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Letters – Clearing the air on vaping

THE Ministry of Health has taken the bold step to regulate the sale of e-cigarettes. The action to confiscate e-cigarettes and vape liquids which contain nicotine from illegal vendors is provided for under the Poisons Act 1952. It baffles the medical fraternity that the good effort by the ministry has received brickbats from some quarters including from another ministry. The decision to ban unregulated sale of e-cigarettes was made after a study conducted by a technical committee formed to look into the effects of e-cigarettes and shisha.

We generally look at the hard facts and the risk posed by an agent. This may involve research done locally, overseas or by combing through literature that are reliable and valid. Some human research may take two to three decades to attain credible and valid results. It makes no sense to wait for that prolonged duration to make a decision as seen in cigarette smoking studies. The damage will be irreversible by then and curtailing the habit later becomes extremely challenging.

The sale of e-cigarettes is banned in many countries like in Singapore, Brunei, Thailand, Cambodia, Hong Kong, Japan and Australia. In Malaysia, e-cigarettes in a short period of two years has already attracted one million smokers.

There are about 600 e-cigarette brands manufactured notably in countries like China and Indonesia. Many of them are devoid of quality control measures and only a few of them have been analysed. Studies have shown a great variety in the levels of the toxic substances and nicotine they produce. E-cigarettes are often designed to simulate the act of tobacco smoking by producing an appealingly flavoured aerosol that looks and feels like tobacco smoke.

It entices people especially schoolchildren and teenagers who often feel hip and fashionable when they smoke e-cigarettes.

Various preliminary studies have shown the presence of nicotine, a highly addictive substance, cancer causing agents or toxic substances like formaldehyde, acetaldehyde and potentially toxic metal nanoparticles in the vapours.

In addition to cancer, they pose reproductive, birth defects and are easily inhaled as well as end up in various vital organs like the heart, lungs and brain. A study by the National Poison Centre at Universiti Sains Malaysia found that 40mg of nicotine contained in 10ml of vape liquids could instantly kill an adult person.

Another area of concern is the refillable cartridges used in some e-cigarettes. Currently, there are no accepted measures to confirm their purity or safety. Smokers have the liberty to decide on the concentration of nicotine. This poses the risk of overdose of nicotine. It also allows over enthusiastic smokers to dabble in lethal concoctions of nicotine with marijuana, amphetamine or other synthetic drugs as detected recently in Johor. Enforcement agencies like the police have difficulty establishing the constituents of e-cigarettes that are spiked with any synthetic drugs even if smoked within reach. The vape liquid has to be sent to a laboratory to establish the exact chemical constituent. Spiked e-cigarettes or vaping has posed major problems in western countries due to the illegal combination with synthetic drugs especially among children and teenagers. There has also been a dramatic increase seen in the United States where vape liquid accidentally come into contact with the users’ skin and resulting in nicotine poisoning and children drinking it. Cases have also been reported in Malaysia among adults and children.

The justification used by the industry for the usage of e-cigarettes or vaping as a replacement for nicotine is preposterous. A World Health Organisation (WHO) report states there is unsatisfactory “rigorous, peer-reviewed studies conducted to show that the electronic cigarette is a safe and effective nicotine replacement therapy”. Quit smoking effort involves a combination of self-motivation, counselling, family, peer or workplace support. Nicotine replacement therapy (NRT) that gives you nicotine in the form of gums, patches, sprays or inhalers is also used to boost success rates. No one act like e-cigarettes is a likely option to justify quit smoking on a long-term basis.

The recent fire and burns suffered by a passenger due to an ignition from an e-cigarette during travel in a domestic airline as well as burns suffered by smokers when e-cigarettes were switched on at homes are also major causes of concern to many.

An estimated 100 million tobacco related deaths have occurred globally over the last century. Tobacco smoking and drug usage including the synthetic drug scourge in Malaysia has taken a toll on the population especially schoolchildren and teenagers who we look upon as the future leaders of the nation. The government is grappling with these problems. We hope not to have a high-tech way to hook a new generation on another bad nicotine habit.

Let us work together with the Ministry of Health, interested stakeholders and the silent majority to resist this lurking malice of the future.

Assoc Prof Dr Jayakumar Gurusamy

Perdana University Graduate School of Medicine

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