Sensible harm based regulation

E-cigarettes (or vaping) have a role in helping New Zealand reach Smokefree 2025.

ASH believes vaping has been, and continues to be highly disruptive to tobacco smoking and presents a fraction of the harm. Creating an environment where smokers could access and use this much safer alternate to mange nicotine addiction is likely to have a significant impact on chronic disease prevention in New Zealand, especially for Maori, Pacific, Mental Health and low income populations.

ASH is urging the Government, and Health Minister Salesa to speed up the review of e-cigarettes and introduce sensible, harm proportionate regulation that support those who want to switch less harm alternates to smoked tobacco. 

We take this position for the following reasons:

Nicotine is addictive, smoke is harmful

Vital to understanding tobacco use, is to understand that tobacco smoking is highly addictive because of the nicotine content of cigarettes, and the mechanism by which nicotine is administered to the brain through combustion and inhalation of smoke.

Very few, if any substances are as addictive as nicotine when delivered via a cigarette. This delivery mechanism is extremely efficient, modifies brain receptors and creates a very high level of dependency.

The nicotine itself is not harmful when delivered in this way. It is the by-product of combustion that causes harm because the smoke contains multiple carcinogens, and leave deposits on the respiratory systems that severely impact on cardiovascular and respiratory function.

Addiction and quitting

The addictiveness of smoked tobacco is evidence in the very low rates of successful quitting, and high rates of relapse to smoking. For example, the average sustained abstinence rates for quitting smoking ‘cold turkey’ at one year is approximately 0.4% of quitters.

Whilst clinical forms of nicotine such as patches, gum and lozenges have been available for many years as quit aids they have a fraction of the efficiency that smoking has in delivering nicotine. Combined with behavioural support, success rates remain low with sustained abstinence at around 1.6% of quitters[i].

E-cigarettes are more efficient at managing addiction

E-cigarettes (vaping) deliver a vapor composed mostly of propylene glycol (also used in asthma inhalers) and flavouring agents. Some, but not all contain nicotine. The current generation of vaping devices normally work using a tank of vaping liquid that is heated into a vapour and inhaled. The nicotine delivery is much more efficient than clinical products, and mimics the inhalation delivery mechanism of smoking.

E-cigarettes and harm

The Cochrane Tobacco Addiction Group concludes that switching to electronic cigarettes is likely to lead to significant improvements in health[ii].

Vaping lacks the most harmful components of conventional cigarettes – tar and nicotine as the inhaled vapor is not a by-product of combustion. Public Health England concluded that they are 95% less harmful than cigarettes, but substantially more effective in delivering nicotine than medicinal nicotine products[iii]. This helps manage nicotine withdrawal with a fraction of the harm from tobacco, and delivered in a way that is far more acceptable to many smokers who want to quit.

E-cigarettes as a gateway to smoking and addiction

Concerns gateway to smoking or flavours attracting non-smokers and young people to take up vaping have not materialised. Data from the ASH year 10 survey shows than 1% of year 10 vapers are never smokers.

 E-cigarettes and stopping smoking

There is increasing evidence that vaping is significantly accelerating the decline in smoking in countries where e-cigarettes are permitted.  In the UK 45% of vapers are current smokers, and 52% are ex-smokers. The UK smoking monitors estimates that over 2.9 million people in the UK vape, and over 1.3 million have quit smoking altogether. Long term ex-smokers are 3 times more likely to report having used an ex-cigarette than NRT[iv].

In New Zealand, quality data on vaping is very limited although this has been surveyed in the New Zealand Health Survey in 2017-18 for the first time. Results will likely be published in December 2018.

 

 

[i]Moore D, Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: Systematic reveiw and meta-analysis. BMJ 2009:338:b1024

[ii]Hartman-Noyce J, McRobbie H, et al. Electtronic Cigarrettes for Smoking Cessation. The Cochrane Library 2016

[iii]McNeill A, Brose LS et al. Evidence Review of E-cigarettes and heated tobacco products. Public Health England. (2018)

[iv]West R.  Electronic cigarettes in England – Latest Trends (2018 Q2) Smoking Toolkit Study. www.smokinginengland.info.