Mazen Saleh is policy director for the Integrated Harm Reduction program at the R Street Institute and is an expert on harm reduction public policy. He also serves on the board of directors for HIPS, a harm reduction organization and syringe service provider based in Washington, DC.

Decades of comprehensive tobacco control policies have driven a massive decline in cigarette smoking in the United States (US) – from 41% of adults in 1944 to 11% of adults in 2024. Nonetheless, roughly 500,000 individuals continue to die from smoking-related diseases each year, including the 75% of Americans with opioid use disorder. In fact, tobacco-related disease leads to more deaths among people who use drugs than drug use itself. More than half of people in treatment for substance use disorder will die from smoking and quitting is exceedingly difficult.

The emergence of e-cigarettes, a new class of products that contain nicotine without the harms of combustion, holds promise for individuals who cannot or will not quit outright. But while there is a growing body of research supporting the use of e-cigarettes as a viable smoking cessation pathway, and some countries have promoted them, other countries and state and local governments have prohibited them entirely or put up significant regulatory barriers to their use.

This fight over e-cigarettes and novel nicotine products is playing out across the US, where policymakers are rushing to regulate these products. Ideally such policies would balance adult consumer and harm reduction needs with concerns of youth use and initiation, but this is not often the case. It is within this environment that we will discuss the policy landscape of novel nicotine products, exploring various policy mechanisms – from taxation and flavor bans to nicotine caps and prohibition – that have been used in an effort to alter people’s smoking behaviors. The presentation will include a discussion on the types of policies that can unlock access to reduced-risk products for people – including people who use drugs – who may be interested in smoking cessation, but not necessarily abstinence from nicotine.