Month: December 2021

The aim is improving health and easing the financial burden of purchasing cigarettes.

A study conducted earlier this year, looked into the feasibility of distributing e-cigarettes to smokers attending homeless centres in Britain, with the aim of improving their health and ease the financial burden of purchasing cigarettes.

As part of this earlier trial, four homeless centres in Great Britain were allocated to either a Usual Care (UC) or E-Cigarette (EC) group. The 32 participants in the UC group, received smoking cessation advice and were offered support by a local Stop Smoking Service. The 48 EC group participants were given a vape starter kit with a 4-week e-liquid supply.

The compiled results had indicated that in both groups, depression and anxiety scores declined over the course of the study. However, the group who received vape starter kits indicated more smoking cessation success. “The EC intervention was well received with minimal negative effects and very few unintended consequences (e.g. lost, theft, adding illicit substances),” reported the researchers.

The objective of this trial was assessing the feasibility of supplying smokers attending homeless centres with free e-cigarette starter kits and estimate parameters so as to inform possible future trials conducted on a larger scale.

A larger trial to be conducted

Subsequently, a larger trial is to be conducted, this time including 32 centres for the homeless across five regions in the UK – Scotland, Wales, London, the South East and the East of England. Vape starter kits, costing an average of about £25 each, will be given for free to people attending 50% of the participating centres, while people at the other centres will be allocated to a care group.

The current trial will include 480 participants, with 240 in each group and 15 from each centre. Prof Caitlin Notley, from the University of East Anglia’s Norwich Medical School, highlighted that the percentage of homeless people who smoke is higher than the one in the general population. “We know that around 70% of people who are homeless smoke tobacco – this is far higher than the UK average of 14.1%. We also know that e-cigarettes are the most popular method of quitting smoking, with some studies suggesting they are more helpful aids than nicotine gum or patches and much less harmful than smoking tobacco.”

She reiterated that e-cigarettes are effective smoking cessation tools because vaping mimics smoking. “Electronic cigarettes mimic the experience of cigarette smoking because they are hand-held and generate a smoke-like vapour when used. They can be an attractive option for helping people switch from smoking, even if they have tried and failed in the past.”

Read Further: ITV

UK Physicians Suggest Financial Incentives for Pregnant Smokers Unable to Quit 

Many people begin using e-cigarettes with no intention to quit smoking, but then do quit smoking. The phenomenon is so widely recognized in the vaping community that it has a name: accidental quitting. Lots of vapers refer to themselves as accidental quitters or accidental vapers.

People who smoke but don’t intend to quit begin vaping for various reasons. They may try vaping out of curiosity, or vape as a substitute in settings where smoking isn’t allowed, or they may buy an e-cigarette on a whim. What we know is that, for whatever reason they try vaping, many discover they prefer it to smoking, or at least that it’s a good enough replacement that they decide to do it full time.

Now for the first time, a peer-reviewed study has recognized the experience of the accidental quitter. “Association of e-Cigarette Use With Discontinuation of Cigarette Smoking Among Adult Smokers Who Were Initially Never Planning to Quit” is the tongue-twister title of an open-access paper published yesterday in the journal JAMA Network Open. The study was authored by a group of researchers led by Dr. Karin A. Kasza, a research scientist in the Department of Health Behavior at the Roswell Park Comprehensive Cancer Center in Buffalo, NY.

The authors found that when smokers vape daily their odds of quitting smoking rise dramatically—even though they didn’t intend to quit smoking before vaping. The researchers identified 1,600 people who, at the beginning of the study, smoked cigarettes, didn’t vape, and didn’t intend to quit smoking. Among that group, 28 percent of those who began vaping daily quit smoking. Among those who didn’t vape at all, just 5.8 percent quit smoking.

“Most other studies focus exclusively on people who are actively trying to quit smoking, but this study suggests that we may be missing effects of e-cigarettes by not considering this group of smokers with limited intention to stop smoking—a group that is often at the highest risk for poor health outcomes from cigarette smoking,” said Dr. Andrew Hyland, Chair of Health Behavior at Roswell Park and one of the study’s authors.

The study used four waves of data from the Population Assessment of Tobacco and Health (PATH) Study, collected between 2014 and 2019. PATH is a national longitudinal study of tobacco and nicotine product users, run jointly by the FDA Center for Tobacco Products (CTP) and the National Institute on Drug Abuse (NIDA). The Roswell Park study was funded by grants from the CTP and NIDA.

In addition to being far more likely to quit smoking completely, smokers who vaped daily were also more than four times as likely to switch from daily to less frequent smoking (45.5 percent) than those who didn’t vape (9.9 percent) or vaped less often (10.2 percent).

The authors believe “accidental quitters” (a term they don’t use) are a large enough group that their experience should matter to regulators like the FDA. “Our findings here suggest that such smokers should be specifically considered when evaluating the risk-benefit potential of e-cigarettes for smoking cessation in the population,” they note in the paper.

Clinical trials have shown that vaping outperforms nicotine replacement therapy for smokers intending to quit. But the smokers represented in the Roswell Park study are a much more difficult group, because they don’t intend to quit smoking.

“We found evidence that the use of e-cigarettes could have a positive impact on this very hard-to-reach group of recalcitrant smokers,” says Dr. Hyland. “To truly understand the health impact of vaping on the U.S. population, we need to consider those with no intention to quit.”

It should surprise no one that vaping, with its endless device and flavor options and its similarity to the act of smoking, offers the best chance to reach the most hardened smokers. Unfortunately, the trick must be performed while smokers are also bombarded with misinformation intended to sow doubt about vaping, and laws and regulations designed to restrict access and affordability. How many smokers would get interested if public health organizations recommended vaping and shared honest estimates of harm compared to smoking?

Sadly, Estonia has recently ranked third in Europe for smoking-related deaths. To this effect, the current bill proposes amendments which would clarify regulations regarding alternative nicotine products, with the aim of encouraging safety and accessibility to such products and reduce smoking rates.

Bill sponsor MP Tarmo Kruusimäe said that previous amendments to the Tobacco Act, have not only led to a rise in smoking rates, but also unintentionally created a booming black market.

Amendments proposed on nicotine content and flavours

The amendments currently proposed would introduce regulations on nicotine content in white snus (tobacco free snus) and modify existing regulations regarding flavoured products and access to online sales.

An release by NNA Estonia summarized the amendments as follows:

“The proposed regulations will:

• Set the maximum nicotine content in ‘white snus’ to 25mg/g and limit the maximum pouch size to 1 gram.
• Prohibit the addition of vitamins, caffeine, taurine and other additives which may give consumers the false impression that ‘white snus’ is beneficial to health or promotes energy.
• Exclude sweet flavours from the selection such as candy, cakes, soft drinks etc., which may be attractive to youth.”

Thankfully the bill proposes reversing a current ban on flavours which allows only tobacco and menthol on the market. The bill proposes extending the selection of flavours but keeping those described as candy, dessert or soft drinks banned.

Online sales would be brought back upon digital identification

Online sale of safer nicotine alternatives is currently banned. The bill would restore domestic online sales upon digital identification (ID-card) to exclude any sales and availability of products to minors. The NNA explained that a similar system has been adopted locally for digital voting which has proven to be very secure.

The proposed amendments would ensure that images and icons relating to child centric graphics such as cartoons, toys, characters, descriptors etc., would no longer be portrayed on the packages.

The display of electronic devices used for safer nicotine use is currently prohibited except in specialist independent retailers. The amendment would allow general retailers to display electronic nicotine products thus allowing adult customers the opportunity to view the range of products available, helping them to make informed choices.

The Bill on Amendments to the Tobacco Act are available on the Riigikogu website.

A European Think Tank Discusses Europe’s Beating Cancer Plan

The purpose of the list is guiding national authorities on the type of medicines that should be available in their countries. On October 1st 2021, the WHO published the updated list containing the infamous drugs.

Chantix

Chantix is known to cause moderate to severe psychological side effects, from horrifying nightmares to suicidal thoughts.

Varenciline, which goes by the trade name of Chantix, is an anti-smoking drug renowned for getting smokers over any cigarette cravings. Whilst considered significantly effective, it is also known to cause moderate to severe psychological side effects, from horrifying nightmares to suicidal thoughts.

After numerous reports about such disturbances, the US Food and Drug Administration (FDA) had placed the most severe warning available on the medication, which led to Chantix’s sales dropping from $846 million in 2008, to $671 million last year.

To compensate for this drop, its manufacturer, Pfizer, had invested heavily in advertising and settling lawsuits against the drug. Moreover, the Pharma company had released data retrieved from a study which allegedly proved that there is no direct link between the consumption of Chantix and experiencing psychological disturbances.

Subsequently, after refusing to lift the warning in 2014, the FDA ha recently decided to change its stance and drop the warning. The agency required that the medication have its side effects listed, it also specified that the label should state that Chantix is more effective than other smoking cessation therapies.

Meanwhile last June, Pfizer was forced to halt the distribution of Chantix and recall some stock after finding elevated levels of nitrosamines in the pills. However, the following month the FDA said it will temporarily allow some manufacturers to distribute the carcinogen-containing drug, below an interim limit of 185 ng per day, until the impurity can be eliminated or reduced to acceptable levels.

Bupropion

On the other hand, Bupropion is actually an anti-depressant medication, and therefore also comes with possible psychological side effects, such as depression and suicidal thoughts. “This medicine may cause some people to be agitated or display other abnormal behaviors. It may cause some people to become depressed or have suicidal thoughts/tendencies. Stop the medication and seek immediate attention if you notice worsening depression, suicidal ideation (suicidal thoughts or behavior), or unusual changes in behavior that are not typical of nicotine withdrawal. Contact your provider immediately if this occurs,” reads a guide about the drug.

Interestingly, the WHO seems undeterred by all these possible adverse effects in both medications. Yet it remains fully against relatively safer nicotine products which can be used for smoking cessation such as vapes and heated tobacco products, and seem less risky than these medications.

The WHO insists on a “quit or die” approach with regards to smoking

In a recent press release, the Independent European Vape Alliance (IEVA) urged the World Health Organization (WHO) to focus on the future of millions of smokers worldwide “rather than its own counter-productive “quit or die” dogma.”

Discussing the infamous WHO FCTC COP9 held in Geneva last November, the press release highlighted that the WHO has lost sight of the importance of harm reduction in relation of tobacco, despite still embracing it in other contexts. “There is conclusive evidence that: completely substituting [vaping] for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes.”

Similarly, 100 top experts in the field of public health and tobacco harm reduction, have sent a clear message to the WHO, a demand to end the war on vaping and other nicotine alternatives.

Amongst the experts were World Vapers’ Alliance (WVA’s) scientific advisor Prof. Bernhard Mayer and Dr. Colin Mendelsohn, an Australian public health expert, and they emphasized that the current anti-vaping approach from the WHO will “lead to more death and suffering from smoking.” “100 experts have spoken, and consumers agree that vaping and other methods of tobacco harm reduction must be at the forefront of saving lives. The WHO ignores that fact for the moment, but we’re asking them to listen. 200 million lives depend on it. It is time to end the war on vaping,” said WVA Director Michael Landl.

Read Further: Mirage

Experts Warn Asian Leaders Against WHO’s Misguided Vaping Guidance

“..the TGA has granted a legal permission which allows pharmacies and a pharmacy marketing groups to advertise (i.e. promote), through certain media, where to obtain nicotine e-cigarettes and liquid nicotine with a prescription”.

In 2020, Australia’s Federal Health Minister Greg Hunt had announced a new measure banning the importation of vape liquid containing nicotine. A number of public health experts, tobacco harm reduction advocates and MPs, had spoken up against this measure, resulting in it being put on hold.

However earlier this year the TGA announced that the sales of the products will be restricted to pharmacies via prescription “..the importation of nicotine e-cigarettes and liquid nicotine for vaping will require a doctor’s prescription. This aligns with current domestic restrictions under State and Territory law, that prohibit the supply of nicotine containing e-cigarettes in Australia without a valid medical prescription.”

Permission to make ‘restricted representations’ of vaping products

Meanwhile, the most recent announcement grants pharmacists the permission to make ‘restricted representations’ of these products. In a statement released on Monday 5th July, the TGA said “generally, it is not lawful to advertise prescription medicines. However, the TGA has granted a legal permission which allows pharmacies and a pharmacy marketing groups to advertise (i.e. promote), through certain media, where to obtain nicotine e-cigarettes and liquid nicotine with a prescription”.

“This means that patients who have been prescribed liquid nicotine for smoking cessation will know where they can fill prescriptions,” continued the statement. “A pharmacy that dispenses nicotine e-cigarettes or liquid nicotine on prescription may, in specified circumstances, promote to those wishing to fill their prescription that it holds stock.”

Vape adverts guidance

An article on AJP summarized the TGA guidance as follows:

• use information to assist the public in obtaining nicotine vaping products such as:
• the location at which the e-cigarettes or nicotine vaping products are available on prescription to assist with smoking cessation
• the kinds of nicotine vaping products that are available, for example nicotine vape liquids, nicotine e-liquids or devices such as e-cigarettes (including e-cigarettes that resemble a combustible cigarette, one that uses pods or another called ‘mods’) – however note that no trade names are allowed
• the concentrations available
• whether the nicotine solution is in base or salt form

However, any promotion must not:

• be made using radio or television (including streaming services)
• be promoted on websites or any other advertising that is not under the direct control of the pharmacy or pharmacy marketing group
• be promoted by social media influencers or brand ambassadors
• be promoted through social media platforms using paid promotion
• contain pictorial representations of nicotine e-cigarettes or liquid nicotine
• contain trade names
• contain references to flavours
• statements or the implication that vaping is not harmful or is less harmful than smoking
• contain statements or the implication that the stocked e-cigarette is superior to another
• include incentives to encourage a user to take up nicotine e-cigarettes

Local group criticizes TGA for publishing list of authorized vape sellers

Meanwhile, as if the current vape restrictions were not bad enough at making vapes hard to obtain as smoking cessation aids. The Australian Medical Association (AMA) is now urging the Therapeutic Goods Administration (TGA) to stop publishing details of authorised prescribers of the products. 

In a letter to the TGA, AMA President Dr. Omar Khorshid said he is deeply concerned by the fact that the TGA would publish a list of authorised prescribers of nicotine vaping products. He claims that these sellers “masquerade” themselves as smoking cessation services, when in fact they do nothing more than provide easy access to the addictive products. 

In contrast, Australian Public health expert and tobacco harm reduction advocate Dr. Colin Mendelsohn has consistently highlighted that the restrictions in place will be detrimental to public health. “Australia’s requirement for nicotine prescriptions is complex, expensive and unnecessary and makes it harder to access vaping products than cigarettes. Is that really what Greg Hunt wants?” he said.

Australia Fines Vaping Advertisers and Importers