Researching safer, effective alternatives to smoking

 

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28 April 2016

PROMOTE E-CIGARETTES WIDELY AS SUBSTITUTE FOR SMOKING SAYS NEW RCP REPORT

A new report released today from the Royal College of Physicians, London, ‘Nicotine without smoke: tobacco harm reduction’ concludes that e-cigarettes are likely to be beneficial to UK public health. Smokers can therefore be reassured and encouraged to use them, and the public can be reassured that e-cigarettes are much safer than smoking.

Tobacco smoking is addictive and lethal. Half of all lifelong smokers die early, losing an average of about 3 months of life expectancy for every year smoked after the age of 35, some 10 years of life in total. Although smoking prevalence in the UK has reduced to 18%, 8.7 million people still smoke. Harm reduction provides an additional strategy to protect this group of smokers from disability and early death.

Since e-cigarettes became available in the UK in 2007, their use has been surrounded by medical and public controversy. This new 200-page report examines the science, public policy, regulation and ethics surrounding e-cigarettes and other non-tobacco sources of nicotine, and addresses these controversies and misunderstandings with conclusions based on the latest available evidence:

- E-cigarettes are not a gateway to smoking – in the UK, use of e-cigarettes is limited almost entirely to those who are already using, or have used, tobacco
- E-cigarettes do not result in normalisation of smoking – there is no evidence that either nicotine replacement therapy (NRT) or e-cigarette use has resulted in renormalisation of smoking. None of these products has to date attracted significant use among adult never-smokers, or demonstrated evidence of significant gateway progression into smoking among young people
- E-cigarettes and quitting smoking - among smokers, e-cigarette use is likely to lead to quit attempts that would not otherwise have happened, and in a proportion of these to successful cessation. In this way, e-cigarettes can act as a gateway from smoking
- E-cigarettes and long-term harm - the possibility of some harm from long-term e-cigarette use cannot be dismissed due to inhalation of the ingredients other than nicotine, but is likely to be very small, and substantially smaller than that arising from tobacco smoking.

With appropriate product standards to minimise exposure to the other ingredients, it should be possible to reduce risks of physical health still further. Although it is not possible to estimate the long-term health risks associated with e-cigarettes precisely, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure.

The report acknowledges the need for proportionate regulation, but suggests that regulation should not be allowed significantly to inhibit the development and use of harm-reduction products by smokers. A regulatory strategy should take a balanced approach in seeking to ensure product safety, enable and encourage smokers to use the product instead of tobacco, and detect and prevent effects that counter the overall goals of tobacco control policy.

Professor John Britton, chair of the RCP’s Tobacco Advisory Group, said:

‘The growing use of electronic cigarettes as a substitute for tobacco smoking has been a topic of great controversy, with much speculation over their potential risks and benefits. This report lays to rest almost all of the concerns over these products, and concludes that, with sensible regulation, electronic cigarettes have the potential to make a major contribution towards preventing the premature death, disease and social inequalities in health that smoking currently causes in the UK. Smokers should be reassured that these products can help them quit all tobacco use forever.’

RCP president Professor Jane Dacre said:

‘Since the RCP’s first report on tobacco, Smoking and health, in 1962, we have argued consistently for more and better policies and services to prevent people from taking up smoking, and help existing smokers to quit. This new report builds on that work and concludes that, for all the potential risks involved, harm reduction has huge potential to prevent death and disability from tobacco use, and to hasten our progress to a tobacco-free society. With careful management and proportionate regulation, harm reduction provides an opportunity to improve the lives of millions of people. It is an opportunity that, with care, we should take.’

Report summary

Smoking is the biggest avoidable cause of death and disability, and social inequality in health, in the UK.
Most of the harm to society and to individuals caused by smoking in the near-term future will occur in people who are smoking today.
Vigorous pursuit of conventional tobacco control policies encourages more smokers to quit smoking.
Quitting smoking is very difficult and most adults who smoke today will continue to smoke for many years.
People smoke because they are addicted to nicotine, but are harmed by other constituents of tobacco smoke.
Provision of the nicotine that smokers are addicted to without the harmful components of tobacco smoke can prevent most of the harm from smoking.
Until recently, nicotine products have been marketed as medicines to help people to quit.
NRT is most effective in helping people to stop smoking when used together with health professional input and support, but much less so when used on its own.
E-cigarettes are marketed as consumer products and are proving much more popular than NRT as a substitute and competitor for tobacco cigarettes.
E-cigarettes appear to be effective when used by smokers as an aid to quitting smoking.
E-cigarettes are not currently made to medicines standards and are probably more hazardous than NRT.
However, the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco.

"...the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco"

Technological developments and improved production standards could reduce the long-term hazard of e-cigarettes.
There are concerns that e-cigarettes will increase tobacco smoking by renormalising the act of smoking, acting as a gateway to smoking in young people, and being used for temporary, not permanent, abstinence from smoking.
To date, there is no evidence that any of these processes is occurring to any significant degree in the UK.
Rather, the available evidence to date indicates that e-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by confirmed smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely.
There is a need for regulation to reduce direct and indirect adverse effects of e-cigarette use, but this regulation should not be allowed significantly to inhibit the development and use of harm-reduction products by smokers.
A regulatory strategy should, therefore, take a balanced approach in seeking to ensure product safety, enable and encourage smokers to use the product instead of tobacco, and detect and prevent effects that counter the overall goals of tobacco control policy.
The tobacco industry has become involved in the e-cigarette market and can be expected to try to exploit these products to market tobacco cigarettes, and to undermine wider tobacco control work.
However, in the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK.

21 April 2016

New study finds exhaled e-cigarette vapour particles disappear within seconds

A new study being presented today at the 4th Workplace and Indoor Aerosols conference in Barcelona shows, for the first time, that exhaled e-cigarette particles are liquid droplets that evaporate within seconds.

The research - a collaboration between Kaunas University of Technology in Lithuania, EMPA Swiss Federal Laboratories for Materials Science and Technology, ETH Zurich the Swiss Federal Institute of Technology and Fontem Ventures - is the first detailed study of its kind conducted to investigate particles in exhaled e-cigarette vapour.

Speaking from the conference today, Professor Dainius Martuzevicius, Vice Dean for Research at the Faculty of Chemical Technology, Kaunas University of Technology and leading expert on indoor air quality, said: "There is little data available on the properties of exhaled e-cigarette 'particles' in the scientific literature and as a result there is a growing discussion amongst the public health community as to whether the 'particles' exhaled following use of vaping products have potential implications for indoor air quality."

12 April 2006

Are E-Cigarettes a Healthy Way to Quit Smoking?

Electronic cigarettes have an unparalleled potential to reduce the public-health impact of smoking, by allowing smokers to replace the habit and nicotine of smoking without the toxic effects of combustion.

- Dr. Rose is a professor of psychiatry and behavioral sciences and director of the Duke Center for Smoking Cessation at Duke University. He can be reached at reports@wsj.com.

 

10 April 2016

 

Wellington City Council to discuss banning smoking and also e-cigarettes (Vaping)

Question to the Committee: what is the harm of developing dependence on a low cost non-fatal device?

A committee of the Wellington City Council is about to ban use of e-cigarettes on its properties. The debate is on 13 April.

 

According to Dr Joe Nitzkin, former chair of tobacco control for the College of Public Health Medicine in the USA:

 

The bottom lines are these:

1)Imposing restrictions and increasing taxes on cigarettes and smoking will reduce tobacco-related addiction, illness and death.

2)Imposing these same restrictions and taxes on e-cigs will have the opposite effect. It will discourage smokers who would otherwise switch to keepsmoking.

3) Vaping is not smoking and should not be defined as such.

 

 

1 January 2016

Prices exceed $1 per cigarette

 

As from 1 January 2016 the following prices have been charged, representing a 10.3% in excise and inflation as well as similar increases in ex-factory price.

Port Royal $78 for 50 g. ($1.09 per cigarette of 0.7 g).

Pall Mall $21.60 for 20 cigarettes.($1.08 per cigarette).

 

 

7 December 2015

NHS to give out e-Voke

E-voke has been licensed by Medicines and Healthcare Regulatory Agency for medicinal use. The aim is to have these gadgets available for prescription by GPs in 2016.

E-vokes are not an e-cig. They rely on producing a powder, like an inhaler.

Vype e-cigarettes have been licensed but will not be available for some time.

Both products are produced by BAT.

C. Wheeler. Express. 7 December and ASH UK 8 December.

 

 

1 December 2015

Excise expected to rise 10.3%

on 1 Jan 2016

According to NZ Customs Service the new rates will be $668.51 per 1000 cigarettes as from 1 January. Smoking tobacco will cost $666.83 per kg of tobacco content. This amounts to an increase of 10.3% in tobacco price since 1 January 2015. This means a cigarette costing $20 in 2015 could cost $22.06 in 2016, assuming tobacco companies also raise their price by the same percentage.

30 November 2015

Viewpoints: Is the jury still out on e-cigarettes?

Monday, November 30, 2015

http://www.drugfoundation.org.nz/matters-of-substance/november-2015/viewpoints/e-cigarettes

Short of a pill that will magically take addiction away, are e-cigarettes the best smoking cessation device since the humble patch? Or are they just another dangerous addiction,?a gateway device for children or, worse, a sneaky attempt by Big Tobacco to renormalise smoking?

In the May 2012 Viewpoints, Matters of Substance compared the arguments and decided the jury was still probably out on e-cigarettes. A recent report by Public Health England, however, has become the first authoritative declaration that e-cigarettes are safer than cigarettes and by a significant margin.

In this edition, we take a look at the English report and at one of its detractors. Is the jury still out, and should we bother waiting?

Public Health England
In August 2015, Public Health England (PHE) published its commissioned report E-cigarettes: an evidence update, which summarised the findings from two extensive literature reviews.

The report’s conclusions were almost startling. It said the evidence suggests using e-cigarettes is 95 percent safer than smoking and that e-cigarettes have the potential to make a significant contribution to the endgame for tobacco. Its policy recommendations included making e-cigarettes much more prominent in smoking cessation initiatives and streamlining convoluted processes for them to be licensed as quit-smoking aids.

Among the report’s findings was that e-cigarette use by people who had never smoked was extremely low, at around 0.2 percent. Regular use (at least once weekly) by young people is also very rare at just 2 percent, and while there is some youthful experimentation, only 0.3 percent of young people who used e-cigarettes had never smoked tobacco before. It said the most important reason people use e-cigarettes is to reduce smoking- related harms and that, while curiosity plays a role in why some people experiment with them, most of these experiments did not lead to regular use.

It concluded from this that e-cigarettes are “not undermining, and may even be contributing to, the long-term decline in cigarette smoking”.

The report made much of a September 2014 Cochrane Review, Electronic cigarettes for smoking cessation and reduction, featuring New Zealanders Hayden McRobbie and Chris Bullen amongst its authors. The review’s meta-analysis of 600 records found that e-cigarettes can “help smokers unable to stop smoking ... to reduce their cigarette consumption when compared with placebo e-cigarettes and nicotine patches”.

The PHE report also found e-cigarettes do not replicate the problems of second-?hand smoke. They release “negligible levels of nicotine into ambient air with no identified health risks to bystanders”. No concerns were found around the labelling of nicotine cartridges or ‘e-liquids’, and when they were poorly labelled, they mostly contained less nicotine than declared. While acknowledging nicotine is a poison, the report found no evidence of nicotine poisoning to users. The risks of poisoning to others (such as children) or of evices causing fires were found to be on a par with other household electrical goods or substances.

The report’s authors discount recent news headlines reporting high levels of formaldehyde found in e-cigarettes as misinterpretations of research findings. They found no indication electronic cigarette users are exposed to dangerous levels of aldehydes and said this could only happen when e-liquid was heated to “levels unpalatable to users”. Instead, they assert that most of the chemicals causing smoking-related diseases are absent in e-cigarettes and that those that are present pose limited danger.

PHE’s findings have been supported by a number of high-profile medical experts, including UK’s Chief Medical Officer Dame Sally Davies. A September 2015 British Journal of General Practice editorial concluded that, for every million smokers who switched from tobacco to e-cigarettes, more than 6,000 premature deaths would be prevented in the UK every year. If all 9 million smokers took up e-cigarettes instead, 54,000 lives could be saved.

Critique of PHE
The PHE research will probably be music to the ears of the millions of smokers around the world who have turned to e-cigarettes but who may still have niggling doubts that their new drug delivery device is really all that better for their health.

But in one of the greatest parade-raining articles so far this century, Martin McKee and Simon Capewell, writing in the British Medical Journal, are scornful of the research and suggest its foundation is built on sand.

First, they say a recent cohort study shows most smokers who switch to e-cigarettes (80 percent) are still also smoking cigarettes at 12 months (dual use) and that reduced smoking may not reduce overall risk of death.

Next, they attack the Cochrane report, on which the PHE report relies heavily, by pointing out that it included only two randomised controlled trials and that, by its own admission, its evidence had limitations and was of “low or very low” quality.

The claim that e-cigarettes are 95 percent safer gets a particular hiding. McKee and Capewell cite a recent systematic review in Preventative Medicine that found serious methodological problems in many of the studies it reviewed and so many conflicts of interest “that no firm conclusions can be drawn about the safety of e-cigarettes” but that “they can hardly be considered harmless”. They also point out the 95 percent figure does not come from a review of the evidence but from a single meeting of 12 people convened to synthesise their opinions on the harms associated with different products containing nicotine. They point out two of those present had received tobacco industry funding in the past and that some other attendees were known e-cigarette champions

McKee and Capewell also dispute the report’s finding that e-cigarettes are not helping to renormalise smoking. They say a July 2015 survey by the Health and Social Care Information Centre showed more than 20 percent of 11–15-year-olds had used e-cigarettes, and 73 percent of these were non-smokers. An American study, published after the PHE report, they say, concluded that “those who had ever used e-cigarettes at baseline compared with non-users were more likely to report initiation of combustible tobacco use over the next year”.

The McKee and Capewell rebuttal, which points out a number of further perceived problems and inconsistencies, does not claim to prove e-cigarettes are as harmful as smoking tobacco. Rather,?its contention is that the PHE report isn’t sufficiently evidence based to underpin changes in public health policy. And therein lies the rub.

The precautionary principle: for
Many of those opposing e-cigarettes rely pretty heavily on the precautionary principle. It’s a bit like insisting that policy must be evidence based but goes a small step further.

The precautionary principle states that, if an action or policy has a suspected risk of causing harm and there is no scientific consensus that the action or policy is not harmful, the burden of proof that it is not harmful falls on those taking an action. In other words, it doesn’t matter that common sense suggests breathing in vapour containing a handful of chemicals is better than breathing in smoke containing hundreds. Until there is enough evidence to provide scientific consensus that e-cigarettes are safe, we cannot endorse them. This is the view taken by the World Health Organization and by our own Ministry of Health, which currently refuses to recommend any?use of e-cigarettes.

That sort of scientific consensus is probably a long way off. There is little available research on the long-term effects of e-cigarettes because they just haven’t been around long enough.

The precautionary principle: against
Massey University Associate Professor Marewa Glover, who also chairs End Smoking NZ, is less a fan of the precautionary principle when it comes to public health policy. She points out the precautionary principle was used first in the environmental risk arena and that there aren’t any real grounds for transferring it to public health.

“Disease and illness are well established areas, and we have well established practices determining risks to health so we don’t need to rely so heavily on such a ‘guilty until proven innocent’ approach,” she says.

In a randomised controlled trial, where the particular new drug being investigated is clearly working and alleviating harm for the intervention group receiving it, a point is reached where it becomes unethical to continue withholding that drug from the control group. Glover thinks the situation is very similar with e-cigarettes.

“E-cigarettes are clearly working in terms of helping people stop smoking – far more than anything we’ve seen so far. We may not have had many randomised controlled trials yet, but the evidence is definitely mounting, so why make it difficult for people who want to use them?”

She also points out there’s an “uncanny exchange” between falls in smoking rates and rising e-cigarette use in the US and the UK that strongly suggests e-cigarettes help people quit.

“And then there’s the anecdotal stories from millions of people who say their health has improved or that e-cigarettes have saved their lives.?The precautionary principle is being used by people who fear another industry-driven epidemic. But an epidemic of what? What’s the disease?”

Is the jury still out in terms of the safety of e-cigarettes? Not at all, Glover says.

“But the jury is absolutely in on how dangerous smoking is, and there’s ample evidence of its harm. With e-cigarettes, there is no evidence of acute or longitudinal harm whatsoever, even though researchers are looking for it.”

You can buy e-cigarette devices in New Zealand, but nicotine must be ordered in from overseas because it is not licensed here for non-medicinal sale. The case is similar in most jurisdictions, and it’s a major impediment, especially if you’re not well off.

Nevertheless, e-cigarette use is growing just about everywhere, suggesting a lot of smokers aren’t bothering to wait for the jury. The day is probably coming when stances soften and e-cigarettes become more officially sanctioned – perhaps not because there’s been a rush of irrefutable evidence but because our government and Ministry of Health suddenly find themselves woefully behind the times. There’s little doubt e-cigarettes are here to stay.

9 November 2015

How cigarette mortality applies to NZ

smokers

Knowing that smoking kills half of current

smokers, but e-cigarettes do not, it can be

calculated that if NZ has 0.6 million smokers

as at present, a total switch of those smokers

to e-cigarettes would have the eventual effect of saving

half of those smokers (300,000) from predictable

deaths due to smoking. If however, only half

switch to E-cigarettes, smoking deaths

would decrease by 150,000 over the

next 15 years.

 

 

2 October 2015

Cigarette consumption, NZ 2014

 

For the years 2010-2014 the average drop

in consumption was 6.3% across New Zealand,

and the fall was 23%. For 2013-4 the fall was 3.8%.

This was the sum of changes in factory-made and

roll-your-own cigarettes. In March 2013 the Census

showed that a total of 15.1% of adults smoked daily.

In 2014 a total of 1% of smokers consumed e-cigarettes daily.

 

 

1 Oct 2015

Reduced nicotine cigarettes reduces nicotine exposure

In this 6-week study 780 smokers (unwilling to quit smoking) of reduced nicotine cigarettes versus standard cigarettes, reduced their nicotine exposure, and dependence on nicotine, and number of cigarettes smoked, as well as craving during abstinence from smoking. Compensation was minimal.

 

Donny E. et al. Randomised trial of reduced-nicotine standards for cigarettes. N. Engl J Med 2015 Oct 1;313: 340-349.

http://www.nejm.org/doi/pdf/10.1056/NEJMsa1502403

NB: this study argues that reduced nicotine in the cigarette means reduced addiction, and increased effect from increased taxation.

 

 

 

19 August 2015

 

Give out e-cigarettes free in England, doctors told

Doctors should be able to prescribe

E-cigarettes says Public Health England,

as it tried to debunk the myth that 'vaping'

was as bad for health as inhaling tobacco

smoke.. If all of England's eight million

smokers switched to e-cigarettes overnight,

over 75,000 lives a year would be saved,

experts say. Not only are e-cigarettes 20

times less dangerous than tobacco, they

are also among the most effective quitting

aids, they added.

 

Kim Lay, The Times London.

http://www.thetimes.co.uk/tto/health/

news/article4531500.ece

 

 

17 July 2015

Ex-smokers know a thing or two about nicotine!

In the USA, in 2014, 16.7% of adults smoked.

In the USA, 6.3 million smokers used e-cigarettes, and 22% used them daily.

Of nearly 2 million ex-smokers 63% use e-cigarettes daily, and obtained their nicotine only from e-cigarettes.

 

(Vaping nicotine e-cigarettes is illegal in NZ, but smoking cigarettes which gives more nicotine is legal!)

 

Rodu B. 30 million US adults have used e-cigarettes, unpublicised CDC data reveals. Tobacco Truth. 14 July 2015. (based on the 2014 National Health Interview Survey, released June 29).
http://rodutobaccotruth.blogspot.co.nz/2015/07/30-million-have-used.e.html

 

1 Jan 2015

Excise and price up again in 2015

Excise up 10% and price of 20 cigarettes reaches $20, and for 30g RYOs, reaches $30.50. Excise will increase again on 1 Jan 2016.

2 Jan 2014

Murray Laugesen. Nicotine and Health – American Council on Science and Health, New York.

Of special interest to smoking cessation experts and policy makers.

 

This world-first publication (71 pages, 137 references) details

 

1 How nicotine affects your health

2 How smokeless affects your health

3 Electronic cigarettes.

 

To view the free copy see http://acsh.org/2014/01/effects-nicotine-human-health/

(and download.)

For more details please see

www.healthnz.co.nz/News2013

__________________________

 

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Disclaimer: Health NZ has no financial interest in any nicotine or tobacco product or business.


Business: Public good research, in particular:

Researchers on nicotine and tobacco.

Formerly Member, Society for Research on Nicotine & Tobacco.

Advocacy: Safer, effective alternatives to smoking.

Clinical trials and pharmacokinetic research

Risk profile testing of alternatives to smoking products Cigarettetesting.htm Alternatives.htm

Policy analysis and advice;

Consultancy, to reduce heart disease, cancer, and smoking.

Aim: To promote the health of New Zealanders

20 June 2015. Vaping in the USA

10% of US adults are now vaping, compared with a year ago. Almost all of these also smoke. www.trust.org/item/20150610110053-ye2me. and ASH UK London.

For more info on e-cigarettes see

www.endsmoking.org.nz

 

15 July 2015

E-cigs and air unaffected; but smoke kills respiratory cells within 6 hours

E-cigarettes (NJoy brands) vapour has no adverse effect on respiratory epithelial cells in a respiratory model of cells in culture for 6 hours, whereas tobacco smoke from commercial brands in the same time killed such cells, preventing their viability.

Authors from BAT in Toxicology in Vitro 15 July 2015. DOI: 10.1016/j.tiv.2015.05.018).

 

31 May 2015. Smoking in Iceland has diminished from 14.2% in 2012 to 11.3% in 2015. Use of tobacco in the lip (Snus) increased from 1.9% to 3.4% in this period. - Embaetti Landlaeknis Directorate of Health.http://www.landlaeknir.is/um-embaettid/frettir/frett/item27026/Dagur-an-tobaks-31--mai-2015

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27 February 2010: New Nicotine cigarette gives fast delivery of nicotine to the lung. Now published. For the full text report in Experimental and Clinical Psychopharmacology, click here to see

Copying: You are welcome to copy information from this website provided www.healthnz.co.nz is acknowledged as source.

Dr Murray Laugesen

QSO for public services

WHO Tobacco or Health medallist

MBChB NZ, FRCS Edin, MCCM NZ, FNZCPHM Dip Obst

Managing director and public health physician

Adjunct Professor, University of Canterbury (Dept of Pyschology).

On leaving the Public Health Commission in 1995 Dr Laugesen founded Health New Zealand Ltd as his consultancy company. Dr Laugesen has been involved in the prevention of cancer, heart disease and smoking at national level since 1984

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