22 July 2012
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.
“DiFranza said even though tobacco companies
now accepted smoking caused cancer, there was an alarming number of
unregulated nicotine products coming to market, such as
nicotine-infused bottled water, electronic cigarettes and tobacco
lozenges. 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
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
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.
DiFranza will be meeting University of Auckland NIHI researchers Natalie Walker and Associate
Professor Chris Bullen and others who are more than half way through
recruiting smokers for a randomised clinical trial of nicotine
electronic cigarettes. The previous clinical trial showed that
ecigs had much the same effect as a medicinal nicotine inhaler, as these
researchers have shown.
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
Professor DiFranza will be
meeting with nicotine researchers at Victoria University of Wellington
who will discuss with their findings on the power of nicotine alone
versus tobacco smoke extract containing nicotine in equivalent
dose, in rats with respect to self-administration. There are as I
understand it, important differences between the two.
- 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.
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.
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 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.
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
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.
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 our knowledge.
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.
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 persistent users.
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
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.
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
The e-cigarette needs regulation, not by banning it under the
Medicines Act, under
the Smokefree Environments Act, as soon as possible.
Regulation. Approval for sale under Smokefree
Environments Act means
Ministry can test for purity of ingredients
If ecigs are not completely safe, a health
warning can be required as for tobacco products.
Doctors can monitor adverse effects.
Packet warnings can advise users to desist
after 6 months, as soon as users are sure they won’t go back to
Licences to import can be withdrawn if new
evidence comes to light.
Royal College of Physicians, London supports light regulation
“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
- 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
bottled nicotine used
dismantled to fill
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
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 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
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
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