Category: Harm Reduction

  • Catch-as-catch-can

    Catch-as-catch-can

    A story in pharmacynews.com.au has thrown some cold water – but not much – on a widely-reported UK study (see Quitting with e-cigarettes, January 31) that found that nicotine-containing electronic cigarettes were almost twice as effective as nicotine patches and gum in helping smokers quit their habit.

    But there was a ‘catch’, the story said. A year after quitting tobacco 80 percent of those who had switched to e-cigarettes were still vaping, while nine percent who had used nicotine replacement therapy (NRT) were still using NRT.

    But that seems to be the limit of the cold water.

    The findings were significant because the NRT users tended to cease treatment prematurely and had higher rates of relapse, Dr. Ryan Courtney (PhD) of the National Drug and Alcohol Research Centre in Sydney, NSW, was quoted as saying.

    “Vaporised nicotine products seem to have quite high user acceptability in terms of the act of using your hands, the sensory-motor aspects,” said Courtney, who is also a senior lecturer in health behaviour science at the University of NSW. “And [users] do actually get enjoyment out of using vaporised nicotine products.”

    But he said the long-term health risks of vaping were unknown, and that GPs and patients should continue to exercise caution.

    “From a harm-reduction approach, vaporised nicotine products frequently do present as a potentially safer option, but there haven’t been the long-term studies that have looked at outcomes,” he said.

  • Prohibition proposed

    Prohibition proposed

    Under a proposal before Hawaii’s state Legislature, cigarette sales would be effectively banned outright by 2024, according to a Hawaii News Now story.

    The ban would go into effect progressively, starting with raising the minimum age for buying cigarettes from 21 to 30 in 2020.

    By 2022, no one under 50 could buy cigarettes.

    And two years later, no one under 100 would be allowed to buy cigarettes.

    The story rated the measure, House Bill 1509, as a long shot. It said it had passed its first reading last week, a procedural hurdle, and had been assigned to committees. But it didn’t yet have a hearing.

    That didn’t mean it wouldn’t get one, the story went on to say, especially after news of the proposal started generating headlines nationally.

    The authors of the bill, two Democratic representatives and a Republican, said the proposed ban simply made sense.

    “The cigarette is considered the deadliest artifact in human history,” they wrote in the preamble to the measure. “The cigarette is an unreasonably dangerous and defective productive, killing half of its long-term users.”

    About 13 percent of Hawaii adults are smokers, which is lower than the national average of 17 percent.

    Hawaii also has one of the nation’s highest cigarette taxes, at $3.20 a pack. And more than a decade ago, the Hawaii Legislature significantly expanded smoke-free zones, and included e-cigarettes in those prohibitions three years ago.

    The measure before lawmakers that would ban cigarette sales would not include e-cigarettes.

  • When quitting isn’t quitting

    When quitting isn’t quitting

    A public health expert in the US has been moved to ask a pointed question of the American Lung Association.

    Writing on his blog, The Rest of the Story, Dr. Michael Siegel (pictured) asked whether the Association really hated smokers so much that it wanted to discourage them from making quit attempts using electronic cigarettes, despite new clinical trial evidence of their superiority to nicotine replacement therapy (NRT).

    On Saturday, Siegel, who is a Professor in the Department of Community Health Sciences, Boston University School of Public Health, referred to a one-year randomized, clinical trial that was published in the New England Journal of Medicine and in which e-cigarettes were compared to NRT as aids to smoking cessation.

    This, the most definitive study yet on the effectiveness of electronic cigarettes for smoking cessation, found that one-year smoking cessation rates with e-cigarettes were nearly twice those obtained using NRT, Siegel said.

    This was great news for smokers, as it suggested that switching to vaping was another smoking cessation option that could be added to those already available.

    Siegel quoted the Association as responding to the study’s results by saying that the US Food and Drug Administration had not found any e-cigarette to be safe and effective in helping smokers quit. ‘We only support methods that are FDA approved and regulated,’ it said. ‘Switching to e-cigarettes does not mean quitting. Quitting means truly ending the addiction to nicotine, which is very difficult.’

    In other words, Siegel said, the Association was saying that despite this clinical trial’s demonstrating that e-cigarettes are probably much more effective than NRT for smoking cessation, they would rather smokers continued smoking than make a quit attempt using electronic cigarettes.

  • Vaping legal but difficult

    Vaping legal but difficult

    Increasing numbers of Saudis are ditching their cigarettes and switching to vaping devices, according to a story in Arab News.

    And they are free to do so because there are no laws banning vaping in Saudi Arabia. Indeed, vapers are free to indulge their habit in public.

    But there is a catch. There are apparently no legal ways to obtain a vaping device or e-liquid.

    The Ministry of Commerce and Investment banned the sale of vaping products in September 2015.

    And Saudi law forbids the sale of such items and considers anyone bringing them in from abroad to be smuggling and, therefore, liable to be fined and have the items confiscated.

    These bans, the News said, were forcing vapers in the Kingdom to seek ‘alternative’ methods of buying supplies – alternative methods whose legality was doubtful, which was leaving vapers unsure if they were breaking the law.

    One problem for the authorities is that while neighboring countries such as the UAE have adopted similar stances towards vaping – selling the equipment is illegal but using it is fine – others, such as Bahrain, are more relaxed about vaping. So Bahrain is a prime location for smugglers sourcing vaping products.

    Many people seem to take a pragmatic view of the situation. Those who spoke to the News called for vaping products to be regulated. “They [vapers] will probably do it anyway,” said a local vaper. “And with Saudi Arabia’s smoking rate being as high as it is, this could be a lucrative area of investment.

    “Tax it. Double the price. Do whatever you have to do. Make it safer for everyone.”

    Saudi Arabia is said to have a high smoking rate, even though the practice is considered taboo. The Saudi Diabetes and Endocrine Association estimates the number of smokers is almost six million. And this figure is expected to rise to 10 million by 2020, or roughly 30 percent of the population.

  • Focus on lung health

    Focus on lung health

    The World Health Organization has said that the focus of World No Tobacco Day 2019 – May 32 – will be on tobacco and lung health.

    According to a note on a WHO website, the campaign is charged with increasing awareness of ‘the negative impact that tobacco has on people’s lung health, from cancer to chronic respiratory disease,’ and ‘the fundamental role lungs play for the health and well-being of all people’.

    ‘The campaign also serves as a call to action, advocating for effective policies to reduce tobacco consumption and engaging stakeholders across multiple sectors in the fight for tobacco control,’ the WHO said.

    The World No Tobacco Day 2019 campaign is due to raise awareness on the:

    • risks posed by tobacco smoking and second-hand smoke exposure;
    • awareness on the particular dangers of tobacco smoking to lung health;
    • magnitude of death and illness globally from lung diseases caused by tobacco, including chronic respiratory diseases and lung cancer;
    • emerging evidence on the link between tobacco smoking and tuberculosis deaths;
    • implications of second-hand exposure for lung health of people across age groups;
    • importance of lung health to achieving overall health and well-being;
    • feasible actions and measures that key audiences, including the public and governments, can take to reduce the risks to lung health posed by tobacco.
  • Traditional quitting

    Traditional quitting

    A hospital in Hong Kong is using acupuncture and counseling to help people quit smoking, according to a story by Li Bingcun for the China Daily.

    The basic course comprises six acupuncture treatments and four face-to-face counseling sessions during the first month.

    If the patient quits smoking during those first four weeks, a practitioner monitors his or her progress at 26 weeks and 52 weeks.

    If the first month’s treatment doesn’t work, patients are encouraged to continue visiting over the following year via a follow-up service, which places no limit on the number of visits that may be made.

    Li said that many smokers had turned to ‘ancient remedies’ in a last-ditch effort to quit their habit.

    More than 10,000 smokers in Hong Kong had used the smoking cessation program offered by the hospital since 2010.

    The program is reportedly Hong Kong’s first smoking-cessation program to be based on traditional Chinese medicine.

  • WHO urged to block its ears

    WHO urged to block its ears

    Public health advocates from around the world today urged the World Health Organization to reject an appeal by the Foundation for a Tobacco Free World to collaborate on tobacco control policies, according to a press note from STOP (Stopping Tobacco Organizations and Products).

    The advocates called on the WHO’s executive board to reject the Philip Morris International-funded Foundation’s appeal to WHO.

    They said agreeing to such collaboration would depart from WHO’s strict long-standing policy of not working with the tobacco industry, whose business practices have been proven to be contradictory with and detrimental to public health.

    ‘When public health experts were alerted to the approach, made in advertisements by the PMI Foundation for a Smoke Free world (FSFW), more than 279 organizations and individuals in 50 countries signed an open letter put forward by STOP …,” the note said.

    But not Clive Bates, who wrote on his blog that he was sent the draft activists’ letter but decided against signing it. He takes a close look at the letter here.

    Meanwhile, Anna Gilmore, professor of public health at the University of Bath and research lead for STOP, was quoted in the STOP note as saying that PMI had “a long and well-documented history of using third parties to infiltrate health policy making”. “No public health gain has ever been achieved by working with the tobacco industry so this latest approach by a PMI-funded entity must be rejected,” she said. “Support to express outrage against the PMI-funded FSFW continues to pour in.”

    The text of the activists’ letter to the director general and executive board of the WHO is below

    ‘We write to you, as members of the global public health community, to express our grave concern at the attempt by the Philip Morris International-funded entity, Foundation for a Smoke Free World (FSFW), to pave the road for partnership with the World Health Organization (WHO).

    ‘Giving any consideration to an organization that is entirely funded by the tobacco industry would fundamentally undermine the significant health and policy gains made to date on the attainment of the Sustainable Development Goals (SDGs) and prevention of noncommunicable diseases (NCDs) through the implementation of the WHO Framework Convention on Tobacco Control (FCTC). It would specifically undermine WHO FCTC Article 5.3 which seeks to protect public health policies from the vested interests of the tobacco industry and on which much of the success of the treaty rests.

    ‘We therefore call on you to reject this approach, in the strongest terms, and reinforce WHO’s 2017 notice to governments and the public health community to reject any affiliation with FSFW because of the “number of clear conflicts of interest involved with a tobacco company funding a purported health foundation, particularly if it promotes sale of tobacco and other products found in that company’s brand portfolio”.

    ‘Analysis of leaked PMI corporate affairs documents suggests that the establishment of the FSFW is consistent with the company’s corporate strategy. The concern is that FSFW effectively operationalizes PMI’s corporate affairs strategy to further PMI’s business interests which include the promotion of its heated tobacco products, a market which PMI seeks to dominate. While PMI and its grantee claim a commitment to reducing harm; reports show that PMIs cigarettes continue to be heavily marketed in ways that attract children and undermine public health policy.

    ‘We are secure in the knowledge that the WHO does not engage with the tobacco industry or its proxies. We trust that you will respond to the PMI-funded FSFW in a manner consistent with the institution’s long-standing principles to protect its credibility and integrity bearing in mind that legitimizing FSFW through engagement would simply advance PMI’s agenda to the detriment of global health.

    ‘In the spirit of promoting partnerships to attain the SDGs, we hope that you will take this opportunity to establish WHO’s leadership in implementing the Model policy for agencies of the United Nations system on preventing tobacco industry interference.

    ‘The health of millions of people requires no less.’

  • Nicotine poses little risk

    Nicotine poses little risk

    A report from the Australian Poisons Centres has confirmed that accidental ingestion of nicotine e-liquid is extremely rare and is usually mild and self-limiting, according to the Australian Tobacco Harm Reduction Association (ATHRA).

    In a note posted on its website, ATHRA said the findings supported the case for legalising and regulating nicotine for vaping as a safer alternative to smoking.

    The study in the Medical Journal of Australia yesterday reported on 202 calls to Australian Poisons Centres for e-cigarette and e-liquid exposure over an eight-year period from 2009 to 2016. Calls were said to have increased as vaping became more popular, but still represented only 0.015 percent of all calls received – fewer than one in five thousand calls.

    Thirty eight percent of the calls were for children, and there were 12 cases of deliberate self-administration by adults for self-harm.

    Most subjects had only mild symptoms. Twelve had moderate symptoms, usually vomiting and sedation. There were no serious reactions or deaths reported.

    ATHRA said the Australian findings were similar to Poisons Centre reports from the US and Europe, which also found that accidental exposure to nicotine e-liquid was usually mild and short lived.

    ‘Although nicotine is potentially toxic, serious reactions from accidental ingestion are rare and most cases make a full and quick recovery,’ the ATHRA note said. ‘Most swallowed nicotine is not absorbed into the bloodstream and much of the remainder is broken down rapidly in the liver.

    ‘Suicide attempts with even very large doses usually result in prompt vomiting. Thankfully there is usually a full recovery but very rare fatalities have occurred in adults and children.

    ‘Nicotine poses no risk to vapers if used in the standard doses as intended.’

  • Wings on, wings off

    Wings on, wings off

    All China’s domestic airlines have been ordered to prohibit immediately smoking and vaping in cockpits, and to punish severely crew members who violate the ban, according to a China Daily story citing a notice issued by the Civil Aviation Administration of China (CAAC).

    The CAAC has ordered airlines to suspend crew members who smoke or vape in cockpits for 12 months for a first offense and for 36 months for repeat offenses. Other crew members who fail to intervene when a member of a cockpit crew is smoking [or, presumably, vaping] were said to be liable to a six-months’ suspension.

    The CAA said that if smoking [and vaping] on a plane resulted in serious consequences, the penalty would be more severe and would be recorded in crew members’ files.

    Smoking was banned in the passenger cabin and toilets of all aircraft in October 2017, but individual airlines had the option to permit smoking in the cockpit for two years. The recent cockpit ban accelerates the original time frame.

    Originally, the rules would not have taken effect until the end of this year, said Zhang Qihuai, a Beijing lawyer specializing in civil aviation. But only Chongqing Airlines and China West Air had implemented the cockpit ban.

    In July, news reports said that an Air China co-pilot who was vaping during a flight from Hong Kong to Dalian, Liaoning province, wanted to turn off the air circulation fan. But he switched off the aircraft’s air conditioning by accident, which diffused smoke [presumably vapor] throughout the cabin and led to the deployment of oxygen masks and an emergency descent.

    The aircraft climbed to its cruising altitude and the flight continued once the problem was identified.

    There were 153 passengers and nine crew onboard. No injuries were reported.

    Zhang said he believed this incident triggered the early enforcement of the regulation.

    “If heavy smokers among the passengers can forgo their habit during flights, there is no reason to make the crew an exception, especially since they are responsible for the safety of all on board,” Zhang said.

  • A plea for civility

    A plea for civility

    In the tobacco harm reduction debate, civility has gone up in smoke, according to a vaping advocate writing at filtermag.org.

    ‘In the pursuit of reducing the harms caused by cigarettes, those of us who advocate for vaping as a public-health harm reduction tool are constantly battling with bullying and harassment, “justified” by moral outrage,’ said Dr. Carrie Wade, who is a senior fellow and the harm reduction policy director for the R Street Institute.

    Wade said that during her first foray into this arena, at the US E-Cig summit in 2017, she was surprised at the level of vitriol she witnessed, at the jeering and boos as different opinions, approaches and research were presented.

    Since then she had experienced such attacks, with the most recent on January 15 when she and her fellow panelists were invited by a state tax board to present on tobacco harm reduction and epidemiology, only to be openly mocked when answering questions from board members.

    But Wade admitted that there were bad actors on both sides. ‘Those who advocate for, or produce and sell e-cigarettes or e-liquids, are also too often guilty of incivility,’ she said…

    ‘Accounts of harm reduction advocates behaving badly are often shared, and there is vitriol on both sides — just look at any Twitter debate around the issue (and yes, I’m ashamed to admit that I’ve taken the bait a couple times myself). It’s easy for those of us on either side of the debate to imagine that the unprofessionalism is one-sided, but that is not the case.’

    Wade pointed out that the major charity Cancer Research UK (CRUK) had recently adopted strict anti-bullying and harassment policies – though these had not been born out of a need to protect those who espoused tobacco harm reduction.

    ‘Anti-bullying and harassment policies should perhaps become much more widespread,’ she said. ‘After all, progress rarely happens without some degree of conflict, but I would argue that it never happens without a willingness to remain civil, to find common ground and compromises. The US surgeon general has correctly pointed this out, stating that personal attacks make future discussion or collaboration unlikely.’