Dual Tobacco-Vape Usage Disproves Vape As Quit-Smoking Tool

Several local studies and a recent public survey by CodeBlue and the Galen Centre for Health and Social Policy found significant prevalence of e-cigarette use among people who never smoked and in dual users of tobacco and vape.

KUALA LUMPUR, March 16 – The growing use of vape or e-cigarettes among teenagers, non-cigarette smokers, and dual users of vape and cigarettes, points to a rising group of people who are getting hooked onto nicotine, instead of avoiding it.

Several local studies and a recent public survey by CodeBlue and the Galen Centre for Health and Social Policy found significant prevalence of e-cigarette use among people who never smoked and in dual users, disproving the notion that vaping helps smokers quit.

A study funded by the Ministry of Health’s National Institutes of Health on the prevalence of e-cigarette use among adults in the country found there is an estimated 602,212 e-cigarette and vape users nationwide, of which 90 per cent of e-cigarette users were current or former cigarette smokers.

Researchers said this supports the fact that tobacco smoking could be the gateway for using other nicotine products, in this case, e-cigarettes.

The study found that 74 per cent of current e-cigarette users also smoked conventional cigarettes or were dual users. There was also a 3.1 per cent prevalence of e-cigarette use among those who never smoked.

Another study on e-cigarette use among students at six local universities found that 74.8 per cent of 1,302 students used e-cigarettes, of which 40.3 per cent were dual users. About 20.4 per cent were e-cigarette users who never smoked.

A CodeBlue-Galen poll also found that 35 per cent of 43 teens surveyed vaped, while 14 per cent of them were dual users of tobacco and vape. Out of 676 overall respondents across age groups, about 11 per cent smoke cigarettes and also vape.

The two studies and the survey suggest that vapes or e-cigarettes are creating an entirely new cohort of nicotine addicts among people who have never smoked a cigarette due to reasons that include the popularity of e-cigarettes as a trendy lifestyle item.

Popular vaping brands found in Malaysia often promote their products as sleek and stylish vape pens with colourful designs, and less as medical products for smoking cessation.

And unlike cigarettes, which are highly regulated in their ingredients, nicotine vape products are widely marketed in a variety of fruity and popular drink flavours that are extremely appealing towards women and younger people.

Prof Dr Mohamad Haniki Nik Mohamed, chief coordinator of the Certified Smoking Cessation Service Provider (CSCSP) at the Kulliyyah of Pharmacy, International Islamic University Malaysia, said regulating e-cigarettes instead of prohibiting them could be regressive to the nation’s tobacco control successes.

“This (move to regulate e-cigarettes) creates a huge problem from a public health perspective because it might renormalise smoking. Although it’s vaping, the act is similar to smoking.

“You see people inhaling and blowing out vapes so this is going backwards, I would say three steps backwards, then all the progress that had been done,” Dr Mohamad Haniki said in a BFM podcast on Malaysia’s smoking cessation strategies.

Dr Mohamad Haniki said if the Health Ministry is adamant on following the evidence adopted by countries such as New Zealand, it would need to regulate e-cigarettes under the Poisons Act 1952, a law that regulates the import, possession, manufacture, compounding, storage, transportation, sale and use of poisons.

“[This means] that will have to produce the proforma – the documentation, the studies, the data, the evidence to the relevant ministries, [and] agencies at the Ministry of Health – the Drug Control Authority (DCA), the National Pharmaceutical Regulatory Agency (NPRA) – so they can view this evidence and then decide whether e-cigarettes are really effective and safe for smoking cessation,” he said.

Azrul Mohd Khalib, chief executive of the Galen Centre for Health and Social Policy, is also doubtful of the government’s move to successfully tax vapes or e-cigarettes in Malaysia due to the “open” and “closed” system in the vaping industry.

“If you want to tax, it might be easy to tax the closed system because it goes through a manufacturing process – it goes through a factory and so forth.

“But what do you do about the open systems where somebody can just mix. A mixologist can just mix it at the back of a store – chrysanthemum tea, air bandung, or sirap, any kind of flavour – and 5 per cent… why stop at 5 per cent nicotine? Why not put 10 per cent nicotine? 

“Where is the control for that? And that’s going to be the problem there because nicotine is a poison, it is toxic, if taken more beyond a certain dose. 

“So how do you control that? We could have cases of people poisoned due to illicit products and what are we going to do about that, then? So, I think there are a lot of problems here that we’re just beginning to unpeel when it comes to legalising vape and e-cigarettes,” Azrul said in the BFM podcast.

A report by the United States Department of Health and Human Services published in 2016 noted that inhalation of e-cigarette aerosol could potentially cause adverse effects due to acute administration of nicotine, flavourants, chemicals, and other particulates, as well as accidental overdose of nicotine and uptake of subsequent illicit drug use.

The Malaysian Vape Chamber of Commerce (MVC), in a report published early last year, said there are 1.12 million vapers. The report stated that 77 per cent of vapers used an open-system device and consumed an average of 12.4 ml per week, while 23 per cent preferred a closed-system device and consumed an average of 5.2 ml per week.

Bangi MP Ong Kian Ming, who is also former international trade and industry deputy minister, thinks that regulating the sale of vape products is a better policy than an outright ban of vape products, given that the more harmful conventional cigarettes are not prohibited.

“Even the vaping industry is supportive of regulation, especially since this will allow greater scrutiny and control over imported vaping products where no tax is paid (usually sold in smaller quantities via e-commerce). 

“However, I recognise the difficulty of regulating e-commerce sales given the proliferation of various websites and channels where these products can be bought. But we need to start somewhere and perhaps the new tobacco bill would be a good place to start outlining some of the regulations for vaping products,” Ong told CodeBlue.

The DAP lawmaker underlined the need for greater dialogue between MOH and all relevant stakeholders, including MPs, in particular the Special Select Committee on Health, Science and Innovation, before the new tobacco bill is tabled in Parliament. This, he said, would increase the quality of public discourse for the benefit of the Malaysian public.

Both Azrul and Ong previously called for easier access to nicotine replacement therapy (NRT) medicines, such as nicotine patches and gums which are only available through pharmacy dispensing. 

Azrul said it has never been “decisively proven” through studies that vapes or e-cigarettes are an effective smoking cessation tool in comparison with NRTs. 

Ong said emphasis should be on NRT products to help smokers quit, instead of promoting e-cigarettes or vapes as smoking cessation tools or as a tobacco harm reduction strategy.

Dr Haniki also sounded caution on inadequate long-term data on e-cigarettes, saying “it’s a matter of time” when researchers will be able to associate more diseases, including lung cancer, with e-cigarettes as was done with conventional cigarettes.

Health Minister Khairy Jamaluddin previously announced plans to outlaw smoking for future generations in Malaysia born after 2005, similar to New Zealand’s recent move in banning the sale of tobacco to anyone born after 2008.

Khairy said recently that the proposed Tobacco and Smoking Control Bill — which prohibits the sale of cigarettes, other tobacco products, and vape or e-cigarettes to anyone born after 2005 — needs further stakeholder engagement and that he will present it at the Dewan Rakyat’s special select committee on health, science and innovation first before tabling it in Parliament.

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