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GP Why are we waging a war on e-cigarettes when they help smokers quit?

Dr Garrett McGovern argues that banning e-cigarette flavours will increase smoking harm and death and will not protect young people.

THE JOINT COMMITTEE on Health published its report this week on pre-legislative scrutiny of the Public Health (Tobacco and Nicotine Inhaling Products) Bill 2019. A number of recommendations were made including a ban on all flavours added to electronic cigarettes (other than tobacco flavour).

The rationale given was that flavours attract young people and that removing their availability would be less appealing to adolescents and this would curtail their use.

The report also states that “tobacco costs the Irish exchequer €10.6 billion every year and that 6,000 deaths a year are caused as a result of smoking”. Nobody can argue with those eye-watering statistics and every effort should be made to reduce smoking harm to all of our citizens.

Further, one of the aims of this bill is “to ensure a smoke-free future for younger people growing up today and to assist smokers who wish to quit a life-long addiction”. The aim is a tobacco-free Ireland by 2037. We have been steadily making progress in reducing the overall number of people who smoke. In 2015 23% of the population smoked. In 2022 that figure is less than 20%.

Progress made

We need to do more, no question, but the statistics are moving in the right direction. This has been achieved in no small part by the enhancement of smoking cessation options available to smokers over the past decade or so.

One of these interventions, which is becoming ever more popular, is e-cigarettes. A device which delivers nicotine via a vapour without the combustion of tobacco (e-cigarettes contain no tobacco at all). It is the burning, inhaled tobacco where pretty much all the harm of smoking comes from.

In Ireland, there are approximately 200,000 people who use e-cigarettes. Almost all of them are smokers or ex-smokers who are trying to quit. International research has shown that fewer than 1% of people vape who wouldn’t otherwise smoke. In other words vaping is a smoking cessation tool and is about twice as effective as any other smoking cessation tool (including Nicotine Replacement Therapy, NRT).

The Royal College of Physicians UK and Public Health England estimate that vaping is at least 95% safer than smoking. Central to smokers making a quit attempt using e-cigarettes is the use of flavours.

Despite these compelling statistics, the joint committee has diverted its attention away from smokers and instead shone a light on young users of e-cigarettes. It is estimated that fewer than 20% of people below the age of 18 years have used e-cigarettes but the vast majority use them irregularly or experimentally. Only 4% use e-cigarettes regularly (i.e. daily or almost daily). This equates to less than 1% of the overall population of people under 18 years of age.

Is vaping harmful?

Even in those who vape regularly there seems to be very little evidence of significant harm. In my own work, I am not yet encountering or treating anyone in clinical practice for a vaping-related disease. In fact, I have not even heard of a single case of a vaping-related harm. Regular use of nicotine seems to be very safe in Nicotine Replacement Therapy (NRT) preparations. Nicotine also seems to be very safe in electronic cigarettes.

This begs the question then: Why are we waging a war against the very product (e-cigarettes) that is helping many smokers escape the clutches of a habit (smoking) that is causing them immeasurable harm and will reduce their life expectancy by 10-15 years in an effort to reduce initiation by only 1% of the adolescent population who are unlikely to be developing significant harm anyway.

Of course, it is important to reduce e-cigarette initiation in young people but a far more important aim is to reduce the number of young people initiated to smoking. E-cigarettes are not a gateway in to smoking (as has often been claimed). They are a gateway out of smoking and a path to a longer and healthier life.

It is incredible to think that in Ireland in 2022 there is no age restriction for e-cigarette use. New Nicotine Alliance (NNA) Ireland and trade groups have been calling for an age restriction for years but this regulatory step should have been enacted long before now. I believe that banning flavours (the constituent of e-cigarettes that attracts smokers) in favour of a tobacco-only flavour (the flavour smokers are trying to get away from) is a mind-numbingly short-sighted policy that is likely to increase the number of smokers in this country and all the harms that come with it.

I also believe it’s going to threaten the viability of the 400 or so reputable vaping retailers who are experts in providing advice to smokers who are trying to quit. A flavours ban is a de facto e-cigarette ban, as the numbers attracted to tobacco flavours will be minuscule and most e-cigarette retail units will likely close. The Joint committee’s exclusion of people who actually use e-cigarettes from these hearings was short-sighted as they are significant stakeholders in this debate.

I am urging the Government to ignore the recommendation of a flavours ban on e-cigarettes. Such a policy will be disastrous and result in more smoking-related harm and death.

Dr Garrett McGovern is a GP specialising in addiction medicine at the Priority Medical Clinic in Dundrum.

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Dr Garrett McGovern
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