Emirates also has lifted the ban
on the sale of vaping products
Earlier this week,
the Emirates Authority for Standardisation and Metrology (ESMA) announced
the lifting of a ban on the sale of e-cigarettes. For the first
time now, e-cigarettes and vaping devices will be legally sold in the UAE under
new regulations, known as UAE.S 5030, which allow the sale of electronic
cigarettes, electronic pipes, electronic shisha devices plus the liquid
refills.
Under the new
standards, Esma will regulate all nicotine components used in e-cigarettes
including other details such as technical specifications, weight, list of
ingredients, import, packaging, and labeling, among others.
Manufacturers will be allowed to sell the battery-powered products as
long as they meet new standards and carry health warnings. E-cigarettes are
expected to be available in stores from mid-April this year.
This carefully
considered decision was made with the sole aim of protecting public
health.
Until now it has
been against the law for retailers to sell e-cigarette products, although it is
not an offence to own or use one and they are widely available online.
Legalizing these businesses will allow the relevant authorities to oversee the
quality of products they sell and to enforce the prominent display of
appropriate health warnings.
In recent years,
there has been a significant cultural shift from traditional cigarettes to
vaping. In some countries, electronic cigarettes are promoted as an effective
way to quit smoking.
Is
vaping safer than smoking?
Use of e-cigarettes
or “vaping” has always been looked upon with suspicion. This is despite
accumulating evidence, which shows them to be safer than the conventional
combustible cigarettes.
Although generally
perceived to be considerably similar, vaping and smoking are not alike. It
therefore becomes important to understand the distinction between vaping and
smoking.
Smoking is a
practice in which a substance (tobacco) is burned and smoke is produced, which
is inhaled into the lungs and is absorbed into the blood. When combustion
occurs, new chemicals are formed via the process of oxidation. Hence, smoke
contains thousands of new chemicals different from those initially burned.
E-cigarettes do not
produce tobacco smoke, but an aerosol, which is commonly termed as “vapor”.
Vaping is the act of inhaling and exhaling a vapor or
an aerosol. Unlike smoke, when vapor is produced, no new chemicals
are formed. The chemicals that are in vapor are the same as those found in the
vaporized substance.
Therefore, the major
and the most important difference between smoke and vapor is the
presence of toxic tar and carbon monoxide in smoke. “People
smoke for the nicotine, but they die from the tar” (BMJ. 1976) as it
is the tar, which contains most of the mutagenic and carcinogenic agents in
tobacco smoke.
An evidence review
of e-cigarettes and heated tobacco products published in 2018 by the Public Health England has said “vaping is at least 95% less
harmful than smoking.” “An advantage of e-cigarettes is that particular
constituents can be removed or minimised in a way that is not feasible with
tobacco cigarettes.”
As vaping does not
involve combustion, no tar is produced and the resultant vapor has no
carcinogens that are normally found in the cigarette smoke.
Long-term NRT-only
and e-cigarette–only use, but not dual use of NRTs or e-cigarettes with
combustible cigarettes, is associated with substantially reduced levels of
measured carcinogens and toxins relative to smoking only combustible
cigarettes, concluded a study reported in Annals of Internal Medicine in 2017.
According to a study
published in Tobacco Control in 2017. “e-cigarette emissions have much less
carcinogenic potency than tobacco smoke”.
In a report by its
Tobacco Advisory Group titled “Nicotine without smoke. Tobacco harm
reduction” and published in April 2016, the Royal College of Physicians has
said, “Although it is not possible to precisely quantify the long-term
health risks associated with e-cigarettes, 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.”
Do
e-cigarettes help smokers to quit?
A key observation of
the Public Health England report (2018) was that “in the first half of
2017, quit success rates in England were at their highest rates so far observed
and for the first time, parity across different socio-economic groups was
observed. It is plausible that e-cigarettes have contributed to this.”
The RCP further
says, “Large-scale substitution of e-cigarettes, or other non-tobacco
nicotine products, for tobacco smoking has the potential to prevent almost all
the harm from smoking in society. Promoting e-cigarettes, NRT and other
non-tobacco nicotine products as widely as possible, as a substitute for
smoking, is therefore likely to generate significant health gains in the UK.”
A study reported as
recently as January 2019 in the New England Journal of Medicine found that
e-cigarettes were nearly twice as effective as conventional nicotine
replacement products, like patches and gum, for quitting smoking. The success
rate was 18% among the e-cigarette group as compared to 9.9% among those using
traditional nicotine replacement therapy.
Can vaping be the answer for lung cancer
Lung cancer is number one cancer in males in urban India and is linked
to tobacco smoking. In one of the harm reduction conference organised by us it
was concluded that there is no evidence that nicotine causes lung cancer. In a
country like India amongst smokers to prevent lung cancer either they should
quit or shift to less harmful non-tobacco inhalation products.
e-cigarettes cut exposure to carcinogens
(HT)
A recent study sponsored by JUUL Labs
and conducted by Deletion Labs, and independent global research facility found
that electronic cigarettes reduce harmful exposure to addictive nicotine and
chemicals known to cause cancer and present a safe alternative to smoking. The study presented before the Society for
Research on Nicotine & Tobacco 2019 annual meeting in San Francisco on
Saturday has found that some advanced e-cigarettes reduce the exposure to
carcinogens.
The study found that electronic
nicotine delivery systems reduce harmful exposure to chemicals known to cause
cancer and present a safe alternative to smoking. The study was based on a
clinical analysis of biomarkers of smokers, non-smokers and people who vaped
(used electronic cigarettes) using a closed nicotine-salt pod system (NSPS).
The study
‘e-cigarettes cut exposure to carcinogens (HT) Changes in Biomarkers of
Exposure Associated with Switching for 5 Days from Combusted Cigarettes to
Nicotine Salt Pod System’ by Joanna Jay et all explored whether switching from
cigarettes to ENDS may potentially reduce exposure to key toxicants.
Data
was presented from a randomized, open-label, parallel-group, inpatient study of
adult smokers that examined changes in primary urine and blood biomarkers of
exposure (BOEs), relative to baseline, following a 5-day exclusive use period
of the nicotine salt pod system (“NSPS”, JUUL Labs, Inc.) with one of four
flavors at 5% nicotine strength (Virginia Tobacco, Mint, Mango, Crème),
abstinence, or continued use of usual brand combustible cigarettes.
In
the study ninety
subjects were randomized into one of six cohorts: use of JUUL system (n=15 for
each of the four flavors), use of usual cigarette (n=15), or abstinence
(n=15). Total nicotine equivalents, and
the following biomarkers were measured in 24-hour urine collections: NNN, NNAL,
3-HPMA, MHBMA, S-PMA, HMPMA, CEMA, and 1-OHP. COHb was measured in blood.
All
subjects randomized to the use of NSPS (n=60 ITT) and usual cigarettes (n=15)
completed the study; four subjects from the abstinence arm terminated early
(n=11; 73% completion rate in-arm). Over
the course of 5 days, mean total nicotine equivalents increased by 9% in the
pooled NSPS group vs. 26% in the usual cigarette group (p>0.05).
Decreases
in the mean levels of all non-nicotine BOEs were observed in the abstinence
group and all four NSPS groups at Day 5 compared to baseline (Day -1); the
cigarette group demonstrated increases in all BOEs except for 1-OHP and HPMA. The eight non-nicotine urine BOEs were
reduced by an aggregate 85.3% in the abstinence group and 85.0% in the pooled
NSPS group (99.6% relative reduction in aggregate biomarkers; p>0.05).
Similar
reductions were seen in the pooled NSPS and abstinence groups for each
individual BOE (p>0.05 for each analyte). In the usual cigarette group,
these BOEs increased by an aggregate of 14.4% (pooled NSPS vs. usual cigarette;
p<0.001 for each analyte). COHb was likewise reduced by 71.8% in the pooled
switching group vs. 69.1% in the abstinence group (p>0.05), while increasing
by 13.3% in the usual cigarette group (p<0.001).
These results support the
hypothesis that complete switching from cigarettes to the NSPS may lead to
meaningful reductions in multiple key, short-term biomarkers of exposure
observed with combustible use.
Incomplete
switching from cigarettes to NSPS (dual-use) was not studied.
Main points
1.
The urine
biomarkers for adult smokers who used NSPS for five days and those who didn’t
smoke were almost at par, with the NSPS group reporting an aggregate mean
reduction of 99.6% relative to the reduction associated with five days of
abstention.
2.
The subjects were all healthy smokers between
the ages of 22 and 62 years, with a minimum 12-month history of smoking 10 or
more king-size manufactured, combustible cigarettes each day.
3.
The study found equivalent reductions in select
short-term biomarkers of exposure between adult smokers who exclusively
switched to JUUL products and those who abstained from smoking over a five-day
period. (Source Hindustan Times)
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical
Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA
