22 July 2012
POSITION ON E-CIGARETTES
a product to help end tobacco addiction
Visiting Professor Dr Joe DiFranza’s
Professor Joe DiFranza’s
was reported in the NZ Sunday-Star Times, 22 July, today at page A6.
While the health effects may not be
as bad as from smoking cigarettes, the concern was, if society was on
the verge of stamping out nicotine addiction, did it need new products
to get people addicted again? “
Smoking NZ trustees are mostly addiction experts, who support the sale
of e-cigarettes as a way to end the sale of tobacco cigarettes.
most harmful constituents in tobacco smoke include cancer causing gases
such as butadiene, heart damaging gases such as hydrogen cyanide and
lung damaging gases such as acrolein, not forgetting tar containing
nitrosamines which cause lung cancer. Tobacco cigarettes eventually
kill half of those smoking them.
by itself, although not harmless, is dramatically less harmful than
tobacco. This means that we need an alternative nicotine delivery
system for the percentage of our smoking population that is so addicted
that despite the best efforts of our public health colleagues they
still smoke. Accepting that their eventual decision to quit nicotine as
well as tobacco may be some years off in the real world, they are at
least protected meantime from the severe harms associated with tobacco
smoking by using nicotine products such as e-cigarettes.
efficacy is proven, nicotine e-cigarette effectiveness can be compared
to any side effects reported by hundreds of users over 6 months. A
balanced judgement can then be made as to
whether nicotine ecigs should be sold in NZ
in corner stores.
would say that ecigs with
nicotine should be sold now with nicotine, from NZ websites. Why
should UK and Chinese websites get all the
- NZ smokers
will find it difficult enough to quit their tobacco addiction, but
allowing them to switch to nicotine ecigs
would make it much easier.
- Getting NZ smokefree
without the help of better substitute products to help smokers
(such as ecigs and denics)
is like reducing smoking with one arm tied behind one’s
like ecigs in a way not true of nicotine
patches and gum – ecigs have their
own fan clubs.
off tobacco to nicotine electronic cigarettes could provide an
important escape product for addicts to inhale while dealing with
their now decreased nicotine addiction in their own good
Smoking NZ views in more detail.
of purchase and legal position. Currently about 1% of NZ
smokers have bought ecigs without nicotine,
but without nicotine ecigs are not very
successful in weaning smokers gradually off smoking. Ecigs are banned in NZ if they contain nicotine. Medsafe says nicotine is a medicine under the Medicines
Act and can only be sold if approved as a medicine. This means nicotine
ecigs cannot be sold.
position: Nicotine in NZ is a tobacco product if not a medicine; because
nicotine is made from tobacco it is a product of tobacco. This means
tobacco and nonmedicinal nicotine
in NZ comes under the Smokefree Environments Act. But first Medsafe would need to declassify nicotine in ecigs as a medicine, by taking out ecigs from under the Medicines Act. The
current ban preserves the monopoly-provider position of the cigarettes
companies as being the only ones allowed to sell addictive nicotine
vapour outside of a pharmacy.
Smoking NZ is promoting use of ecigs as one
of its top policies to end smoking of tobacco. Every ecig cartridge smoked is a packet of tobacco
cigarettes not smoked. In USA and UK some 3% of smokers use ecigs. That amounts to billions of tobacco
cigarettes not smoked. Laugesen et al NZ Med J 2010,
of ecigs being a gateway to adult tobacco
addiction. Ecigs do not by itself
kill people and would be most unlikely to lead to tobacco addiction in
the NZ tobacco policy environment, The
Smokefree Environments Act strictly controls tobacco product
marketing. For example, as from
tomorrow, “discount tobacco” signs at retailers are gone.
addiction risk. This develops in nicotine gum users in some 8% of
users, ( http://www.healthnz.co.nz/Addiction_TobNic.htm
) but this is not a reason to take it off the market. Addiction to
nicotine is regarded as a side effect of a valuable treatment for
smokers. E-cigarette forum and vapers club surveys report most members desert after 3 months to 6 months.
and adolescents. There
have been no published reports of never smokers developing nicotine
addiction after using nicotine inhalers - either medicinal inhalers or e-cigarettes. If it did
occur, it would not become a youth fashion. Only advertising could make
ecigs cool for young smokers.
Advertising is banned for nicotine e-cigarettes, either as a tobacco
product or as an unlicensed medicine. Ecigs
for adolescents have not caught on so far. They may do,
but as long as addictive cigarettes are priced higher and
higher, adolescents addicted to nicotine will be unable to afford
more than or two per day.
free world might mean banning nicotine–perhaps in the 22nd
century. Meantime 1 billion smokers are predicted to die of tobacco
smoking this century.
achieve a smokefree NZ by 2025, we first need to get some 600,000
smokers off their probably fatal addiction to tobacco. Smokers like ecigs,
and ecigs can help them to quit their tobacco
addiction is controllable. After 2025, nicotine in ecigs can be easily controlled through taxation in
future and banned if necessary once combustible tobacco cigarettes are
no longer sold.
8. Legalise the antidote to lethal
tobacco cigarettes. For the next 20 years in NZ we believe we need to legalise nicotine in s to get more people off
smoking sooner, ie to maximise
the effects of the tax increases we are asking for.
Quitting sooner means fewer cigarette deaths. Cigarette deaths are due to
smokers quitting too late. People are likely to switch off tobacco
smoking sooner than otherwise, if a nicotine
satisfying is available as an alternative they can gradually or
suddenly switch to. It is all about improved choice of stop smoking
Some controversy. The Cancer Society of NZ has a 2011 position
statement on its website on ecigs at www.cancernz.org.nz and search.
Since that time new research has been published, and the tide is slowly
turning to be more supportive of electronic cigarettes.
Smoking webisite information is found at www.endsmoking.org.nz under
Smokers options, and envisions a key role for Ecigs
as a clinical and policy lever for phasing out tobacco cigarette sales.
policy untenable needs review. However this is an active issue, and
End Smoking NZ believes that ecigs, the best
thing yet to compete with tobacco cigarettes, should not be banned or
regulated in NZ as if they were party pills, in such a way they in
effect cannot be sold, as an unknown product
best banned, which is the case at present, while smoking
tobacco is sold in some 10,000 shops, kills 5000 annually while ecigs have killed no one anywhere to the best of
regulation under the Smokefree Environments Act of ecigs as a non-medical stop smoking aid, seems a
suitable policy which all parties could examine and eventually reach
got to get people off the cigarette smoke” –
e-cigarettes “stuck in legal
Dr Marewa Glover director Auckland Centre for Tobacco
Control Research discusses E-cigarettes on Breakfast with Petra Baguist
Petra: “The Ministry of Health is saying
that e-cigarettes are far safer than a normal cigarette, and yet it is not
possible to sell the nicotine that goes with them. What’s the
crux of that situation?”
Could it be classified as a tobacco product?
“Possibly”…“People are using them to switch off
from smoking and - why not? I would like see more smokers to have more
access to things like this - alternatives that are safer. We’ve
got to get people off the cigarette smoke.”
NZ Ministry of Health says
E-cigarette ‘far safer’ than smoking
Ministry of Health advice to NZ Parliamentary
Health Committee, April 2011 at pages 15-18.
Health Select Committee recently asked the Ministry of Health to
provide advice on electronic cigarettes:
e-cigarette delivers only nicotine in a mist of propylene glycol,
without the other 4,000 or so other chemicals in tobacco smoke, it is far
safer than smoking.”
safety data would therefore suggest that the e-cigarette poses few
risks to people, and is safer than continuing to smoke. However, this should
be confirmed with data from long-term outcome studies.
Ministry of Health believes there are research questions still to be
answered around the e-cigarette before the Ministry would support its
introduction and/or promotion in New Zealand. Trials to assess long term cessation
outcome and safety are needed.”
End Smoking NZ congratulates the NZ
Ministry of Health on possibly being the first ministry of health to
concede e-cigarettes are safer than smoking. The Ministry, however,
continues to use Medicines legislation to ban their sale to smokers,
thus obviating the need to regulate ecigs so
smokers could use them. The Ministry could, but is not classifying them
for sale under tobacco products legislation. Not one death has occurred
from e-cigarettes globally to our knowledge. Meantime cigarettes kill one in two
judges that ecigs are indeed “far safer
than smoking”, let smokers decide which risk they wish to take.
Health says the e-cigarette
“ is far safer than smoking.” But
the Ministry wants more research on safety and efficacy before
introducing nicotine e-cigarettes for sale.
End Smoking NZ says the Ministry of Health should
the real peril of smokers facing a 50% risk of dying from continued
what smokers want. Smokers want
a level playing field – they want freedom to
buy nicotine cartridges just as they can buy cigarettes at any of
long as Government permits sale of lethal tobacco cigarettes,
Government has a duty to permit sale of a full range of safer cigarette
substitutes for smokers to buy as of right.
are not up to medicinal standards of purity. Rather than banning their
sale as medicines they should be sold as cigarette substitutes under
the Smokefree Environments Act. Medicinal purity standards required by the Medicines Act
prevents nicotine e-cigarette cartridges being sold in NZ
e-cigarette needs regulation, not by banning it under the Medicines
Act, under the Smokefree
Environments Act, as soon as possible.
Approval for sale under Smokefree
Environments Act means
can test for purity of ingredients
ecigs are not completely safe, a health
warning can be required as for tobacco products.
can monitor adverse effects.
warnings can advise users to desist after 6 months, as soon as users
are sure they won’t go back to smoking.
Licences to import can be withdrawn if new evidence
comes to light.
Royal College of Physicians, London supports light regulation
released March 2011.
“In our view, nicotine products should be allowed on the
market so long as
the nicotine meets
acceptable purity standards, the dose and rate of absorption do not
exceed that of a cigarette, and the product is shown to be tolerable
suppress the urge to smoke.”
- RCP to MHRA UK, 20 April, 2010 replying to consultation MLX 364 on The
Regulation of nicotine containing products.
Sources and prices, New
Zealand, December 2010
Distributors: please report updates to firstname.lastname@example.org
Child access to nicotine liquid
E-cigarette Starter kit, typically
with spare charger, cartridges, battery.
84 mm length model no 1123, $99.90 recharging case and 6
Non-nicotine cartridges $
cartridges for e-cigarettes 16 mg**
www.elusion.co.uk *£9.99 for 5
e-cigarette, with cartomiser, 250 puffs with charger
Hydro one cartomiser
with battery and
Cartomisers to fit
cartomisers for $29.50 ##
*Nicotine can be personally imported for one’s
own use. See website.
**this is per ml. Most cartridges contain much less
than 1 ml liquid. Cartomiser = cartridge with
Postage and any discounts: check each website
carefully. Listing here does not mean endorsement of the product by End
Smoking NZ: none of the above are as yet
approved for sale as medicines in NZ.
E-cigarette non-nicotine starter kits can be sold
and advertised along with nicotine-free cartridges within NZ.
Nicotine e-cigarette cartridges, if sold within NZ
as tobacco products, cannot be advertised.
Some websites offer flavours and various nicotine
strengths. Switchers initially need maximum strength.
Getting started: Doctor Vapor's E-Cig 101
1 - What Do I Order First? http://www.youtube.com/user/DoctorVapor#p/u/6/bGRoOfv6dnw
Class 2 - Attys,
Refills and Dripping http://www.youtube.com/user/DoctorVapor#p/u/5/UxirXIHXysg
Class 3 - Cartomizers
Class 4.1 - Big Battery http://www.youtube.com/user/DoctorVapor#p/u/0/uAIfkNkkmtQ
Class 4.2 - Big Battery http://www.youtube.com/user/DoctorVapor#p/u/1/62jbMV-ZJBU