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July, 2016:

New Zealand ready to move on standardised tobacco packaging

Jul 19th, 2016
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http://www.scoop.co.nz/stories/GE1607/S00059/new-zealand-ready-to-move-on-standardised-tobacco-packaging.htm

The New Zealand government’s consultation on the draft standardised tobacco product packaging will close at the end of July. Chair of Cancer Council Australia’s Tobacco Issues Committee and renowned global authority on standardised tobacco packaging, Kylie Lindorff is visiting New Zealand to encourage the Government to implement the measure as soon as possible.

Standardised packaging was enforced in Australia in 2012 – the impact of which has seen an increase in people wanting to quit smoking and an ongoing reduction in smoking up-take. A post-implementation review of standardised packaging in Australia concluded the tobacco standardised packaging measure had begun to achieve its public health objectives of reducing smoking and exposure to tobacco smoke and it is expected to continue to do so into the future.

Lindorff is supporting New Zealand to follow Australia’s lead and tighten the regulations they have adopted. “Research conducted after the implementation of standardised packaging in Australia has shown the tobacco industry is still finding way to advertise to consumers – for instance, brand and variant names of tobacco products flourished after standardised packaging was adopted in an attempt to remind smoker of the supposed brand differences their old decorated packs conveyed. New Zealand should learn from this and restrict brand and variant names,” commented Lindorff.

Cancer Society Auckland Chief Executive, John Loof, trusts the Government will learn from what has happened in Australia and not delay this measure any longer.

“Standardised packaging has proven to be effective and legally viable in Australia. The longer we wait, the further removed we are from achieving the Government’s goal of a Smoke-free Aotearoa by 2025,” he said. “Tobacco use remains the leading cause of preventable death in New Zealand, with 4500 to 5000 deaths every year”.

Lindorff will be in Auckland on Wednesday 20 July 2016 to give a seminar on standardised tobacco packaging hosted by Cancer Society Auckland and Hāpai te Hauora.

EU: Tobacco giant PMI won’t start smuggling after deal ends

Jul 19th, 2016
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https://euobserver.com/economic/134403

It almost looked like the anti-smuggling agreement between the European Union and tobacco giant Philip Morris International (PMI) would expire without any public acknowledgement.

After 12 years of cooperation, the increasingly controversial agreement expired on 9 July without any press release or public announcement.

On Monday (18 July), the EU commissioner responsible for the file, Kristalina Georgieva spoke to EUobserver to explain her decision not to renew it.

In her office in the commission’s Berlaymont building in Brussels, decorated with purple furniture, Georgieva said that it was the right decision in 2004 to sign the agreement, and it was the right decision in 2016 to let it expire.

“When we signed the agreement there was a lot of support for it in the European Parliament, among the public, and rightly so. Because it was a legal victory for the EU at the time when there was nothing else to fight illegal smuggling with. But today this is no longer the case,” she said.

The EU-PMI deal was agreed as part of an out-of-court settlement after PMI was accused of smuggling its own goods to avoid paying taxes.

More than a year ago, Georgieva promised MEPs an assessment report into the cost and benefits of the agreement, which made the EU, its member states and PMI partners in the fight against illegal tobacco smuggling.

It included reporting obligations for PMI, and payments into EU and member state coffers of around €1 billion during the 12-year period.

No Eureka moment

In February, the commission published the long-awaited assessment report that contained few strong arguments for renewing.

In March, the EU parliament adopted a text in which it urged Georgieva, one of the commission’s vice-presidents, not to renew the agreement.

“I wouldn’t say that was a moment when the light bulb came,” she said, adding that the picture became gradually more clear when laying out the pros and cons of continuing with the agreement, and talking to “numerous people”.

One argument in favour was that the new legal tools that are supposed to bring tobacco companies in check will not come into force until a few years.

“What determined that it is best to let it expire, was when we took a very careful look into what it has delivered so far and what is the risk of the regulatory gap,” said Georgieva.

She said she believed the risk of PMI smuggling its own cigarettes to avoid taxes “is very minimal, if not none”.

“Why? Because Philip Morris says so, they have committed very publicly that with or without the agreement they will continue the same practices,” she said.

She said the tobacco sector is also something of an oligopoly, with only four major companies selling most cigarettes in Europe, and the other three companies have similar agreements that run until 2022 and 2030.

Georgieva called it “the peer pressure factor”.

“In that peer group, in this particular sector, it is unlikely that the company would behave worse than its peers,” she said.

Track-and-trace
But the “most important” element of the agreement was that it convinced tobacco companies to introduce some kind of track-and-trace system. That way, if a smuggled product is found, its origins can be traced back to the factory.

Track-and-trace is part of the new tobacco products directive, and also part of an international treaty backed by the World Health Organisation (WHO).

The directive went into force in 2014, although the commission is still due to present detailed track-and-trace rules, which are expected next year.

The WHO’s Protocol to Eliminate Illicit Trade in Tobacco Products will enter into force once 40 countries have ratified it – so far 18 have done so.

“We are very much on the view that 2022 is realistically the target year for the protocol to be into force,” said Georgieva.

The EU is a signatory and ratified the text last month. Because the EU is not a country, its ratification does not count as one of the 40. But were all EU member states to ratify, the treaty would enter into force globally.

Belarus
However, Georgieva said she wanted to focus her efforts on convincing countries where tobacco smuggling is “most pervasive”.

“I’m thinking of Belarus,” the Bulgarian politician said.

“Cigarettes are being bought legally in Belarus and they are smuggled into the European Union. In Belarus they are much much cheaper,” she said, although she was quick to add that in the eastern European country there was “a very strong commitment to fight illegal trade”.

Once the WHO protocol comes into force, it may spell trouble for the three remaining tobacco agreements.

The WHO has said that the deals are in conflict with the treaty to which the protocol is a supplement, the Framework Convention on Tobacco Control.

But Georgieva said the commission’s legal service had a different interpretation, and that both the existing agreements, as well as a renewed PMI deal, would have been legally possible.

“This being said, we did take also this into account – that there is difference in interpretation – and that although we feel we are on sound legal ground, given that what matters is not just the legality of it, but what matters is our collective sense of justice and doing the right thing, and so we did not prolong,” she added.

Successful
Although the agreement has gained several vocal opponents in the last two years, Georgieva said she wanted to stress that the PMI agreement has been “successful”.

“We cannot establish a direct causal consequence between: here is the agreement and here is the shrinking [of PMI goods being smuggled], but the fact is that 85 percent less tobacco products are smuggled,” she said.

“One of the things we need to learn as a human race is that when something is done, to call it quits. To say: great, we have achieved what we have been able to achieve, there is no need to continue.”

Testing on Animals Is Shameful, Says Tobacco Industry Editor

Jul 19th, 2016
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http://www.peta.org/blog/testing-animals-shameful-says-tobacco-industry-insider/

Countless animals will suffer and die now that newer tobacco products, such as e-cigarettes, will be required to have Food and Drug Administration (FDA) approval in order to enter or remain on the market—and one tobacco industry expert isn’t pleased one bit.

In a scathing op-ed, George Gay, an editor for industry publication Tobacco Reporter, writes of the inherent deficiencies of experimenting on animals:

Have you ever tried to get a puppy to sit down with a cup of coffee and vape? No, the puppy will be tested under hugely stressful circumstances that, in respect of inhalation studies, will see her constrained, with a mask covering her mouth and nose through which vapor will be delivered, probably in ludicrous quantities and for periods that, in the case of a cancer study, might last her whole life.

Gay writes that it is “shameful” to test on animals in order to demonstrate the health risks of tobacco to humans and that those who find it acceptable “have a ridiculously inflated view of their own importance.”

Why should countless nonhuman animals be subjected to barbaric experiments so that we can snuggle under a totally threadbare security blanket as we take up what, with all due respect, is a fairly dumb habit.

This dumb habit is also not one that other animals take up freely. In laboratories, experimenters force rats into tiny canisters so that cigarette smoke can be pumped directly into their noses for hours on end. When the experiment is over, the animals are killed and dissected.

Rats squeezed into inhalation tubes

Rats squeezed into inhalation tubes

“[M]umbo-jumbo,” Gay asserts. Different animals have different reactions to toxins, and, as the rat experiment shows, animals in laboratories aren’t exposed to cigarette smoke in the same manner or time frame as human smokers are. “These experiments are ancient vestiges of a primitive body scientific and should be cut off.”

But what’s the alternative? Paraphrasing PETA’s own Joseph Manuppello, Gay points to the recent successes of cutting-edge technology:

[S]tudies that use in vitro methods have the ability to assess potential modified-risk tobacco products more quickly and to provide more specific, actionable and human-relevant data than do animal studies. In vitro models could also better reflect genetic and environmental differences within the human population.

In addition to in vitro technology, manufacturers can also effectively use human-based research methods and the existing body of knowledge from human epidemiological and clinical studies to ascertain health concerns associated with tobacco. These non-animal methods are humane, more relevant to humans, and usually take less time and money to complete.

What You Can Do

Testing tobacco products on animals has already been banned in Belgium, Estonia, Germany, Slovakia, and the United Kingdom. Write to the FDA to request that it follow the lead of agencies in these progressive countries by banning tobacco tests on animals:

Center for Tobacco Products
Food and Drug Administration
10903 New Hampshire Ave.
Document Control Center
Bldg. 71, Rm. G335
Silver Spring, MD 20993-0002
AskCTP@fda.hhs.gov

Teens Are Vaping Because It ‘Looks Cool,’ Study Finds

Jul 18th, 2016
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http://motherboard.vice.com/en_ca/read/teens-are-vaping-because-it-looks-cool-study-finds

Is it time to start producing after school specials about vaping? A new study published Monday found teens who vape are predominantly motivated by looking cool, and while that may not be the most Earth-shattering finding, it adds to growing concerns about teens vaping.

There’s no doubt that vaping is becoming increasingly popular among teens. But what’s not so clear is how concerned we need to be over this trend. Are kids who would have smoked choosing e-cigarettes instead, which are widely shown to be less harmful than cigarettes? Or are kids who wouldn’t have smoked at all getting drawn in by vaping and eventually going on to smoke real cigarettes?

A survey study published Monday in the Canadian Medical Association Journal went straight to the source to find out more about which kids are vaping and why. Over 2,000 high school freshman from Ontario’s Niagara region were surveyed on their smoking and vaping habits. While only 10 percent of respondents said they had tried an e-cigarette—and the majority of those kids, 56 percent, had only tried it once—most of those teens said they tried vaping because it was “cool, fun, or something new.”

It also showed that the teens who had tried e-cigarettes were also more likely to have risk factors associated with smoking, like having family members or friends who smoke. So it raises the question: are e-cigarettes a less harmful path for kids that were probably going to smoke anyway or a gateway for kids who might have avoided tobacco if not for a new trendy gadget?

“I don’t know if you can necessarily tease that apart,” Dr. Michael Khoury, a pediatrician and lead author of the study, told me over the phone. “We just have to be careful. When we see what happens to adolescent cigarette smoking rates in the coming years, that will be a suggestion as to whether or not e-cigarettes have played a role.”

Proponents of vaping tend to get testy about studies that suggest teens are vaping more, or that vaping is a gateway to smoking. They’re worried that overemphasizing the problem will lead to regulation that will strip away this harm reduction tool from the adults who need it. A study published last week in Nicotine and Tobacco Research projected that e-cigarettes could lead to a 21 percent reduction in smoking-attributable deaths, and another recent survey found an estimated 6.1 million European smokers had quit by switching to vaping.

Khoury said that while there’s growing evidence that vaping can be a successful harm reduction tool among adults looking to quit smoking, this survey shows that—at least in this one population of youth—that’s not what’s motivating teens to vape. And if teens are vaping for other reasons, particularly if they then go on to smoke as some studies have shown, that should be cause for concern.

“I’m not saying it’s a fact, but it’s a cause for concern and we need to be looking at it within the scope of something that could be useful to adults,” Khoury said. “It’s not like we’re talking about heroin or alcohol or any other drug. We’re talking about something that could be potentially useful under the right circumstances as a harm reduction device.”

In other words: just because vaping can be a harm reduction tool doesn’t mean it’s harmless in all scenarios. The best way for vaping to be more widely accepted for the good it does is to reduce the harm it may have, and that means keeping it out of the hands of kids trying to look cool.

Japan’s JT Buys 40% Stake In Ethiopian Tobacco Monopoly For A Record $510M

Jul 18th, 2016
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http://afkinsider.com/129796/129796/

Japan Tobacco Inc. (JT), the seller of Camel and Winston cigarettes outside the U.S., announced on Sunday it had won a bid to buy 40 percent of the National Tobacco Enterprise S.C. from the Ethiopian government for a record $510 million.

JT said in a press release (in Japanese) that it has signed a share purchase agreement of $510 million with the Ethiopian Government for 40% of the total shares in the country’s tobacco monopoly after submitting a successful bid last May.

“The JT Group is delighted to be entering the Ethiopian market where we currently have no presence,” said Mutsuo Iwai, executive vice president and president of the tobacco business.

“Ethiopia will be an important expansion of our geographic footprint in emerging markets. As the largest shareholder, we expect to be able to exert significant influence over the direction of the company. The country is currently experiencing double-digit economic growth, with industry volume also expected to continue to increase.” Iwai added.

The more than half a billion dollar bid by the publicly listed Japanese company was the highest offer ever made for any Ethiopian state-owned enterprise, Addis Fortune reported.

It was more than double its closest rival British American Tobacco – maker of brands such as Rothmans and Dunhill, which offered $230 million for the same stake, Bloomberg reported in May.

Other companies that were involved in the bid included Phillip Morris International, known for Marlboro and a Chinese company—China Logistics Company Ltd. They were among the five bidders, including an unnamed individual from Niger.

The National Tobacco Enterprise S.C., a company established in 1942 as the Imperial Ethiopian Tobacco Monopoly, is one of the four public companies the Ethiopian government said it will privatize in 2016.

The country’s Ministry of Enterprises said in March it plans to sell some of governments shareholding in Bahir Dar Textile S.C., Kombolcha Textile S.C., National Tobacco Enterprise S.C. and Ethiopian Crown Cork and Can Manufacturing Industry S.C.

National Tobacco Enterprise S.C. was first privatized in 2008 when 22 percent of its shares were sold to a Yemeni company, Sheba Ethiopia Investment Plc, for $35 million.

Sheba’s bid to beef up its share by 20 percent was however disqualified after its representatives arrived late for the bid opening meeting in May, Addis Fortune reported.

With JT’s purchase Sheba’s stake in the Ethiopian company is now valued at $255 million, seven times the amount they paid in 2008.

In 2012, Ethiopia offered to sell over 40 public enterprises, including several large farms, a winery and a big hotel, over the next three years, Reuters reported.

While it managed to sell some firms, several other still remain unsold due to lack of interest from foreign investors.

Graphic warnings on tobacco packs ready

Jul 18th, 2016
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http://www.phnompenhpost.com/national/graphic-warnings-tobacco-packs-ready

The Association of Tobacco Industry of Cambodia announced on Saturday that new cigarette packaging, including graphic images and warning text, was ready – as required by the government as of July 23 – but may not hit the market for a few months as businesses get rid of old stock.

According to a law adopted on October 22, 2015, and clarified by the Ministry of Health on February 15, graphic photos need to cover 50 per cent of the cigarette packets, and a written message in Khmer must cover another 5 per cent.

Fines are 4 million riel (about $1,000) for noncomplying tobacco companies; 2 million riel for distributors and wholesalers; and 10,000 riel for retailers.

Mom Kong, executive director of the Cambodia Movement for Health, said the cigarette companies should roll out the new packaging immediately.

“The government gave the companies nine months to prepare. That is a very long time, and I don’t think the companies need to take any more time,” Kong said.

“In Laos, the government gave companies four months, other countries had six or seven. So nine months for Cambodia is enough for companies to sell their products with the new warnings.”

“I will see if there are no new warning packages on the market by the end of July,” Kong said. “We will be a watchdog on the market and monitor how the companies obey, for Cambodians’ health.”

ITIC Founding Co-Chairmen

Jul 17th, 2016
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World’s third-largest tobacco producer quits cigarettes

Jul 15th, 2016
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As cigarettes face increasing regulation and a diminished customer base, under Lars Dahlgren’s leadership Swedish Match is looking ahead to a smoke-free tobacco industry

Based in Stockholm, Swedish Match is a company that makes snuff, chewing tobacco, cigars, matches and lighters. However, it is most famous for making snus – a unique Swedish variety of moist snuff, designed to be placed under the upper lip for long periods of time. The company is the third-largest producer of tobacco products in Europe, according to the 2015 Financial Times Global 500 list. The two other largest tobacco firms on the continent, by the same measurement, are British American Tobacco and Imperial Tobacco. Both of these are UK-based.

While the UK is not exactly known as a hotspot of tobacco use in Europe, historically it played a larger role in the development and growth of the tobacco industry, while Sweden – at least within popular perception – has played a much smaller role. It should be seen as no small feat, then, that this Swedish tobacco company has managed to secure itself so lofty a position. A large part of its success is due to the company’s forward-looking approach when it comes to selling tobacco. The firm itself no longer produces cigarettes, having divested from that particular product 11 years ago. Rather, Swedish Match has steered away from smoke-related tobacco products, focusing instead on the safer snus and chewing tobacco alternatives. This strategy has been followed under the overall direction of one man since 2008: CEO Lars Dahlgren.

Dahlgren and Swedish Match have recognised that smoking tobacco is on the way out. Fewer and fewer people want to enjoy nicotine through the traditional method of burning and inhaling tobacco smoke. However, the consumption and enjoyment of nicotine through other means is far from at a dead end. With the health threats of cigarettes universally known, consumers are looking for safer ways to get their fix – and removing the combustible element massively reduces the potential risks. The recent explosion in popularity of electronic vaporiser cigarettes attests to this. Swedish Match, under the leadership of Dahlgren, has accepted this trend and acted according.

Dahlgren’s strategy as CEO has not been to batten down the hatches and defend smoking from the ever-growing regulation of governments around the world, amid a general decline in use. Rather, he has taken the initiative to push Swedish Match to develop its focus away from conventional cigarettes.

Striking the match

Even before its divestment, Swedish Match was always more than just a cigarette producer. The company is over 100 years old; its origins lie in two firms founded in Sweden in the early 20th century, one producing tobacco products and the other matches and lighters. Svenska Tobaksmonopolet, founded in 1915, started to produce tobacco as a monopoly firm, while Svenska Tändsticks was founded in 1917 and produced matches. The two firms joined together in 1992, under the Procordia Group, before merging into the company that exists today – Swedish Match. As of 1996, Swedish Match has been listed on the Nasdaq Stockholm exchange. In 2015, it had total revenue of €1.5bn, and an operating income of over €425m.

With its nearly 5,000-strong workforce, Swedish Match sells its products worldwide, in more than 100 countries. The firm’s snus products have a majority market share in both Sweden and Norway, and its other products also enjoy market dominance further away from home. Swedish Match’s Redman chewing tobacco has a 40 percent market share in the US, while its cigar products hold almost 25 percent. Its matches and lighters are leaders in a wide range of markets, including the UK, various Scandinavian nations, France, Spain, Australia, Brazil, Russia and France.

Dahlgren himself has worked his way up since joining the company shortly after graduating, as an assistant controller. Now aged 46, Dahlgren climbed to the top through first reaching the position of CFO in Swedish Match’s Philippines office, before working for a few years in the firm’s group finance division. Finally, in 2004, he gained an executive role, serving as the head office’s CFO in Stockholm. Four years later, in 2008, he was appointed CEO. Dahlgren hopes to dispel the myth that tobacco companies are led by out-of-touch traditionalists, clinging to what is left of a declining and increasingly unfashionable market.

“I think many people perceive the tobacco industry as conservative and middle-aged”, he said in an interview with the Swedish Match website. “At Swedish Match, it is the complete opposite; we constantly strive to think in a youthful and innovative manner in everything we do.”

Adapt and improve

As the result of a merger between a firm producing lighters and matches, and another producing tobacco products, Swedish Match has a wider product base than most tobacco companies. At the same time, its production of the uniquely Swedish snus means its tobacco-producing arm is also more varied.

In a world of reduced smoking levels and increased tobacco control – with policies regulating and discouraging smoking from local government councils all the way up to national governments and beyond – Swedish Match’s diverse product base gives it an edge. Rather than fighting the tide of anti-smoking campaigns, it has even embraced it, seeing it as an opportunity to gain market share for its non-smoke tobacco products.

In 1996, when the company first became publically listed, its “smokeless tobacco business consisted of chewing tobacco and moist snuff in the US, and snus in Scandinavia”, said Dahlgren. Now, however, snus products have seen growing sales, particularly in the US. This has been part of a drive to focus on non-cigarette tobacco products. “Today, Swedish Match is truly a different company with a truly different vision.”

According to Dahlgren: “Swedish Match adapts and thrives.” And, in a world of smoking cessation, it is doing both. As he has noted: “In line with our strategic focus and vision, we are working diligently and enthusiastically to facilitate the trend and goal of a world without cigarettes.” And the adaptation seems to be working: snus products now account for more than 50 percent of Swedish Match’s operating profits.

Dahlgren said that now, “in line with our strategic focus and vision, we are working diligently and enthusiastically to facilitate the trend and goal of a world without cigarettes”. The company has taken clear steps towards this, gradually divesting from smoking products. It has already wound up its cigarette operations and, in January 2015, the company took the decision to reduce its shareholding in Scandinavian Tobacco Group, a cigar-producing firm. The company was founded in 2010, and Swedish Match previously owned 49 percent of it, which has now been cut to 31.2 percent.

Snus is, of course, still a tobacco product, meaning it still has some associated health risks. However, it remains much safer than cigarette smoking. In spite of this, many anti-smoking campaigns and local authorities have attempted to clamp down on non-smoking tobacco products. As Dahlgren has noted: “We face challenges through product taxation, regulation, and even the efforts of anti-tobacco organisations.” However, Swedish Match has taken steps to work towards remedying this through the relevant authorities. In the US, for instance, the firm has made an application to the US Food and Drug Administration (FDA) for its snus products to be classified as a Modified Risk Tobacco Product, allowing them to potentially escape certain punitive anti-smoking regulations.

Across the Atlantic

This attempt at a US reclassification is also part of Dahlgren’s forward-looking strategy. The US is seen as a key market for Swedish Match to expand into with its snus products; already a key market for chewing tobacco, Swedish Match has identified it as having a strong potential to become a large destination for snus.

The US is one of the few places in the world where the use of chewing tobacco has gained widespread use and cultural status. However, Americans are increasingly turning away from the product; Swedish Match estimated that in 2014 the company had a 40 percent market share for chewing tobacco in the US, representing an eight percent decline from 2012. Likewise, 2015 saw further a decline in sales volumes. Although Swedish Match owns Red Man, the market-leading premium brand in the US, it recognises use of the product is in decline. For this reason, alongside the decline of smoking, Swedish Match is gearing a lot of its efforts towards expanding its snus market in the US.

Swedish Match’s various snus products saw good growth in the US market last year. “For snus and moist snuff in the US, the General snus brand had good growth in both consumption volumes and market share, and the overall snus market experienced more rapid growth”, said Dahlgren. Dahlgren put the increased popularity of the product down to “its taste, its quality, and its benefits versus smoking”.

While Swedish Match’s application for Modified Risk Tobacco Product status is still awaiting approval, Dahlgren appears confident that it will be achieved. “While we are still awaiting an FDA decision, we were very pleased to see that Swedish Match this past year was the first and so far only tobacco company to have received product approvals under the pre-market approval process of the FDA”, he said. With its pre-existing brand dominance and its acceptance of changing market conditions, Swedish Match is well positioned to grow its snus sales in the US market. It has recognised which tobacco products are on the decline, and has focused its energies accordingly, as well as working with regulators in order to ensure lighter regulation of its products.

Nicotine Addiction Clinical Presentation

Jul 15th, 2016
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http://emedicine.medscape.com/article/287555-clinical

Nicotine addiction is now referred to as tobacco use disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). [2]

There are 11 possible criteria, of which at least 2 must be present in the last 12 months:

1. Tobacco taken in larger amounts or over longer periods of time
2. Persistent desire or unsuccessful efforts to cut down or control use
3. A great deal of time is spent on activities necessary to obtain or use tobacco
4. Craving or a strong desire or urge to use tobacco
5. Recurrent tobacco use resulting in a failure to fulfill major role obligations at work, school, or home
6. Continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by effects of tobacco (eg, arguments with others about tobacco use)
7. Important social, occupational, or recreational activities are given up or reduced because of tobacco use
8. Recurrent tobacco use in situations in which it is physically hazardous (eg, smoking in bed)
9. Tobacco use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco
10. Tolerance, as defined by either the need for markedly increased amounts of tobacco to achieve the desired effect or a markedly diminished effect with continued use of the same amount of tobacco.
11. Withdrawal, as manifested by either the characteristic withdrawal syndrome or the use of tobacco to relieve or avoid withdrawal symptoms.

Symptoms of withdrawal include difficulty concentrating, nervousness, headaches, weight gain due to increased appetite, decreased heart rate, insomnia, irritability, and depression. These symptoms peak in the first few days but eventually disappear within a month.

Symptoms of nicotine toxicity, otherwise known as acute nicotine poisoning, include nausea, vomiting, salivation, pallor, abdominal pain, diarrhea, and cold sweat.

A previous history of depression, use of antidepressants in the past, and onset of depression during previous attempts to quit smoking should be obtained.

The time to first cigarette and total cigarettes per day are the 2 strongest predictors of nicotine addiction. The nicotine dependence and nicotine withdrawal could be treated by means of the following [4, 29] :

• Other forms of nicotine delivery
• Drugs that selectively target one or more of the underlying mechanisms
• Behavioral treatments, acupuncture, and other therapies

LCQ20: Regulation of e-cigarettes

Jul 15th, 2016
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http://7thspace.com/headlines/528171/lcq20_regulation_of_e_cigarettes.html

Hong Kong (HKSAR) – Following is a question by the Dr Hon Priscilla Leung and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (June 15):

Question:

In 2014, the World Health Organization issued a report proposing to bring electronic cigarettes (e-cigarettes) under regulation. Since then, a number of countries have enacted legislation to regulate e-cigarettes. Earlier on, the media captured photographs of a girl smoking a fruit-flavoured e-cigarette in a public place, causing some members of the community to worry about the increasing popularity of smoking e-cigarettes among young people and children in Hong Kong. They are of the view that there is an urgent need to regulate the manufacture, import, sale, distribution and publicity of e-cigarettes (including e-cigarettes not containing nicotine).In this connection, will the Government inform this Council:

(1)as the Food and Health Bureau (FHB) submitted a paper to the Panel on Health Services of this Council in as early as May last year indicating that the Government would study the enactment of legislation to regulate e-cigarettes, and the officials from the Bureau have reiterated such intention to the media in recent months, and quite a number of members of the community have also requested for expeditious enactment of legislation, of the timetable and details of such legislative work, and whether the authorities will undertake to introduce the relevant bill to this Council within this year;

(2)given that quite a number of e-cigarettes and e-cigarette liquid are currently sold on the Internet, how the Government has planned to regulate the online sale of e-cigarettes;

(3)whether it has studied how overseas legislation and relevant initiatives which regulate e-cigarette products not containing nicotine; if it has, of the details, as well as the provisions and initiatives which are of reference value to Hong Kong; and

(4)as it was discovered in a survey commissioned by FHB and conducted by the University of Hong Kong in the past two years that 2.6% of primary school students and 9% of secondary school students indicated that they had smoked e-cigarettes before, whether the authorities have launched publicity exercises targeting both secondary and primary school students on the perils of smoking e-cigarettes; if they have, of the details; if not, the reasons for that?

Reply:

President,

My reply to the questions raised by the Dr Hon Priscilla Leung is as follows:

(1)According to the Pharmacy and Poisons Ordinance (Cap. 138), e-cigarettes containing nicotine are considered pharmaceutical products.They have to comply with the relevant requirements on safety, quality and efficacy, and must be registered with the Pharmacy and Poisons Board of Hong Kong before they can be put up for sale or distribution in Hong Kong.Under the same ordinance, nicotine is categorised as Part 1 poison which can only be legally possessed or sold by licensed medicine dealers, including “licensed wholesale dealers” and “authorised sellers of poisons”. Illegal possession or sale of Part 1 poisons or unregistered pharmaceutical products is an offence.Any person convicted of the offence is liable to a maximum fine of $100,000 and imprisonment up to two years.

In addition, under section 3 of the Smoking (Public Health) Ordinance (Cap. 371), no person is allowed to smoke or carry a lighted cigarette, cigar or pipe in a no-smoking area, and “smoke” is defined as “inhaling and expelling the smoke of tobacco or other substance .”As such, smoking of e-cigarettes or similar products in a statutory no-smoking area is an offence.

We are discussing the legislative arrangements with relevant departments. It is expected that the amendment bill, which aims to completely prohibit the import, manufacture, sale, distribution and advertising of e-cigarettes, will be introduced for the scrutiny of the Legislative Council in 2016-17.

(2)The legislative proposal to regulate e-cigarettes being considered by the Government will apply to all sale activities of e-cigarettes, whether they are conducted physically or online.The Department of Health (DH) has put in place an established mechanism to monitor the drugs supplied on the market (including the Internet).The DH will carry out investigations upon receiving information about suspected illegal possession or sale of unregistered pharmaceutical products or Part 1 poisons, and take joint actions with the Police or make test purchases where necessary. Legal actions will be taken if any irregularities are detected.

(3)We note that other jurisdictions such as Singapore, the United States, the United Kingdom and a few other countries have planned / adopted measures to either regulate or completely prohibit the import, distribution and sale of e-cigarettes. We will study in details the regulatory approaches adopted by different jurisdictions and formulate a suitable tobacco control policy in the light of the actual situation in Hong Kong.

(4)The Tobacco Control Office (TCO) of the DH has, by producing and broadcasting more new TV and radio Announcements in the Public Interest, stepped up publicity to increase public awareness of the potential harm in using e-cigarettes.The TCO has also produced information leaflets and posters, and uploaded the relevant information to its website for reference of the public and healthcare personnel.To discourage the use of e-cigarettes among young people, the TCO has also strengthened education on the potential harm of e-cigarettes.By sending letters, promotional leaflets and posters to all primary and secondary schools in the territory, the TCO has advised schools to remind their students not to use e-cigarettes.In collaboration with various non-governmental organisations, the TCO also promotes smoke-free lifestyle and disseminates the message of abstaining from e-cigarettes in kindergartens as well as primary and secondary schools.The Government will continue its health education work to prevent the general public and students from starting to use e-cigarettes.

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