11 May 2011                         This file is about all types of e-cigarette not just Ruyan brand

22 July 2012

  

         END SMOKING NEW ZEALAND’S POSITION ON E-CIGARETTES

 

                   - a product to help end tobacco addiction

 

        Replying to Visiting Professor Dr Joe DiFranza’s comments today

 

 

Professor Joe DiFranza’s was reported in the NZ Sunday-Star Times, 22 July, today at page A6.

 

http://www.se tuff.co.nz/sunday-star-times/latest-edition/7323934/Smokers-rights-website-cynical

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? “

Reply

 

End Smoking NZ trustees are mostly addiction experts, who support the sale of e-cigarettes as a way to end the sale of tobacco cigarettes.

 

The 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.

Nicotine 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.

 

Once 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.

 

(Many would say that ecigs with nicotine should be sold now with nicotine, from NZ websites. Why should UK and Chinese websites get all the business? )

 

 

In more detail.  

  • 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 back.
  • Smokers like ecigs in a way not true of nicotine patches and gum – ecigs have their own fan clubs.
  • Switching 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 time. 

 

End Smoking NZ views in more detail.

 

1, Prevalence 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.

 

2. Legislative 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.

 

3. End 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,

 

4. Risk 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.

 

5. Nicotine 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.

  

6. E-cigs 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.

 

A drug free world might mean banning nicotine–perhaps in the 22nd century. Meantime 1 billion smokers are predicted to die of tobacco smoking this century.

To 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 smoking addiction. 

 

 

7.  Ecig 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.

 

9. 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 products.

 

  

10. 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.   

 

The End 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.

 

11. Current 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 our knowledge.

 

12. Light 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 agreement on.

___________________________________________________________________________

11 May 2011

“We’ve got to get people off the cigarette smoke” –

 e-cigarettes “stuck in legal limbo”

 

Dr Marewa Glover director Auckland Centre for Tobacco Control Research discusses E-cigarettes on Breakfast with Petra Baguist

http://tvnz.co.nz/breakfast-news/wednesday-may-11-4164865/video

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?

 

MG: “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.

The Parliamentary Health Select Committee recently asked the Ministry of Health to provide advice on electronic cigarettes:

 

“As the 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.”

 

“The current 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.

 

“The 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 persistent users.

 

If Ministry judges that ecigs are indeed “far safer than smoking”, let smokers decide which risk they wish to take.

 

 

Summary 

Ministry of 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

1)   Consider the real peril of smokers facing a 50% risk of dying from continued smoking.

2)   Consider 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 10.000 shops. 

 

3)   As 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.

 

4)   E-cigarettes 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

5)   The e-cigarette needs regulation, not by banning it under the Medicines Act, under the Smokefree Environments Act, as soon as possible.

6)   Regulation.  Approval for sale under Smokefree Environments Act means

a)  Ministry can test for purity of ingredients

b)  If ecigs are not completely safe, a health warning can be required as for tobacco products.

c)   Doctors can monitor adverse effects.

d)  Packet warnings can advise users to desist after 6 months, as soon as users are sure they won’t go back to smoking.

e)  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 and to

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 hnz@healthnz.co.nz

 

 

Elusion & Hydro

 

www.Elusionec.co.nz

Child access to nicotine liquid

Impossible

 Nicotine leakage

Eliminated

E-cigarette Starter kit, typically with spare charger, cartridges, battery.

 84 mm length model no 1123,  $99.90 recharging case and 6 cartridges

Non-nicotine cartridges  $

$29.50 for 5

Nicotine*

cartridges for e-cigarettes 16 mg**

www.elusion.co.uk *£9.99 for 5

www.elusion.com.au

AUD19.99 for 5

e-cigarette, with cartomiser,  250 puffs with charger

 

 

$29.50 Hydro one  cartomiser with battery and

USB charger

www.hydroelectroniccigarette.com

Cartomisers to fit

5 Hydro 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 atomizer.

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

Class 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 http://www.youtube.com/user/DoctorVapor#p/u/3/OXAwsqRI0E8

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

________________________________________________________________________________________________

 

3 June 2009   Health warning:

Precautions required with e-cigarettes

Avoid bottled nicotine. Liquid nicotine (e-liquid) is small bottles of up to 30 mL or more, on the internet, or from stores in the USA, ARE often meant to last consumers one month; and often unlabelled as to nicotine dose. End Smoking NZ and Health New Zealand Ltd does not recommend sale or use of e-liquid unless Nicotine solution sold in child-proofed cartridges or un-openable disposable e-cigarettes or atomisers to avoid this risk.

Acute poisoning risk. For a child, the lethal dose is 10 mg nicotine. Bottles on sale can contain many times this amount. Even if the cap of a liquid nicotine bottle is child proofed, risk remains if someone else leaves it open. For adults, absorption of a fatal dose of 40-60 mg of nicotine could rapidly occur by  spilling the liquid on one’s skin while using liquid nicotine to moisten the wick– a risk heightened by distraction, fatigue, alcohol, drugs. (Wash it off immediately). Wear gloves.

Avoid gravity feed. Old brand e-cigarettes should not be tipped up above mouth level, as the e-cigarette liquid can ooze out and drain nicotine on to the lips.

Avoid child-openable brands of e-cigarette and refill cartridges. Old long-length 3-piece e-cigarettes might allow young children to unscrew them giving access to a wick moist with nicotine solution, flavours in the liquid masking the bitter nicotine taste. Latest 2-piece brands (6 mg in 0.3 ml liquid), and 1-piece disposables, allow no access.

 

 

Safety results, April 2009:

E-cigarette Safety: Ruyan e-cigarette benchtop tests. Poster 5-11. See. www.healthnz.co.nz/DublinEcigBenchtopHandout.pdf  The poster itself is found in the following two  Powerpoint files: http://www.healthnz.co.nz/DublinEcigPoster1.ppt and http://www.healthnz.co.nz/DublinEcigPoster2.ppt 

The mist of the e-cigarette has been rigorously tested in the laboratory. Of over 60 priority-listed cigarette smoke toxicants tested, trace levels for some only were detected in the mist of the Ruyan® e-cigarette. The results are to be submitted for publication shortly in a peer-reviewed journal.  On the basis of findings to date, inhaling mist from the e-cigarette is rated some two orders of magnitude (100 times) less dangerous than smoking tobacco cigarettes. The nicotine dose per puff is comparable to that of a medicinal nicotine inhaler. E-cigarette nicotine is apparently not absorbed from the lung, but from the upper airways.

Update on the e-cigarette, October 2009

http://www.healthnz.co.nz/ElectronicCigsDarwinOct09.pdf

 

Efficacy results, April 2010

Health New Zealand Ltd sponsored this research on behalf of Ruyan, manufacturer of the Ruyan V8 e-cigarette, and it was carried it out in Auckland by researchers at the School of Population Health, University of Auckland. See http://www.healthnz.co.nz/2010%20Bullen%20ECig.pdf  The study was published in Tobacco Control in April 2010.

 

 

TV3  2008  The Ruyan V8 Classic. An LED lights up the end. The white part is the battery. The nicotine is housed just upstream of the fingers. Recent models shorter (84 mm), and lighter.

Legal status (New Zealand)

E-cigarettes and non-nicotine cartridges can be sold in New Zealand, but not nicotine cartridges.

Nicotine when sold as a medicine comes under Medicines Act and approval for a new nicotine medicine is very expensive and takes several years. Import of e-cigarettes and nicotine cartridges for personal use is allowed.

About the device

The e-cigarette nicotine inhaler mimics the smoking experience more closely than any smokeless product to date and provides nicotine without causing smokers to cough.

It looks and acts like a cigarette, gives the pleasure of drawback, with a nicotine effect within 15 minutes. It is likely to be popular as a much cleaner and safer alternative to smoking, by eliminating the tar and the toxicant gases. More frequent puffs deliver more nicotine. Mouth holding longer may help. Use before coffee, coke, and fruit juice, not after.

 

 

 

Extended use, misuse of e-cig

 

The e-cigarette is an inhaler and the commercial brands do not appear to deliver nicotine deeply into the lung. Its ability with other drugs is untried. Nicotine by e-cigarette is probably absorbed from the throat and upper airways rather than from the lung.

 

People mixed tobacco with marijuana for smoking long before e-cigarettes, and smoking is the most dangerous way to consume cannabis or tobacco.

Devices for heating and vaporizing cannabis long preceded the e-cigarette. Whether or not e-cigarettes could be used for that purpose, no smoke will be inhaled. 

It is not known whether the e-cigarette would facilitate absorption of THC, the active ingredient in cannabis. The e-cigarette vapourises liquid but does not burn plant material such as marijuana or tobacco. If cannabis is vaped by e-cigarette, rather than combusted and smoked in a joint,  then no smoke is inhaled. Lung cancer  is likely after many years of smoke inhalation, of either tobacco or marijuana smoke.

E-cigarette vaping of cannabis is likely to cause far lung damage than smoking.

For example, the illegality of cannabis makes adulteration possible, and prevents legal controls on its production. Also research safeguards are lacking. The effect of inhaling and vaporizing THC in the e-cigarette liquid has not been tested and researched by anyone to our knowledge.

 

Note: End Smoking NZ trust has no financial interests in any nicotine, tobacco or pharmaceutical company.

The e-cigarette provides a safer alternative for smokers. No deaths have yet been reported from e-cigarette use.

Dr Murray Laugesen chair; Prof Ross McCormick, Sir John Scott KBE, Trish Fraser MPH, Dr Marewa Glover, Trustees 

Making it easier to quit smoking for good © 2010 End Smoking NZ