The VA Needs to Follow the FDA’s Guidance on Smoking Alternatives
COMMENTARY

August 28, 2020by Sean Ullman, COO, Iraq and Afghanistan Veterans of America
U.S. Dept. of Veterans Affairs. (Photo by Dan McCue)

According to Iraq and Afghanistan Veterans of America’s (IAVA) annual member survey 34% of veterans use tobacco products versus 13.7% of their civilian counterparts (2018 data). Smoking cigarettes is detrimental to a person’s health, and quitting is the best path forward. For veterans, who use tobacco products at a rate almost three times their civilian counterparts, the truth is more complicated, as many of their primary health care providers are not presenting every available harm reduction option to help curtail this addiction.

Why is veteran use of cigarettes at such a high level? They may use nicotine to cope with stress, heighten awareness and increase calmness; all of which are important for keeping a level head in the field. The prevalence of cigarettes in the military has created a culture of use and for many veterans, upon separation from the military, a pattern of continued use and addiction.

The Department of Veterans Affairs (VA) functions as both a primary health care provider for many veterans and as one of the country’s leaders in medical research. America’s service men and women rely heavily on the department’s expertise and guidance when seeking treatment. That trust extends to addiction. Veterans who wish to quit smoking have options through the VA; including available cessation programs. Though these programs are known to have mixed results as 50% of IAVA’s tobacco-using members have tried these programs but were unsuccessful. Veterans can also seek out help elsewhere in the form of support groups and over the counter options, including nicorette, the patch, and chantix.  

Following service, a veteran may not want – nor be able – to quit. Thankfully there are other options. Over the past five years, the rise of vaping has become a viable alternative to combustible cigarettes. Instead of inhaling carcinogenic smoke, a user inhales a heated aerosol vapor. 

The US Food and Drug Administration (FDA) is responsible for regulating and authorizing new products like Juul and IQOS for public consumption, as well as approving designations like the Modified Risk Tobacco Product. Applying for a modified risk designation is a rigorous and detailed process. Firstly, a company must demonstrate its product decreases the risk of harm to the user when compared to using a similar product or that its product reduces exposure to harmful chemicals. Additionally, they must demonstrate that the product is expected to benefit the health of the population as a whole, taking into account both users and non users of the product. This means that the FDA will continue to monitor these products to make sure non-smokers are not using them, including youth.  

As of now, the FDA has reviewed IQOS as a Modified Risk Tobacco Product as the only inhaled option to be authorized, joining other modified risk products like Snus by Swedish Match. In the future, other non combustion aerosol nicotine delivery products will need to be put into the FDA’s reduced risk designation pipeline. In fact, the FDA should expedite its review of these products to validate their applicable use and potential benefits over their combustion cigarette counterparts, the more options available for America’s veterans the better.

In the meantime, veterans are relying on the VA for the most up-to-date information on cigarette alternatives. The department should be sharing information about FDA reviewed modified risk options along with cessation programs with every American veteran who checks the “yes” box next to the smoking question on their intake forms, regardless of whether or not they are working towards quitting. Reducing overall harm to smokers can functionally decrease the risk of morbidity later in life, and we owe our country’s bravest all the latest information and tools at their disposal. 

For our veterans seeking assistance, IAVA’s Quick Reaction Force is standing by to connect with any veteran battling addiction to discuss the pathways available to them. Overcoming addiction can be a daunting task, but ultimately achievable with help. Whether through counseling, support, cessation, or harm reduction there are many paths that are less deadly than smoking cigarettes. The FDA must continue to do its part, expediting harm reduction review, and the VA must start doing its part by sharing alternatives with patients and supporting America’s veterans as they continue to fight their addiction battles.


Sean Ullman is COO of Iraq and Afghanistan Veterans of America. Founded by an Iraq veteran in 2004, IAVA is the non-partisan leader in advocacy, public awareness and 1-on-1 care management and peer support. It organizes locallydrives historic impacts nationally and fights for over 400,000 veterans and their allies nationwide. If a veteran or their family is in need of assistance now, please reach out to IAVA’s Quick Reaction Force at quickreactionforce.org or 1-855-91RAPID (855-917-2743) to be connected promptly with a veteran care manager who will assist you.

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