation of funding for treatment programs, we are relying on outdated information that does not accurately reflect the current situation as drug use and patterns change. It’s time to bring this kind of real-time outcome data to America’s addiction crisis and make it available to the public, so we know if what we are doing to address the opioid epidemic is making a difference.

And finally, New York State’s long-awaited ban on the sale of flavored e-cigarettes and vaping products, which are highly attractive to young people, has gone into effect. New York becomes the fourth state to ban flavored vaping over concerns about the surge in teen vaping and related breathing illnesses. According to data from the state health department, e-cigarette use among high school students soared to nearly 28 percent in 2018 from 10 percent in 2014—making the ban on flavored products a wise policy decision.