Proper regulation of e-cigarettes can help prevent sickness, premature death of millions of Filipino smokers: tobacco harm reduction expert

MAKATI CITY – Appropriate regulation of electronic cigarettes (e-cigarettes or “vapes”) can help prevent serious sickness in and the premature death of millions of cigarette smokers in the Philippines, according to a leading expert on tobacco harm reduction and e-cigarettes.

Dr. Farsalinos urged the Philippine government to create a regulatory framework for e-cigarettes that is reasonable, proportionate, and realistic. “It must be different from regulation of tobacco cigarettes; otherwise, people may be deceived into thinking that e-cigarettes are the same as tobacco cigarettes.”

According to Dr. Farsalinos, an appropriate e-cigarette regulatory framework is important to ensure product quality; promote harm reduction products only to intended populations (i.e. smokers and former smokers); maintain a competitive advantage for harm reduction products compared to smoking (price, availability, accessibility; and promote research to monitor population use and develop better (and even safer) products.

“The average lifespan of a smoker is 10 years shorter than a non-smoker. According to the World Health Organization, there are around 20 million Filipino smokers, half of whom will die prematurely due to smoking-related diseases. Effective tobacco harm reduction approaches must be made available to Filipino smokers through the creation of an appropriate local regulatory framework for e-cigarettes,” said Dr. Konstantinos E. Farsalinos, Research Fellow at the Onassis Cardiac Surgery Center and University of Patras in Greece.

Dr. Farsalinos spoke during a media briefing held on April 5, 2017 at the Holiday Inn Glorietta in Makati City.

Nicotine doesn’t kill, tar does
According to Dr. Farsalinos, tobacco cigarettes are the most harmful nicotine delivery system ever developed. Nicotine is the drug in tobacco that causes addiction to smoking. Its stimulant effect adds to the addictive properties of tobacco smoking.

Nicotine is the reason why quitting smoking is very difficult, Dr. Farsalinos said. Smokers who stop smoking suddenly and completely (“quit cold turkey”) often relapse. At least 8 out of 10 smokers fail to quit with currently approved smoking cessation methods, which include nicotine replacement therapies (NRTs) and oral medications. NRTs, which come in patches and gums, have a 7% success rate at one year while oral smoking cessation medications (varenicline) have a 20% to 25% success rate at 1 year.

While smoking is a leading cause of heart disease, stroke, and lung cancer, among many others, these diseases are not caused by nicotine. Dr. Farsalinos quoted Professor Michael Russell, a pioneer in the study of tobacco dependence, who in 1976 said, “People smoke for nicotine but die from the tar.”

Tar refers to the combustion products of cigarettes produced by the burning of organic matter, dried tobacco leaf, Dr. Farsalinos explained. These combustion products are burned at a temperature of over 800ºC, which produces many toxins (carbon monoxide, formaldehyde, ammonia, hydrogen cyanide, arsenic, DDT, etc.) that are subsequently inhaled by the smoker.

What is tobacco harm reduction?
Dr. Farsalinos said that many people perform harm reduction approaches and behaviors on a daily basis. For example, the use of seatbelts and helmets is a harm reduction approach because it does not eliminate but only reduces a person’s risk of injury or death in the event of an accident. The same logic applies to the use of condoms. The use of medicines is another harm reduction approach. However while medicines can treat diseases, no medication is absolutely safe—all have side effects.

“Tobacco harm reduction operates on the same principles. It provides a safer alternative to reduce the harmful effects of smoking by providing nicotine to people who cannot or do not want to quit by themselves or with currently approved methods,” Dr. Farsalinos explained. “Tobacco harm reduction uses less harmful products that provide a cleaner, safer form of nicotine intake.”

E-cigarettes 95% less harmful than conventional cigarettes
Dr. Farsalinos said there are many studies showing that e-cigarettes by far carry a lower risk than tobacco cigarettes. Two of the most recent and most authoritative are those of Public Health England released in 2015 and the Royal College of Physicians released in 2016. The independent studies both concluded that e-cigarettes are at least 95 percent less harmful than smoking.

“E-cigarettes are a lot safer than tobacco cigarettes because e-cigarettes heat and vaporize liquid at lower temperatures reaching only 180ºC to 250ºC. Unlike tobacco cigarettes, e-cigarettes do not burn organic matter at very high temperatures and therefore do not produce toxic fumes,” Dr. Farsalinos explained.

The main components of the liquid used in e-cigarettes (“e-liquid”) are propylene glycol and glycerin, accounting for 95% of the e-liquid. The remaining components are water, nicotine, and flavorings. “There is no single component of e-liquid that was developed particularly for e-cigarettes. Glycerol was approved for human consumption in 1959, propylene glycol in 1982,” said Dr. Farsalinos.

E-cigarettes help smokers quit, reduce cigarette use
“A growing body of evidence shows that e-cigarettes are helping smokers quit and reduce their cigarette consumption,” said Dr. Farsalinos.

A study by Action on Smoking and Health released in 2016 showed that the number of e-cigarette users in Great Britain has been steadily increasing since 2012. It found that the number of smokers in the country is decreasing while the number of ex-smokers is increasing. The study revealed that regular e-cigarette use among non-smokers in Great Britain is minimal to zero—providing more evidence that e-cigarettes are not a gateway to smoking.

More than six million smokers in the European Union (EU) have quit smoking and more than 9 million have reduced smoking consumption with the use of e-cigarettes, according to the Eurobarometer survey released in 2016, of which Dr. Farsalinos was the principal investigator. Eurobarometer assessed, among others, smoking and e-cigarette use patterns in all 28 member-states of the EU.

“Our survey revealed a 35% smoking cessation rate and 32% smoking reduction rate among e-cigarette users. Compare this to the 7% smoking cessation rate with NRTs and 20% to 25% smoking cessation rate with oral medications. These are probably the highest rates of smoking cessation and reduction ever observed in such a large-population study,” said Dr. Farsalinos.

The 2016 Monitoring the Future survey showed that since e-cigarettes became popular, smoking decline has accelerated among adolescent students in the US. More than 45,000 students from 372 public and private schools in the US participated in the survey.

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