Gov. Charlie Baker on Tuesday ordered a four-month ban on all in-store and online sales of vaping products in Massachusetts, citing a need to learn more about health risks associated with e-cigarettes in the midst of a multi-state outbreak of lung illnesses.
The ban, which is the first of its kind in the country, applies immediately to all flavored and unflavored vaping products and devices, including tobacco and both medical and non-medical marijuana.
"We as a commonwealth need to pause sales in order for our medical experts to collect more information about what is driving these life-threatening vaping-related illnesses," Baker said. "We also need to better understand the inherent dangers of vaping both nicotine and marijuana. With all this information we can then develop a set of targeted measures and response."
Since Public Health Commissioner Monica Bharel on Sept. 11 mandated that any unexplained vaping-associated pulmonary disease be immediately reported, 61 cases have been reported to the Department of Public Health. The department, in turn, has reported three confirmed cases and two probable cases to the Centers for Disease Control and Prevention, Baker said.
"Personally, I'm afraid that this may just be the tip of the iceberg," Bharel said at a meeting of the state's Public Health Council.
The governor on Tuesday declared a public health emergency in connection with the vaping-related illnesses, and put his ban before the Public Health Council, which met in an emergency session and unanimously ratified it to a round of applause from doctors and advocates in the audience.
The ban took effect just after 4:30 p.m. on Tuesday after the ratification vote, and lasts through Jan. 25, 2020, according to Baker's office.
The council also approved a statewide standing order making nicotine-replacement products like gum and patches available at pharmacies as a covered insurance benefit without a prescription. Sudders said the order was similar to one previously adopted to increase access to the opioid overdose reversal drug Narcan.
Pediatric pulmonologist Dr. Alicia Casey said she and her colleagues at Boston Children's Hospital have seen multiple teenagers with chronic symptoms, some becoming more severely ill. She called the ban a "critical and necessary step."
"We have had teens with cough, mucus production, difficulty breathing, shortness of breath, low oxygen levels, needing oxygen, breathing tubes and ventilators, not responding to antimicrobial therapies, undergoing multiple tests to uncover the cause and sustaining at minimum temporary but possibly permanent lung damage," Casey said. "We cannot stand aside and allow our children to become the next generation of nicotine addicts."
As of Sept. 17, 530 cases of lung injury associated with e-cigarettes or vaping had been reported to the CDC, and seven deaths were confirmed. Missouri officials announced an eighth death on Sept. 19, and Kansas announced the ninth on Monday.
Though Michigan and New York have previously taken action to ban flavored vaping products, Sudders said Massachusetts is the first state to institute an emergency ban applying to both flavored and unflavored products. President Donald Trump has also announced a plan to remove flavored e-cigarette products from the market.
Sudders said local boards of health will be responsible for enforcing the ban.
"First of all, we expect compliance," she said. "Second is we have the capacity through the local boards of health to institute fines, and/or up to confiscation of products if they're not removed from the shelves."
A group representing convenience stores, the New England Convenience Store & Energy Marketers Association, said in a statement that it "understands Governor Baker's call for a pause in the sale of vaping products as it provides an opportunity to evaluate the source of the illnesses affecting the country and the commonwealth" and will immediately notify members so they can remove vape products from their shelves.
State officials plan to post guidance for retailers online, along with information for youth and parents.
E-cigarette company JUUL Labs said it will fully comply with local laws and federal policy, but criticized the decision by Baker.
"Removing e-cigarettes from the market will create a thriving black market of counterfeit and compatible products, made with unknown ingredients under unknown manufacturing standards, drive former adult smokers who successfully use vapor products back to cigarettes and deny the opportunity for current adult smokers to have alternatives," a JUUL spokesperson said in a statement.
State officials say they are increasing the availability of smoking cessation resources. Meanwhile, a bill that would ban the sale of all flavored tobacco products in Massachusetts began moving through a legislative committee on Tuesday. The bill is sponsored by Rep. Danielle Gregoire in the House and Sen. John Keenan in the Senate.
"The House is committed to addressing vaping and tobacco use among children," House Speaker Robert DeLeo said in a statement. "Earlier today, the Joint Committee on Public Health polled H.1902, Rep. Gregoire's bill. As we continue to learn more about the moratorium, we look forward to collaborating with our partners in the Senate and with the Baker Administration to develop long-term, legislative solutions to these issue."
Senate President Karen Spilka, in a WGBH radio interview, called vaping a "public health crisis" and said she is "in favor of outlawing flavored vaping, tobacco, you know, anything" because flavors target children.
Baker said the flavor ban bill is "one of the things that we would hope would end up being part of the conversation that we would have if we need to pursue legislative answers to this."
Gregoire said she was "a little disappointed" that Baker "didn't give more credit to the Legislature, who was kind of out in front of this issue, and also a little disappointed he didn't point more to the partnership that we could have on this issue." She said that if Baker had voiced explicit support for her bill during the press conference, she was "sure we would have expedited and put it on his desk as soon as possible."
"The more people that come to the table realizing a solution is required, the better off we're going to be," Gregoire said. "At the end of the day, this is about protecting our kids and I don't really care how we get there. We just have to do something."
Keenan, in a statement, said he was glad to see Baker taking action, but believes an "underlying crisis" still exists.
"We need legislation that bans all flavored tobacco products and permanently tells big tobacco that they cannot target our kids with flavors, including menthol, ever again," he said.
Shaleen Title, a member of the state's Cannabis Control Commission, criticized the ban on Twitter, writing that it was a "terrible decision."
"Purposely pushing people into the illicit market — precisely where the dangerous products are — goes against every principle of public health and harm reduction," Title wrote. "It is dangerous, short-sighted, and undermines the benefits of legal regulation."
Based on a one-week sales snapshot provided by the Cannabis Control Commission, concentrates, including vape cartridges, account for roughly 20 percent of all legal marijuana product purchases in Massachusetts. Marijuana flower or buds make up just less than half of all items purchased at licensed stores.
The American Lung Association, in a statement, urged all Americans to stop using e-cigarettes and said Baker's announcement "reinforces the need for the FDA to clear the market of all flavored e-cigarettes in order to address the youth e-cigarette epidemic."
Bharel said public health officials are urging vape users, especially those who may have started using e-cigarettes as a way to quit smoking, not to return to traditional cigarettes.
Colin A. Young contributed reporting.
