As international evidence of the harms of e-cigarettes mounts, a statement has been released from the Chief Medical Officer and State and Territory Chief Health Officers warning Australian users of an emerging link between vaping and lung disease.
Below, Croakey editor Jennifer Doggett summarises some recent international developments in the regulation of vaping and outlines the key points from the Chief Medical Officer and his state/territory colleagues.
Jennifer Doggett writes:
When e-cigarettes first came onto the market they were heralded as a safer alternative to tobacco smoking and an effective cessation strategy for smokers looking to quit.
This view was supported by some addiction experts in Australia who have called on the Government to make these products more accessible to the community.
However, some experts in this area have also been vocally opposed to vaping. Croakey has previously reported Professor Simon Chapman’s review of the gaps and limitations in the evidence for e-cigarettes as a ‘harm reduction’ strategy for tobacco users. Along with other public health advocates, he has also expressed concerns about the role of the tobacco industry in misleading authorities about the safety of this product.
One reason for these divergent views is differing interpretations of the role of e-cigarettes as a smoking cessation strategy and how the risks associated with vaping are balanced against the significant harms associated with tobacco use.
There are some studies which have found that e-cigarettes can help smokers to quit. But evidence is now indicating that vaping may in fact be more dangerous than traditional cigarette smoking, making its role as a cessation strategy redundant.
There have been seven recorded vaping-related deaths in the USA, with reports that another 380 deaths, suspected of being caused by vaping, are being investigated. According to the Centre for Disease Control most of the deaths being investigated involved people who used Tetrahydrocannabinol (THC), either with or without nicotine, in their e-cigarette products.
Canada has also just reported its first vaping-related severe lung illness in Ontario.
Breaking news: Canada’s first vaping-related severe lung illness has been reported in the London area. This comes as health minister @celliottability orders hospitals to report possible cases to province’s chief medical officer. https://t.co/OToPcZPfZh
— Carly Weeks (@carlyweeks) September 18, 2019
These reports and growing concern from the medical community about the risks of e-cigarettes have prompted action from governments and public health authorities worldwide.
Overnight both Michigan and New York have banned the sale of flavoured vaping products.
— Max Lewis (@MaxLewisTV) September 18, 2019
"It is undeniable that vaping companies are deliberately using flavours like bubblegum, Captain Crunch and cotton candy to get young people hooked on e-cigarettes – it's a public health crisis and it ends today” – NY Governor Cuomo. https://t.co/i5InfiPSL2
— Angela Pratt (@angepratt) September 18, 2019
CBS and CNN have both stated that they will no longer advertise e-cigarettes.
CBS has now joined @CNN and its parent company, @WarnerMediaGrp, in no longer accepting e-cigarette ads.
7 people have DIED in the U.S. due to a lung-related illness linked to vaping.😱https://t.co/5RLLKyn0sG
— Dr. Dena Grayson (@DrDenaGrayson) September 18, 2019
India announced a ban on electronic cigarettes this week, “The decision was made keeping in mind the impact that e-cigarettes have on the youth of today,” India’s finance minister, Nirmala Sitharaman, told reporters in the capital, New Delhi.
Australian Medical Authorities’ statement
Key messages from the Australian statement are:
- There is growing evidence implicating e-cigarettes in a range of harms to individual and population health. E-cigarettes are relatively new products and the long-term safety and health effects associated with their use and exposure to second-hand vapour are unknown.
- International evidence is emerging of a possible link between the use of e-cigarettes and lung disease. This includes severe lung disease requiring intensive care support and, as at 11 September 2019, at least six fatalities being linked with vaping in the United States.
- Individuals who use e-cigarettes presenting with unexplained respiratory symptoms (cough, shortness of breath, chest pain), sometimes associated with gastrointestinal and other non-specific symptoms, should seek medical advice.
- Clinicians should ask patients whether they are using e-cigarettes (commonly known as ‘vaping’) in the same context as encouraging smoking cessation and should reiterate that no e-cigarette product has been evaluated for safety.
- Health professionals and consumers should report adverse events following e cigarette exposures to the Poisons Information Centre by phoning 13 11 26 (24 hours a day, seven days a week).
- Liquids used in e-cigarettes (e-liquids), even when labelled ‘nicotine free’, can contain harmful and widely varying substances such as nicotine, heavy metals, volatile organic compounds and cancer-causing chemicals. In some cases overseas, the use of cannabinoids has also been reported.
- At a population level, there continues to be insufficient evidence to promote the use of e-cigarettes for smoking cessation. Unlike any e cigarette product, all smoking cessation products lawfully available for sale in Australia have been evaluated for safety and efficacy and have been registered with the Therapeutic Goods Administration (TGA). To date, the
- TGA has not approved any e-cigarette product as a therapeutic good to help smokers quit.
It recommends that:
- Individuals who use e-cigarettes presenting with unexplained respiratory symptoms (cough, shortness of breath, chest pain), which are sometimes associated with gastrointestinal and other non-specific symptoms, should seek medical advice.
- Clinicians should ask individuals presenting with respiratory symptoms of unclear cause whether they use e-cigarettes (commonly known as ‘vaping’).
- If e-cigarette product use is suspected as a possible cause of a patient’s lung symptoms or disease, the patient should be advised to cease their use of e-cigarettes.
- Smokers or vapers attempting to quit should use evidence-based treatments. Smoking cessation medication (approved by the Therapeutic Goods Administration) combined with behavioural intervention provides smokers with the best chance of quitting for good.
The Australian statement was strongly backed by the AMA which called on users to seek evidence-based smoking cessation treatments.
Note advice from all Chief Medical Officers in response to emerging evidence of link to lung disease in US. Smokers attempting to quit should use evidence-based Treatments. Use TGA approved smoking cessation Rx. AMA backs strong response to vaping deaths https://t.co/ZEOf52xeJn
— AMA President (@amapresident) September 18, 2019