Cigarette smoking remains Washington’s most persistent and costly public health problem, killing more than 8,000 residents annually and driving 1 in 4 cancer deaths statewide, yet harm reduction strategies using FDA-authorized lower-risk nicotine products offer a promising path forward, according to tobacco policy expert Jeffrey Willett.
Smoking costs Washington’s Medicaid program roughly $850 million, an especially daunting amount given projected $3 billion in annual cuts following federal legislation passed in July 2025. Smoking is increasingly concentrated among vulnerable populations, including military veterans, people with mental health or substance use disorders, LGBTQ adults, and seniors. About half of smokers try to quit each year, yet fewer than 1 in 10 succeed using traditional cessation tools alone, such as counseling or medicinal nicotine replacement therapies. Millions are turning to lower-risk, noncombustible nicotine products such as e-cigarettes and nicotine pouches because the burning of tobacco, not nicotine itself, causes most smoking-related diseases—a distinction recognized for years by independent scientists and the FDA, which established a “continuum of risk” for tobacco products.
Current legislative proposals threaten harm reduction goals. As of January 1, thanks to a tax increase passed by the Legislature in 2025, a nicotine pouch costs more in Washington than a pack of cigarettes. Two bills currently under consideration would worsen this disparity: HB 2382 would cut the Modified Risk Tobacco Product discount in half, and SB 6129 would remove the MRTP discount entirely and increase the nicotine pouch tax from 95% to 100%. When less harmful alternatives become harder to obtain or more expensive than cigarettes, fewer adults switch and more keep smoking.
Opponents raise concerns about youth nicotine use, which is legitimate, but youth nicotine use in the United States has fallen to the lowest levels in decades thanks to Tobacco 21 laws, improved age-verification, and sustained education efforts. Policies that blur the distinction between youth protection and adult access risk sacrificing adult lives without delivering meaningful additional protection for youth. Public health has long embraced harm reduction in other areas, from condoms to clean syringes and overdose prevention. Washington can lead by aligning tobacco policies with science.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: http://www.spokesman.com/stories/2026/feb/07/jeffrey-willett-if-we-want-to-end-smoking-harm-red/