Category: Harm Reduction

  • New end game in sight

    New end game in sight

    Due to the rapid take-up of alternative tobacco devices in Japan and South Korea, Philip Morris International is looking to begin talks with governments within five years on phasing out traditional cigarettes, according to a story by Jackie Horne for asia.nikkei.com.

    Horne said the time frame was based on projections of when the number of people using ‘new smoke-free devices’ would overtake the number of people smoking traditional cigarettes in those two countries.

    “If you extrapolate the figures, then logically we could reach the tipping point in five years,” CEO Andre Calantzopoulos reportedly told the Nikkei Asian Review in a recent interview in Seoul.

    “That is when we could start talking to governments about phasing out combustible cigarettes entirely.”

    ‘Calantzopoulos, who became chief executive in 2013, has staked his company’s future on next-generation devices it claims can reduce toxicity by as much as 90 percent,’ said Horne. ‘These include the IQOS device, which heats, rather than burns, tobacco packed into what resemble mini cigarettes.’

    Calantzopoulos was quoted as saying that Asia was extremely important to the company as it implemented its strategy of phasing out conventional cigarettes.

    The region was home to 60 percent of the world’s more than one billion smokers and Japan was the first and still the most successful market for IQOS.

    Consumer take-up in South Korea, where sales began on a limited basis in late May, had also been encouraging.

    Horne’s piece is at: http://asia.nikkei.com/Business/Companies/Japan-South-Korea-face-tipping-point-Philip-Morris-CEO?page=1.

  • Casino risk lottery ending

    Casino risk lottery ending

    Macau’s Legislative Assembly on Friday approved a revised bill on tobacco smoking that will require the ‘very-important-people’ areas of the city’s more than 30 gambling establishments to set up smoking lounges, according to a story in World Casino News quoting the GGRAsia news agency.

    The background to the story is that, in October 2014, the government of Macau banned smoking on ‘mass-market’ casino floors as part of regulations that provided for the establishment of fully-enclosed and games-free smoking lounges.

    These smoking restrictions did not apply to those parts of gambling establishments that were reserved for so-called ‘very important people’.

    But Macau’s newly amended Regime on Tobacco Prevention and Control, which, it was reported, is due to come into effect on January 1, is said to give the city’s casinos one year to install smoking lounges, absent of gaming facilities, in their very-important-people areas.

    Under the regulations, all the smoking lounges in the city’s casinos will be required to conform to enhanced technical standards, which will be determined by the government in a separate executive order.

    The news agency reported Macau Health Bureau data as having indicated that, in the first half of 2017, 328 people had been fined for smoking in unauthorized areas inside Macau’s casinos.

    Of those fined, 83.5 percent were reportedly tourists.

  • IQOS aimed at GCC states

    IQOS aimed at GCC states

    Philip Morris International is in talks aimed at introducing its IQOS heated-tobacco product to member states of the Gulf Co-operation Council (GCC), according to arabianindustry.com.

    It wasn’t stated in the report with whom PMI was in talks.

    Lana Gamal-Eldin, director corporate affairs Middle East, Philip Morris Management Services (Middle East), was quoted as saying that IQOS was available in 25 markets around the world.

    And by the end of this year it was expected to be in key cities or nationwide in 30-35 markets, subject to capacity.

    “The GCC is very important for us and we hope to make the product available as soon as proper regulations are in place and as our international manufacturing facilities step up,” said Gamal-Eldin.

  • E-liquid policy must change

    E-liquid policy must change

    The head of the Australian Drug Law Reform Foundation has told a federal parliamentary committee that the country’s policy on e-liquids must change, according to an Australian Associated Press story.

    Electronic cigarettes are licit products in Australia but the sale and possession of the nicotine used in them is illegal.

    Dr. Alex Wodak, a retired doctor, cited a major study by a public health agency in England that found electronic cigarettes were about 95 percent safer than were combustible cigarettes.

    Australia should facilitate easy access to a diverse range of products, such as flavoured nicotine liquids, that would appeal to smokers who wanted to quit, he said.

    “It’s very important, in harm reduction and public health generally, to have your intervention [be] attractive to the people most at risk,” he said.

    “I think having a vibrant vaping community network, through the distribution of vaping shops, is very important from a public health perspective.”

    Meanwhile, Colin Mendelsohn, an associate professor in the School of Public Health and Community Medicine at the University of NSW, said Australia’s policy focus on abstinence when it came to smoking was naive in the face of another option: harm minimisation.

    “The reality is that many smokers are unable or unwilling to quit,” said Mendelsohn, who is a GP and tobacco treatment specialist helping smokers to quit. “We can’t just sacrifice them.”

    The committing is hearing from experts about how the health risks of electronic cigarettes and combustible products compare, and how such products should be regulated.

    The AAP story is at: http://www.sbs.com.au/news/article/2017/07/12/doctors-plead-e-cigarette-reforms.

  • Harm reduction opposed

    Harm reduction opposed

    Professor Chia Kee Seng, dean of the National University of Singapore’s Saw Swee Hock School of Public Health has warned against smokers switching to heat-not-burn (HNB) tobacco products, according to a story by Lin Yangchen published by straitstimes.com.

    The Times indicated that Chia was not impressed by claims that some HNB products delivered 90 percent fewer toxins than did regular cigarettes.

    “Ten per cent of a highly toxic product still makes it highly dangerous. Simply put, there is no safe level of smoking.”

    Chia said that HNB products and electronic cigarettes, many of which are banned in Singapore but are bought online, continued to make it difficult to achieve the ultimate aim, which was to “de-normalise smoking”.

    Chia champions raising the minimum legal smoking age, something that is being considered by the authorities in Singapore.

    Studies had shown that people who did not start smoking before they were 21 years of age were unlikely ever to begin. At the same time, the younger people were when they first started smoking, the more likely they were to become habitual smokers.

    Singapore should follow Australia and other countries that required the standardized packaging of cigarettes, Chia added, thereby removing the power of branding to give the perception that smoking was acceptable.

    The Times reported that the latest slew of changes to Singapore’s anti-smoking policies had come as the government’s drive to get more people to quit the habit and slowed.

    Although the incidence of adult smoking in Singapore fell progressively from 23.0 percent in 1977 to 13.3 percent in 2013, it has been stuck at that level since then.

  • Health improvements noted

    The Spanish vapers’ association, Anesvap, has published research results that confirm what other studies have shown: that vaping does not act as a gateway to smoking for young adults, that vaping is not as addictive as smoking, and that vaping dramatically reduces smoking rates, according to a story by Diane Caruana published on vapingpost.com.

    The research suggests that 99.6 percent of vapers in Spain are adults and that the average age is 38.5 years. They comprise about 80 percent men and 20 percent women.

    The average nicotine concentration vapers use when they first start vaping is 11.42 mg/ml, while the overall average concentration is 4.04 mg/ml.

    More than 85 percent of the study subjects stated that the wide array of flavors available were important in enticing them to switch from smoking to vaping, a finding that is in line with what many public health experts have been saying in response to e-liquid flavour bans.

    Ninety percent of respondents said that they started vaping in a bid to improve their health, and more than 92 percent of those said they had detected improvements in their health.

  • KT&G to launch HNB device

    KT&G to launch HNB device

    KT&G has said that it will this year launch heat-not-burn (HNB) tobacco products in response to the growing popularity of these smoke-free devices, according to a Yonhap News Agency story.

    South Korea’s biggest tobacco manufacturer is due to begin marketing the new product in September, a KT&G official said.

    Phillip Morris Korea (PMK) began selling its IQOS HNB product on the local market on May 27.

    “We are witnessing the growing popularity of IQOS, although it’s not been so long since its launch in South Korea,” a PMK spokesperson said, while refusing to elaborate on the level of sales.

    PMK was quoted as saying that IQOS released about 10 percent of the toxic substances emitted by conventional cigarettes.

    ‘IQOS heats the tobacco just enough to release a flavorful nicotine-containing vapor without burning it,’ it said.

    ‘The tobacco in a cigarette burns at temperatures in excess of 600 C, generating smoke that contains harmful chemicals. But IQOS heats tobacco to much lower temperatures, below 350 C, without combustion, fire, ash, or smoke. The lower temperature heating releases the true taste of heated tobacco.’

    British American Tobacco (BAT Korea), meanwhile, was quoted as saying that it would follow suit in August with the sale of its Glo HNB device and Neostiks, the consumable item used with the system.

    ‘Initial production of Neostiks in the Sacheon Factory is planned for export to Japan and for preparations for launching Glo in Korea,’ BAT Korea said on its web site.

    ‘Neostiks, specially designed tobacco sticks for Glo, are heated by the device to create a vapor with an experience similar to that of a cigarette but with reduced potential for risk.’

  • No kudos for vaping

    No kudos for vaping

    Vaping advocates, particularly in the UK, have been left outraged after claims about the country’s falling smoking rate made no mention of vapor products or, indeed, harm reduction, according to an opinion piece by Fergus Mason published on vapingpost.com.

    On the 10th anniversary of the ban on smoking in pubs, most press releases and blog posts had focused on the fall in the incidence of smoking that had occurred since the ban was introduced – from around 21 percent in 2006 to just over 16 percent now, Mason said.

    But, in fact, the figures showed that smoking rates in the UK had been falling for years before the ban.

    Moreover, they showed that from 2007 to about 2011 this decline had stopped.

    ‘Smoking rates didn’t start heading down again until e-cigarettes became popular several years later, and then they began dropping at an unprecedented speed,’ Mason said.

    ‘However, you wouldn’t know this from the self-congratulatory outpourings from pressure groups.

    ‘ASH, who claim to be supportive of vaping, didn’t mention tobacco harm reduction at all in their numerous statements on the ban. Instead they credited the fall to plain packs, which were only introduced this May, and the ban on smoking in cars with children.

    ‘Cancer Research also failed to mention vapor products.

    ‘However, a statement by Public Health England [PHE] made clear that vaping had played a role in the decline.’

    Meanwhile, Mason reported a British politician as having criticised the EU’s approach to vapor products, saying the Commission’s scaremongering could have a “perverse effect” and risk reversing progress made on reducing smoking.

    ‘Anne Main, the Conservative MP for St Albans, highlighted the landmark 2015 PHE report which estimated vaping to be at least 95 percent safer than smoking, and argued that the UK is not doing enough to support science-based solutions to tobacco use,’ Mason said.

    ‘She said that continuing with the regulations in their current form was likely to make this worse.

    ‘In particular, she said the use of health warnings similar to the ones on tobacco could dissuade people from making the switch to reduced-harm products.

    ‘Main also urged the British government to rethink the regulations once the UK has left the European Union.’

  • IQOS under scrutiny

    IQOS under scrutiny

    Government authorities in South Korea said today they would be examining from next month the heated-tobacco product IQOS for any health risks it might pose, according to a Yonhap News Agency story.

    IQOS, went on sale locally in June.

    At a press conference in May called to announce the June launch of IQOS in Korea, Philip Morris Korea was quoted by The Korea Herald as saying that the device’s heated tobacco sticks delivered similar levels of nicotine to that delivered by traditional cigarettes, but reduced the exposure to harmful or potentially harmful chemicals by 90 percent.

    The Yonhap story quoted that the Ministry of Food and Drug Safety as saying it would verify the claims. It said it would measure nicotine and tar levels.

    Meanwhile, heated-tobacco products and electronic cigarettes were said to be ‘under scrutiny for their tax benefits’. These products attracted taxes that were 50-60 percent of those that were levied on conventional cigarettes.

    Opposition lawmakers have introduced a revision to existing rules that would hike taxes on heated tobacco products and electronic cigarettes since, the lawmakers say, they, like conventional cigarettes, use tobacco.

    Their move is supported by the drug safety ministry.

  • Gathering steam

    Gathering steam

    Tobacco harm reduction took center stage at the recent Global Forum on Nicotine in Poland.

    By Stefanie Rossel

    The fourth annual Global Forum on Nicotine (GFN) took place in Warsaw, Poland, June 15–17. Under the theme “reducing harm, saving lives,” this year’s conference attracted 350 delegates from 54 countries. Attendees not only had the opportunity to listen to almost 50 lectures, but they could also study a variety of posters explaining the most recent research in the field of reduced-risk products.

    The GFN is funded exclusively by registration fees, and it attracts a broad base of stakeholders involved with new and potentially safer nicotine products. Participants include academics, public health experts and parliamentarians, along with manufacturers and distributors. Consumers and consumer advocacy groups are involved as well.

    The conference was preceded by ISoNTech, an international symposium on nicotine technology, which made its debut this year. Opened by Hon Lik, widely regarded as the inventor of the modern e-cigarette, it gave tobacco companies an opportunity to present research related to their nicotine delivery devices. Tobacco-heating products (THPs) featured prominently this year. Studies conducted by manufacturers suggest these devices deliver significantly lower levels of toxins than do combustible cigarettes.

    The GNF was opened by Ethan Nadelmann, former director of the Drug Policy Alliance (DPA) in the United States. The DPA is a nonprofit organization that seeks to decriminalize responsible drug use and promotes harm reduction. In an emotional lecture, Nadelmann urged governments to learn from the mistakes in America’s war on drugs and cautioned against prohibitionist policies for smoke-free nicotine-delivery devices. The illegal market, he warned, would flourish.

    Changing roles

    The main part of the conference, divided into two tracks with partly parallel sessions, explored the changing roles of public health and manufacturers of reduced-risk products (RRPs) and looked at the conditions under which the interests of tobacco companies and public health might coincide. It also raised the question of whether the rules of engagement, regarding, for example, Article 5.3 of the World Health Organization’s Framework Convention on Tobacco Control, which bans the tobacco industry from participating in tobacco control policy negotiations, needed to be changed now that tobacco companies have products that could benefit public health.

    The question about the credibility of tobacco companies’ new research, given their past misuse of science, was partly answered in a presentation on the rapidly developing science on nicotine use. Comparing e-cigarettes, THPs and conventional cigarettes, Konstantinos Farsalinos, a cardiologist at the University of Patras in Greece, reached conclusions similar to those of Philip Morris International (PMI). In Farsalinos’ study, PMI’s iQOS delivered higher levels of nicotine to the aerosol than do e-cigarettes but lower levels than do conventional cigarettes.

    The definition of combustion was hotly debated at the conference. A combustible cigarette burns at between 600 degrees and 950 degrees Celsius, according to Thomas McGrath, manager of RRPs at PMI. During the exothermic reaction that takes place inside the cigarette, the tobacco is burned to ash and generates smoke that contains more than 7,000 chemicals. THPs, by contrast, operate at considerably lower temperatures. According to McGrath, the temperature of the tobacco next to the heating element in iQOS reaches a maximum of approximately 300 Celsius—well below the temperature required for combustion, which exceeds 400 Celsius—while most of the tobacco is significantly below 250 Celsius. Contrary to combustible cigarettes, the temperature in iQOS decreases when air is being drawn through the device.

    By now, several THPs are available on the market, but there is no standard way yet of assessing whether a product is heating rather than burning tobacco. To comprehensively assess this aspect, a team of British American Tobacco scientists has developed a five-step approach, which they introduced during the poster presentations.

    The complex phenomenon of dual use of vaping products and combustible products was another focal point of the GFN. As dual use is a highly individual issue, existing data provide only limited insight. Tom Kirchner, clinical associate professor of public health, medicine and urban science at New York University, described a new model that shows the number of combustible cigarettes displaced by e-cigarettes and essentially is a categorizing or classifying approach.

    Nicotine: just another culprit?

    The conference demonstrated that the role nicotine plays in tobacco harm reduction for the time being will remain a matter of discussion. Neal Benowitz, professor at the University of California in San Francisco, acknowledged that his concerns about nicotine kept changing as new studies were released. Focusing on the question of whether physicians should recommend nicotine uptake in vaping, he stressed the pharmacological effects of nicotine, which he said include cardiovascular disease, reproductive toxicity, cancer and chronic obstructive pulmonary disease. He concluded that short-term nicotine use posed little cardiovascular risk, whereas long-term use might be harmful.

    While the focus currently is on delivering nicotine more safely, Eric C. Donny, from the department of psychology at the University of Pittsburgh, argued that people should be pushed to positive behavior change by reducing nicotine in combustible smokes. While acknowledging that nicotine was not the direct cause of harm, he claimed that it sustained the use of a “vehicle” that was deadly. The availability of alternative nicotine-delivery devices might not be enough to rapidly reduce smoking, he noted; therefore policies were needed that minimized the appeal of cigarettes relative to RRPs. Reducing nicotine in combustibles and enabling the growth of RRPs, Donny said, might be synergistic, complementary approaches to ending smoking.

    Snus ban challenged

    The second track of the GFN dealt with policy, advocacy and practice. The EU’s longstanding ban on snus featured prominently in this session. Although snus gives a similar nicotine dose as does a combustible cigarette without presenting the same risks for cancer, the product is banned in all EU countries bar Sweden. Looking at 50 years of increasing snus use in Sweden, Lars Ramstrom of the Institute for Tobacco Studies in Sweden stated that patterns of dual use of combustible cigarettes had changed considerably over this period, with snus use gradually replacing smoking. Today, Sweden has a prevalence of daily smokers of 5 percent, by far the lowest in the EU, as well as the lowest tobacco-related mortality rate. If the EU allowed the sale and use of snus, 320,000 smoking-related deaths could be prevented each year, he calculated.

    In July 2016, Swedish Match filed a legal challenge to overturn the EU snus ban. Even though its previous challenge, in 2003, failed, experts are optimistic about the outcome of the current case, given that there is now significantly more scientific evidence available to support snus’s harm reduction potential. In addition, because it has so far not been available on the EU market, snus could be claimed to be a novel tobacco product, for which the revised Tobacco Products Directive (TPD2) contains a regulatory path to market.

    Unlike snus, e-cigarettes are available in a large number of markets. Nevertheless, electronic nicotine-delivery devices face many challenges as lawmakers struggle to decide the new technology’s place in society, as snapshots of various countries during the conference proved. E-cigarettes are technically illegal in Australia, where nicotine is classed as poison. In spite of restrictions, people are embracing vaping, and the sector has been growing. It remains legal in Australia to import nicotine liquids for personal use. In February 2017, the medicines regulator rejected an application to legalize nicotine-containing e-cigarettes, which leaves combustible cigarettes more accessible than a safer alternative.

    New Zealand, which has similar legislation on vaping products, in March shifted its policy. Reflecting the general consensus that vaping is safer than smoking, the government plans to legalize e-cigarettes to help the country become smoke-free by 2025. While sales would be restricted to adults and vaping would be banned in nonsmoking areas, the vapor products would not be subject to tobacco taxation and plain packaging laws.

    In Europe, the TPD2, which came into force in May 2016, has significantly changed the business environment for the vapor industry. In countries such as Poland and the U.K., researchers have witnessed the effects on public perception of negative coverage of the vapor industry in the mass media, which is often based on poorly designed and misleading studies.

    Other issues tackled at the GFN included the availability of less hazardous tobacco products for certain groups in society, such as people with mental disorders, individuals with addiction issues and poor people (groups that tend to have high rates of smoking prevalence). As far as future regulation of novel nicotine products was concerned, conference speakers said that legislators should promote innovation, set standards on product safety, and give the tobacco and vapor industries appropriate marketing freedom to build new brands. Consumers, on the other hand, should get appropriate freedom to use those products, while they needed to be informed about the risk.