Category: Harm Reduction

Gateway leads nowhere
The Philippines’s Department of Health (DOH) is stubbornly refusing to consider the growing body of evidence supporting electronic cigarettes as comprising a less harmful alternative to combustible cigarettes and an effective smoking cessation aid, according to an opinion piece by Mary Ann LL. Reyes published in The Philippine Star.
Health Undersecretary Eric Domingo was said recently to have reiterated the DOH’s warning that the use of e-cigarettes was not a good alternative to cigarette smoking and that, because e-cigarettes contained nicotine, the DOH was concerned that vapers would become addicted to nicotine and then become cigarette smokers.
Reyes said that Domingo’s statement was hardly surprising. The DOH followed the World Health Organization position that the only way to reduce smoking was for smokers to quit or die, and that anything less than an abstinence-only approach was unacceptable. Like the WHO, the DOH was highly skeptical of the potential for new technologies, such as e-cigarettes, to reduce smoking-related harms.
What was worrying, Reyes wrote, was the DOH’s stubborn refusal to consider the growing body of evidence supporting e-cigarettes as a less harmful alternative to conventional cigarettes and an effective smoking cessation aid.
February 27 had seen the publication by Public Health England of its latest evidence update summary on vaping.
One of the updated evidence review’s key findings immediately stood out because it ran completely counter to Domingo’s statement. E-cigarettes were not a gateway to smoking.
The evidence showed that e-cigarette use in the UK remained largely confined to those who already smoked or ex-smokers who had now quit using an e-cigarette, while quitting smoking remained the key motivation among adult vapers. The fear that the number of young people using e-cigarettes regularly would increase sharply was not happening in the UK. While experimentation was increasing, vaping among young people remained low at 1.7 percent and was mainly confined to those who already smoked.
March 28, 2019
Health improvements
A study by BMC Public Health has concluded that health professionals should provide balanced information about the possible short- and long-term positive and negative health effects of electronic cigarette use.
The study, Perceived health effects of vaping among Hungarian adult e-cigarette-only and dual users: a cross-sectional internet survey, was said to have been aimed at exploring self-reported adverse events (AEs) and perceived health changes due to e-cigarette use among Hungarian adult e-cigarette-only users (former smokers who switched completely to e-cigarette use) and dual users (smokers who used e-cigarettes and combustible tobacco cigarettes concomitantly).
It was described as a cross-sectional, web-based survey of 1042 adult Hungarian e-cigarette users conducted in 2015, in which participants reported AEs and changes in physiological functions since they switched from smoking to e-cigarette use or while dually using e-cigarettes and combustible cigarettes. Confirmatory factor analysis with covariates was applied to explain perceived health changes due to e-cigarette-only use and dual use.
The results showed that dual users were significantly more likely to report AEs of vaping than were e-cigarette-only users. ‘Experiencing health improvements were significantly more likely among e-cigarette-only users than for dual users for all surveyed physiological functions, the study found.
‘E-cigarette-only users reported larger effects of vaping on sensory, physical functioning, and mental health factors compared to dual users.
‘Self-reported changes in sensory and physical functioning were significantly higher among individuals using e-cigarettes more than a year and people who were past heavy smokers (smoked ≥20 cigarettes per day).
‘Gender was related to sensory improvement only; males reported greater improvement than females.’
The researchers concluded that the majority of e-cigarette-only users reported more perceived beneficial changes in physiological functions and fewer AEs than did dual users.
‘Perceived short-term benefits of e-cigarette use may reinforce users despite the uncertainty of long-term health consequences,’ they concluded.
‘Health professionals should provide balanced information regarding the possible short- and long-term positive and negative health effects of e-cigarette use during consultations with patients.’
March 28, 2019
E-cig education sought
Vaping groups in the Philippines have urged the Department of Health (DOH) to educate smokers about alternative products, such as electronic cigarettes, to help them quit smoking, according to a story in The Philippine Daily Inquirer.
The appeal was made by The Vapers Philippines (TVP) and the Philippine E-cigarette Industry Association after Public Health England published new evidence on vaping.
“We call on the DOH and local health care professionals to look at the latest evidence on vaping from England, a country which is experiencing tremendous success in reducing adult smoking rates,” Peter Paul Dator, the president of TVP, was quoted as saying.
Dator lauded public health officials in the country for doing a good job in raising public awareness about the health risks associated with smoking.
“Unfortunately, their efforts stop there,” he said. “The public should also be educated about alternative products that can help smokers quit.”
March 27, 2019
Pregnant finding
Researchers at the Department of Drug Design and Pharmacology of the University of Copenhagen, Denmark, say that tobacco smokers who become pregnant cannot protect their fetuses sufficiently by undertaking a quit-tobacco-smoking course, according to a story by Stephen Gadd for The Copenhagen Post.
“When a pregnant woman uses nicotine chewing-gum or any other form of nicotine substitute in connection with stopping smoking, she risks damaging her fetus as much as if she’d continued to smoke,” associate professor and brain researcher Jesper Tobias Andreasen, was said to have told BT tabloid.
The negative effects were said to be caused by nicotine’s reducing the flow of blood through the placenta leading to the fetus not receiving enough oxygen to the brain. This could cause conditions such as ADHD, anxiety, depression and addictive tendencies later in life.
Andreasen points out that a ‘stop smoking’ course is all very well but the only safe way to do it is to go ‘cold turkey’ – without any form of nicotine substitutes.
Vaping was said also to present a risk to the fetus because the levels of nicotine in the liquids used contained ‘very variable amounts and often more than normal cigarettes’.
Up to now, the Copenhagen research has been carried out on mice. But Andreasen said that it was known “from extensive studies that people who have been exposed to nicotine in the womb show a higher propensity to ADHD, anxiety, depression and drug abuse”.
The researchers say they intend to publish their findings in a scientific journal within the next couple of months.

March 25, 2019
Problem cannot be patched
Taxpayers in the state of South Australia will pay for nicotine substitutes for prisoners as the state moves to make its jails smoke-free, according to a story by Rebecca Puddy at abc.net.au.
The Department for Correctional Services has estimated that 80 percent of South Australia’s 2,800 prisoner-population comprises smokers, with 75 percent smoking daily.
Under the current smoking rules, prisoners can buy their own cigarettes and tobacco from canteens.
A $2 million bill for nicotine patches and lozenges will form part of the $6.2 million cost to taxpayers of keeping cigarettes out of the state’s prisons in the years to 2022, with additional funding set aside for health and security measures, staff costs and quit support.
The smoking ban has received bipartisan support and strong backing from Cancer Council SA and the Public Service Association, the union representing the state’s prison guards.
Under the current structure, SA Health pays for NRT in prisons that have not enacted a smoking ban but will hand over this cost to the Department for Correctional Services when the ban is introduced at the end of the year.
Under the rules to be introduced as prisons become smoke-free, taxpayers will foot the bill for the first six weeks of a nicotine replacement program, with prisoners required to pay one quarter of the cost for the next three weeks, and 50 percent of the cost for the final three weeks.
Cancer Council SA spokeswoman Alana Sparrow said the Government had worked with stakeholders to develop a “good evidence-based approach”, learning from the experiences of other states.
“We have looked at evaluations in different states and territories – in some it has worked extremely well but we are also learning from the experiences in other states like Victoria,” she said.
A 2018 study of former prisoners in Queensland found 94 percent relapsed to smoking within two months of their release, with 72 percent doing so on the day of their release
March 22, 2019
Taxing balancing act
Indonesia is to follow a policy of foreshadowing cigarette excise increases in such a way as to limit smoking while lessening the impact of any cigarette-sales reduction on tobacco-industry jobs, according to a story at en.tempo.co.
Finance Minister Sri Mulyani Indrawati said the Government had to address two concerns before issuing a regulation on cigarette excise: its impacts on health and the industry.
Sri Mulyani said that the use of tobacco by smokers, especially children, would badly affect their health in the future; so the Government imposed excise on tobacco products in a bid to lessen its consumption.
However, on the other side of the coin, the tobacco industry employed a large number of workers, including tobacco and clove farmers.
Speaking before millennials at a Youth Engagement event at Balai Sarbini, Jakarta, Sri Mulyani implied that, given these circumstances, it was difficult for the Government to decide whether to prioritize individual physical health or economic health.
Therefore, she said, the Government planned to gradually increase taxes based on the roadmap of tobacco excise, which would provide “a signal to the tobacco industry and regional administrations”.
At the same time, Sri Mulyani said, the Finance Ministry, through the Customs and Excise Directorate General, would strive to reduce the illegal trade in cigarettes.
In 2017, the illegal trade was said to have accounted for 10.9 percent of the cigarette market, a figure that fell in 2018 to 7.03 percent.
March 22, 2019
A means to an ENDS
The Broughton Group said yesterday it had launched Broughton Nicotine Services, a spin-off from Broughton Laboratories that will specialise in ‘accelerating safer nicotine-delivery products to market; advancing a smoke-free future’.
‘The launch coincides with the development of a 15,000 ft² CRO [contract research organization] facility (pictured – Karen Ross Photography Studio) in Lancashire [UK] designed specifically to address the needs of the Electronic Nicotine Delivery Systems (ENDS) market,’ Broughton said in a press note.
‘Having operated in this rapidly expanding and changing market for almost 10 years, the company is now perfectly placed to guide ENDS companies through a period of growth and regulatory change.
‘Broughton Nicotine Services raised over £5 million in 2018 to invest in the new facility which includes several specialist laboratories equipped with the latest aerosol collection instruments, high-spec analytical equipment and fully validated software data management systems.
‘An impressive stand-alone stability facility covering all ICH [International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use] storage requirements has been included in this initial phase of developments.
‘Led by a growing team of experienced scientists and analytical chemists, the operation is aligned with capacity for further expansion during 2019 to meet the expectations of its global client base.’
Chief executive Dr. Paul Moran was quoted as saying that there had been a rapid change during recent years within the reduced-risk nicotine products market. “At Broughton Nicotine Services, we are committed to supporting this evolving industry towards creating a smoke-free future through innovations, scientific advancement and regulatory compliance,” he said. “Operating as an independent company within the Broughton Group, specialising in next generation nicotine delivery, will enable us to continue to accelerate the transformation of this exciting industry for our clients.”
March 21, 2019
Round one to e-cigarettes
The High Court of Delhi, India, has stayed the Central Government’s attempt to ban electronic cigarettes in the country under the Drugs and Cosmetics Act, saying that these products do not fall within the Act’s definition of a drug, according to a story in the Bar & Bench, relayed by the TMA.
Two e-cigarette companies, Litejoy International Pvt Ltd and M/S Focus Brands Trading were said to have petitioned the court in response to a February 22 Communication from the Directorate General of Health Services asking state licensing authorities to prohibit the sale, manufacture, distribution, importation and advertisement of e-cigarettes and ENDS [electronic nicotine delivery systems] in their jurisdictions.
The petitioners argued that ENDS were less risky substitutes for combustible cigarettes and that the Government’s decision affected the right of consumers to choose e-cigarettes in place of cigarettes.
Additional Solicitor General, Maninder Acharya, submitted that since ENDS assisted smokers to give up their tobacco addiction, ENDS and all other devices fell within the definition of ‘drugs’ as defined under Section 3(b) of the Act.
The court observed that the devices were not sold as therapeutic devices so the Central Government did not have the jurisdiction to issue the circular.
The government has two weeks to issue its response and the case will be heard on May 17.
March 20, 2019
Looking for change
Knowledge∙Action∙Change (KAC), a private sector public health agency based in the UK, has called for action to prevent the dramatic rises in smoking rates in Africa that have been predicted by the World Health Organization.
In a note issued through PRNewswire, KAC said that while globally smoking rates were decreasing, in many lower- and middle-income countries, African nations among them, rates were increasing. WHO data showed a steep rise in smoking in many African countries, with many five-year projected increases at five percent and more.
With this in mind, public health experts from KAC had this week visited Lilongwe, Malawi, and Nairobi, Kenya, to launch No Fire, No Smoke – The Global State of Tobacco Harm Reduction 2018 (GSTHR), ‘a landmark report on the worldwide availability, regulation, and use of lower-risk alternatives to tobacco, such as e-cigarettes (vapes), heat-not-burn devices, and Swedish snus (pasteurized oral tobacco)’.
‘A proven public health strategy, harm reduction refers to policies, regulations, and actions that reduce health risks by providing safer forms of hazardous products or encouraging less risky behaviors, rather than simply banning them,’ the note said.
‘Independent evidence from the UK Government’s leading public health body demonstrated recently that vaping is at least 95 percent safer than smoking tobacco. Yet despite the WHO Framework Convention on Tobacco Control (FCTC) of 2003 citing harm reduction as one of its main tactics, the WHO has been persistently negative about e-cigarettes, has called for their ban or strict regulation, and sees them as a threat, rather than as a public health opportunity.
‘Partnering with the information dissemination project, Tobacco Harm Reduction Malawi, and the newly launched Campaign for Safer Alternatives based in Kenya, the GSTHR report’s publishers presented global findings on tobacco harm reduction, showing that many smokers have switched to safer products and dramatically reduced the risks associated with smoking.’
“We need to halt the dramatic rises in smoking rates in Africa which are predicted by WHO,” Professor Gerry Stimson, director of KAC and Emeritus Professor at Imperial College London, was quoted as saying. “Most smokers want to quit smoking, but they find it hard to stop using nicotine. Around the world, millions of lives depend on both consumer and government acceptance of safer alternatives to smoking.”
Meanwhile, Chimwemwe Ngoma, project manager, Tobacco Harm Reduction Malawi and holder of a Global Tobacco Harm Reduction Scholarship, said that Tobacco Harm Reduction Malawi believed that all citizens of Malawi should be informed of the health consequences, addictive nature, and mortal threat posed by tobacco consumption and exposure to tobacco smoke. “Malawians should be able to make more informed public and personal choices, including having access to safer nicotine products, to enable them to live longer and healthier lives,” he said.
And Joseph Magero, chair of the Campaign for Safer Alternatives and holder of a Global Tobacco Harm Reduction Scholarship, said society’s relationship with tobacco and nicotine was changing due to technical developments in vaping devices and other safer nicotine products. “The Campaign for Safer Alternatives has formally launched this week to ensure more people across East Africa receive accurate information on alternatives to smoking,” he said. “By arming people with information, we can finally begin to curb the tobacco epidemic.”
March 19, 2019
That’s some ‘problem’
A public health expert in the US has set out to answer a question that has probably popped into many heads in recent times: why does vaping seem so threatening to the tobacco control movement?
Writing on his blog, The Rest of the Story, Dr. Michael Siegel (pictured), a Professor in the Department of Community Health Sciences, Boston University School of Public Health, starts off by saying that he and his colleagues in the tobacco control movement had based their entire careers on the principle that it was wrong to lie to the public.
On the other hand, much of their campaign against Big Tobacco had been based on the contention that cigarette companies lied to the public about the health risks of smoking.
However, Siegel said he believed that during the past few years the tobacco control movement had largely abandoned truth as a central value in so far as its campaigns against vaping were concerned.
Why is vaping so threatening to the tobacco control movement? he asks. Is it threatening because it is extremely dangerous – basically as harmful as smoking – and is therefore harming the health of the nation’s 11 million adult vapers?
No, he replies to his own question; it’s precisely the opposite…
‘The problem with vaping is that it is not killing anyone, so there is no punishment for the vice of being addicted to nicotine,’ he said. ‘And that’s something that the tobacco control movement can simply not tolerate.’
March 19, 2019