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According to the Department of Otolaryngology at UAMS, the normal course of a middle ear infection is for the infection or puss to build up behind the ear drum, causing the ear drum to burst

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[59] The impact of microplastic and macroplastic into the ocean is not subjected to infiltration directly by dumping of plastic into marine ecosystems, but through polluted rivers that lead or create passageways to oceans across the globe

But if not, a massive black market [for cigarettes] will develop, and the authorities will lose control. People will find their way to unregulated markets and this will actually increase their exposure to harm. Even with regular cigarettes fully available, there is already a large illicit market in the US, to evade taxation