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November 17th, 2016:

Surgeon general ramps up addiction battle

The U.S. surgeon general has released the first comprehensive report on addiction in America, and he wants it to have as much public health punch as the groundbreaking report on the dangers of tobacco 50 years ago.

In an interview with POLITICO on the eve of its release, Surgeon General Vivek Murthy said that he’s determined to make the report an action item in communities across the country, and not just put it on the shelf.

“We can’t afford not to address it,” he said. “We can’t afford to stay on the path we’re on.”

More than 20 million people in America have substance abuse problems; 78 die every day from opioids alone.

The report, released Thursday morning, is about substance abuse broadly — both alcohol and drugs, legal and illegal. But it’s the opioid epidemic that has grabbed public attention. And opioids have gradually emerged as one of Murthy’s top priorities, particularly as he’s traveled the country listening to families’ stories.

In Washington and the states, Republicans and Democrats alike have endorsed a more robust response, and Congress passed bipartisan legislation — although it’s not yet funded. But the report, “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health,” arrives amid heightened uncertainty about policy and access to treatment.

The incoming Trump administration has not outlined a detailed opioid policy, although Donald Trump during the campaign pledged to stop illegal drugs from flowing across the borders and to make sure people with addiction have “the assistance they need to unchain themselves.”

Beating tobacco starts with going easy on vaping

Stopping smoking has always been a bit of a drag. White-knuckle determination to resist the need to smoke is accompanied by a bewildering variety of inhalers, gums, sprays, patches, tablets and counselling, much of which is associated with modest success and some of which has serious adverse side-effects.

Stopping smoking remains a global health priority since it is still the leading cause of premature death and serious ill health. With the advent of e-cigarettes, quitting smoking has become fun as smokers discover a world of user-modifiable e-cigarette kits and a limitless range of flavours. In a survey of more than 22,000 vapers carried out by researchers in Glasgow, smokers typically started vaping with high-nicotine, tobacco-flavoured e-liquids before progressing to zero-nicotine fruit flavours as they moved further away from the world of smoking.

Although they have helped millions to turn their back on tobacco, e-cigarettes have attracted controversy due to fears that they may attract non-smokers and lead to renormalisation of smoking. Government bodies in Europe and the United States are imposing restrictive regulations on e-cigarette production, sales and use that will limit the range of flavours and reduce access to the modifiable e-cigarette kits that vapers seem to enjoy.

At a World Health Organisation meeting in Delhi this month on tobacco control, delegates were asked to support a worldwide ban on e-cigarettes. Here in the UK, the appetite for regulation is enormous. Almost all council areas within the UK already maintain a ban on the use of e-cigarettes at work, leaving vapers to stand in the cold.

With Brexit, the UK has the opportunity to develop regulations governing e-cigarettes that can ensure that these devices remain widely available for smokers at the same time as their appeal to non-smokers is minimised.

Flavours are important, as are retaining the user-modifiable e-cigarette tanks that allow users to produce the voluminous vaper clouds that have become so characteristic of these devices.

We need to discourage e-cigarette use by non-smokers, not by forcing people to vape in hiding but by recognising what this technology is achieving in saving smokers’ lives.

Dr Neil McKeganey is director of the Centre for Substance Use Research in Glasgow

EC consults on tobacco excise duties

The European Commission (EC) has opened a public consultation on the revision of Directive 2011/64/EU, which sets out EU rules on the structure and rates of excise duty applied to manufactured tobacco. EU citizens and stakeholders alike are invited to give their opinions.

Directive 2011/64/EU defines and classifies various manufactured tobacco products according to their characteristics and lays down the relevant minimum rates of excise duty for the different types of products. These rates are reviewed every four years. The EC’s last report, in December 2015, said there could be scope to improve Directive 2011/64/EU in order to reduce the administrative burden for both member states and economic operators and reduce distortions in the internal market. The report was accompanied by a proposal for the revision of the Directive.

The consultation is intended to add to the possible policy options under analysis. It closes on 16 February 2017.