“Electronic cigarettes should not be sold on the open market”

  • Exclusive: the Supreme Health Council refuses to allow nicotine e-cigarettes to be sold anywhere except in pharmacies despite support to the opposite.
  • They are certainly less dangerous than “real” cigarettes, but don’t help smokers to quit.

Pulmonologists, oncologists and toxicologists appointed by the Supreme Health Council to decide the fate of electronic cigarettes have rendered a harsh judgment. The report, exclusively disclosed by Le Soir, was approved Wednesday morning by the organization that provides input to public authorities. The report will be sent to Health Minister Laurette Onkelinx to provide background for her decision. The e-cigarette phenomenon is growing with 2% of Belgians using them regularly, a figure that has increased tenfold in a year. The use rate will continue to grow, because 40% of young French adults have already tried them. The experts recognize that it’s “reasonable to think that e-cigarettes are much less toxic” than regular cigarettes. E-cigarettes work via an element that heats a liquid which in turn releases a vapor that is inhaled by the smoker. The liquid may or may not contain nicotine, but the vast majority of electronic cigarettes chosen by smokers who are trying to quit or reduce their consumption, do contain nicotine.

There is no combustion nor true smoke, the major causes of harm from cigarettes, but that’s not enough to clear these things. Why not?

1. The risk. “The e-cigarette is not without risk because of the effects of the aerosol on the mouth, throat and respiratory passages and the presence of toxic substances in unknown quantities and whose long term safety has not been sufficiently studied,” the experts emphasize. Those experts also warn against “a diversity of products that present different labeling problems or problems relating to nicotine dosage.” To the point where “the accidental ingestion of a capsule containing a high dose of nicotine is potentially fatal for a child.” 

2. Effectiveness for quitting. The experts recognize that the product seems “to be a possible new method for quitting smoking,” the advertising argument used by the overwhelming majority of vendors. “Sold as is, it must be subject to safety and effectiveness criteria,” just like other pharmacological products used for quitting, such as patches and gum. Currently, no product sold in Belgium meets these requirements. The experts, who think that too few studies have focused on effectiveness in aiding cessation, also emphasize that “smoking less results in almost no cardio-vascular improvement, and in very little for other diseases,” including pulmonary and cancer-related illnesses. However, “quitting completely is very good for one’s health.”

3. A potentially real addiction. The experts recognize that the electronic cigarette “probably doesn’t have the same addictive power,” which might make it a substitute, but “its effectiveness still has not been proven” compared to gum and the patch. In addition e-cigarettes might maintain an addiction through their continuity with real cigarettes. The person who “vaporizes” at the same times, in the same places, has the same tastes associated with additives such as menthol and receives the same relaxation effect as with a real cigarette.

4. A gateway. Another problem: e-cigarettes could be a Trojan horse for real cigarettes. The experts think that additional studies are needed because one study “whitewashed” the cigarette on this accusation. In addition, “use is growing significantly in the United States. The more adult smokers use it, the more attractive it becomes. The danger is in having smoking once again becoming normal.” In fact the experts think that even a flavored non-nicotine cigarette “might be experienced unconsciously or consciously as a preparatory act for the future consumption of tobacco products by imitation.” That is why the experts recommend that even these non-nicotine cigarettes be strictly regulated, such as by banning statements that they improve health and by setting strict controls over flavors and additives.

5. Measures to be taken. The experts recommend that the electronic cigarette with nicotine be considered to be a medication until its effectiveness, quality and safety is proven. Sales would be limited to pharmacies and advertising would be strictly limited. However, sales would be made without a prescription. The experts request that controls be strengthened. As a matter of fact, all sales of electronic cigarettes with nicotine are currently illegal in Belgium. Some stores offer the liquid capsules connected with specific brands, allowing the “vaporizer” to keep his or her favorite flavor. The experts also recommend banning “manual” refills of these capsules, given the potentially fatal risk from a high dose of nicotine. All the same, the experts demand that smoking an e-cigarette remain forbidden in locations where smoking is not allowed. The experts accept that e-cigarettes without nicotine will remain openly available to adults (18 years or over) but forbid statements saying that they have health benefits. No advertising will be permitted. Finally, the experts request that objective information be provided to the health and education sectors, where the public is most likely to seek information.

Essentially, the experts are asking that the status of electronic cigarettes remain as it currently exists, but with improved enforcement on the ground. The sale of banned products will obviously continue to grow. However, negotiations in progress at the European level between the Commission, Council of Ministers and Parliament might put these rules into question. Requiring that e-cigarettes meet the high status of medication is far from being supported unanimously. A majority seems in favor of some regulation, but up to what point? We will find out December 18, the date of the final negotiations.

FREDERIC SOUMOIS

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