Researching safer alternatives to cigarette smoking

Last updated Jan 2010

R & D plan 2003-2012: the quest for safer product choices for smokers

Alternative (smokeless or nicotine) products can, if they contain sufficient nicotine, enable smokers not ready to quit their nicotine addiction, to quit smoking and avoid smoking risk. First, however, we face:

1) Need to correct widespread public misinformation about nicotine. Nicotine addicts smokers, but does not kill them. Government could helpfully fund an information campaign on the relative harms of smoking versus nicotine and smokeless tobacco.

2) Need to encourage smokers to stop smoking, by quitting altogether or by switching to a non-smoke product.

Stopping smoking still requires an act of will. To encourage smokers to stop smoking, government can

• Raise cigarette excise rate and price.
• Increase the salience of media campaigns to encourage smokers to quit or switch.

3) Need for more uniform regulation of nicotine products. Cigarettes, the most lethal nicotine product, can be sold without permission. Yet pure nicotine products can only be sold if registered as medicines (delaying introduction by 2 years). Sale of nicotine products as alternatives to cigarettes is needed (as in USA, where the Ruyan electronic cigarette is on sale as a cigarette alternative in 2008). Permission to sell as a cigarette alternative in New Zealand could be fast tracked if Nicotine regulations were created to provide for alternatives, under the Smoke-free Environments Act.

4) Need to tax tobacco products fairly, according to risk. The tax on snus should be reduced to about one percent of the tax rate on loose tobacco. The tax on RYO smoking is half that of the tax on factory made cigarettes: it ought to be doubled to bring it into line with the risk of smoking any kind of tobacco cigarette, RYO or factory-made.

Health New Zealand Ltd’s 2003-2012 R& D plan to promote safer alternatives to cigarette smoking

Name of product	Barrier to increased sale	Manufacturer	Remarks	Next steps, 2008-09-10	Health New Zealand Ltd role
Tobacco Products
HNZ 1 Firesafe cigarettes	Manufacturers fail to supply market with fire safe cigs.	All cigarette manufacturers	Voluntary agreement in effect.	NZ Standards in 2009 adopt fire- safe standard	In 2003 in Tobacco Control showed RYOs are firesafe. HNZ in 2009 helps set Standard via Standards Committee.
HNZ2 Marlboro UltraSmooth	Our research, and since withdrawn from US market	Philip Morris USA	No safer than a Holiday regular brand	Project complete.	Published research on this cigarette in 2006 in Tobacco Control.
HNZ3 Reduced- nicotine cigarettes (RNC)	RNCs not sold commercially in NZ at present	Vector Tobacco Company	To find whether Quest 3 RNCs (very low in nicotine), if used for 6 weeks with NRT, increase success in quitting.	CTRU begins recruiting for this RCT in April 2009 through to Oct 2010.	Dr Laugesen a co-investigator in this 3 year study (The RELIQ study)
HNZ4 Swedish Snus (moist tobacco snuff)	Requires law change to allow sale. Regulations needed to exclude snuffs not in line with Swedish standards.	Swedish Match	Can’t be sold in NZ. Can only be imported for personal use; cost prohibitive due to tax.	RCT for stop smoking study still needed. Lack of non-tobacco donor.	Co-applicant with Professor Crane, Wellington School of Medicine, to HRC for funds for RCT for stop smoking; Not successful in 2006, 2007, 2008.
HNZ5 Nasal tobacco snuff	Legal to sell, illegal to advertise. Ministry of Health provides no public information on (low) relative harm of snuffs.	Swedish Match	Few repeat sales in 2007-8. Sales cannot succeed while advertising banned.	No further research worthwhile as sales low.	Health NZ research on nasal snuff now complete and displayed at www.endsmokng.org.nz
Nicotine-only products
HNZ 6 Nicotine gum, patch, lozenge	Subsidised by government through vouchers.	Pfizer, Novartis	Aims to elucidate benefits of greater choice for quitters.	CTRU RCT is finished recruiting.	Co-investigator wth CTRU team. (the SONIQ study)
HNZ 7 Nicotine pouch, spray, lozenge.	Sale in NZ requires registration as a medicine. Market small. NN has not yet applied to sell it in NZ.	Niconovum AB. (NN) Helsingborg, Sweden	On sale in Sweden in 2009. Mouthspray also, and gum.	CTRU with HNZ completed PK study** in 2007. NN is selling in Sweden.	Co-investigator with CTRU. (The NEWS study). Study now published. McRobbie, 2009, 2010. .
Electronic cigarette A). HNZ8 PK testing and effect on cravings B) HNZ 9 Benchtop tests	Sale in NZ requires approval as a medicine. Sale is permitted in USA and UK as a cigarette alternative.	Ruyan (Holdings) Ltd, Hong Kong and Beijing, China. Funded by manufacturer	In 2008, Health NZ Ltd is main tester for Ruyan outside of China. In 2008 back-ground paper 2008 written for WHO’s Tobacco Regulation Committee.	PK testing finished, 2009. Submitted for publication.	Co-investigator. (the WIRED study) Contract manager for the funder. To be published early 2010.
				Safety testing completed, 2009. Paper submitted.	Coordinator and principal investigator
HNZ 10 Nicotine inhaler	Not in production. Not registered for sale.	Inventor	Funded.	A novel product tested in 2009.	CHINS (Christchurch Inhaled Nicotine study) Manager. Paper in preparation
HNZ 11 E-cigarette	No study of acceptability to quitters	Ruyan	Applied for funds to 2 funders	Un-successful	Principal investigator
HNZ 12 E-cigarette	No study of efficacy in Smoking cessation	Ruyan	Funds applied for		Co investigator
HNZ 13 E-cigarette	No study of efficacy in Smoking cessation	Ruyan	Funds applied for		Co investigator

*RCT = Randomised Controlled Trial. CTRU = Clinical Trials Research Unit, Univ. of Auckland.

# NHF = National Heart Foundation.

**PK study = pharmacokinetic study to show blood nicotine increased.

© Health New Zealand Ltd 2010