REGULATORY DOSE

Proposed e-cigarette ban: Users are up in arms, fear they will return to smoking tobacco

Many users of e-cigarettes say the devices have helped them quit tobacco. But the jury is out on the actual safety of these vapourisers.

Even as the Ministry of Health and Family Welfare considers a ban on e-cigarettes in India, vapers across the country are coming together to protest such a move. Vapers are users of electronic cigarettes that are also called e-cigarettes or vapourisers. Vapers in India are worried that a ban will push them back into the habit of smoking cigarettes, which are considered more harmful.

“We are very scared,” said Chirag Gulati, a 27-year-old businessman in Delhi. “We will have to go back to cigarettes.” Chirag had been smoking cigarettes incessantly for five years before he gave them up last year in favour of e-cigarettes.

An e-cigarette is a battery-operated device that contains nicotine but not tobacco. It is often marketed as a smoking cessation device that helps smokers quit tobacco and eventually quit smoking altogether. Along with nicotine, e-cigarettes are filled with propylene glycol – which helps produce vapour – and flavouring agents. They do not contain 6,000-odd carcinogenic compounds found in cigarettes and other tobacco products.

In the United Kingdom, Europe and Canada, the use of e-cigarettes is restricted and regulated, but not banned completely. The countries accept the device as a harm reduction tool that helps people quit smoking tobacco and move on to a habit that is less harmful.

In India, some states like Karnataka, Kerala, Jammu and Kashmir, Punjab and Chandigarh have banned the sale and distribution of e-cigarettes on the premise that they are unsafe, are addictive and can sometimes cause death. If 30 mg of nicotine is consumed in one go, it can be fatal. In fact, the World Health Organisation has maintained that there is little and “low quality” evidence that e-cigarettes actually help smokers quit tobacco and eventually smoking. It also warns that toxicants in e-cigarettes can have harmful effects on a person’s health.

“Nicotine is as harmful as tobacco,” said Arun Kumar Jha, economic advisor to the health ministry who also handles tobacco control. “We have no evidence to show it reduces smoking.”

Jha said that the health ministry is undecided on how to control the sale and distribution of e-cigarettes, as the product does not fall under any statutory law. Currently, there is no clear regulatory framework for e-cigarettes under which the product can be regulated.

In August, the Association of Vapers India – a group of about 300 people who were involved in advocacy related to e-cigarettes – decided to act against the state-level bans that have been passed but not properly enforced yet. The group filed a public interest litigation against the ban of sale and distribution of e-cigarettes in Karnataka. The Karnataka High Court has admitted the petition and will hear the matter at the end of September. The government has to file a reply before the hearing.

Better than cigarettes: Vapers

Rahul Adhlakha, 33, is a Delhi resident who runs a call centre and started vaping two months ago. He had smoked cigarettes for 16 years and had gone up to two packs a day despite suffering chest burns. He had tried quitting several times using nicotine patches and lozenges.

“Once after I quit smoking for two months, I wandered into a shop selling cigarettes while on the phone,” said Adhlakha. “I did not even realise when I reached the shop and when I started smoking again. Only after the call ended did I realise what I had done.”

However, one day, he bought an e-cigarette instead of tobacco cigarettes on whim.

“Since that day, I have not smoked a single cigarette,” he said. “I started vaping with 6 ml of nicotine, but have now reduced the nicotine content to 3 ml in a month’s time.”

Other vapers have similar stories and also report feeling better – higher energy levels, better skin, and better taste and smell.

“Every smoker is sick of smoking and thinks of quitting every single day,” said Abhinav Bhaskar, who runs a shop that sells e-cigarettes.

Some vapers said that they had helped others quit smoking cigarettes and counsel those beginning to use e-cigarettes. Adarsh Kaushal, a vaper from Chandigarh, said that he has encouraged many smokers to try vaping. “For me it is social service and I am doing my bit to save them,” said the 42-year-old web designer. Kaushal smoked for nearly two packs of cigarettes every day for nearly 20 years. He started to smoke when he was 14, and tried quitting at least 20 times.

Another reason vapers like e-cigarettes is because it feels like smoking. Nicotine patches or lozenges do not give the same “hand-to-mouth feel” – the feeling of holding a pipe and inhaling smoke – that vaping does.

Rahul Adhlakha on the extreme right talking about how vaping helped him quit smoking
Rahul Adhlakha on the extreme right talking about how vaping helped him quit smoking

Not devoid of harm

Despite the glowing references from vapers, health experts are divided on e-cigarettes. In 2015, Public Health England, which is the executive agency of the UK Department of Health, concluded that e-cigarettes are 95% safer than smoking and that it has a potential to help smokers quit tobacco products.

Professor Kevin Fenton, director of health and wellbeing at Public Health England, said, “E-cigarettes are not completely risk-free but when compared to smoking, evidence shows they carry just a fraction of the harm. The problem is people increasingly think they are at least as harmful and this may be keeping millions of smokers from quitting. Local ‘stop smoking’ services should look to support e-cigarette users in their journey to quitting completely.”

After examining the latest evidence, the Royal College of Physicians in England, also came to a similar conclusion that e-cigarettes may be beneficial to the their public health. While the report speaks of the need for regulation, it suggested that regulation “should not be allowed significantly to inhibit the development and use of harm-reduction products by smoker”.

The WHO, however, has been vehemently against the product. In its 2016 report, the WHO said that the scientific evidence regarding the effectiveness of e-cigarettes as a smoking cessation is “scant and of low certainly, making it difficult to draw credible inferences.” The WHO raises concerns of the health effects of inhaling nicotine and aerosols. It offers various regulatory options to the member countries including banning it to minors, increases taxes on it, banning advertising and promotion of the product among others.

Countries such as UK, Canada, countries in the European Union more recently New Zealand have placed restrictions on selling the product to young people below the age of 18 years, displaying health warnings on the devices, and restrictions on advertising.

Vaping products should be regulated and have warning labels, the vapers say.
Vaping products should be regulated and have warning labels, the vapers say.

“Don’t ban, regulate”

The petition in the Karnataka High Court clarifies that the association is not contending that e-cigarettes are not harmful, but that they are less harmful compared to tobacco cigarettes. This makes-cigarettes integral to tobacco de-addiction programmes. The petitions asks that there not be an outright ban and that states consider establishing rules, regulations and guidelines for the manufacture, sale and the use of e-cigarettes. The state, the association suggests, can regulate nicotine content and the use of other chemicals. For example, England allows only 2 mg nicotine content in refill packs. It also wants the state to conduct a proper study on the product.

The association is clear that people below the age of 18 should not be allowed to vape.

“The state should open its eyes and do some research before they decide to ban a product,” said Pradeep Herle, a IT professional in Bengaluru, who has been vaping for nearly four years.

Over the past few years, vapers in India have formed several Facebook and Whatsapp groups. So far, they have mostly discussed the kinds of vaping devices available and studies related to vaping. But now, many in these groups have shifted to advocating for vapers. To raise money court procedures before filing the PIL at the Karnataka High Court, the Association of Vapers India conducted a fundraising exercise last month, to which e-cigarette vendors and vapers both contributed.

“Some vapers have made a commitment of contributing every month to the cause,” said Pratik Gupta, director of the association. “About 40% of the contributions are from individual vapers.”

What drives the activism? “The concept of life without tobacco dependence is what keeps us going,” said Imran Saleem, a businessman in Bengaluru, who is active in the association and is helping out with the co-ordination between the lawyers for the petition.

Herle smoked for nearly eight years and has quit smoking completely only about three-and-half-years ago when he started vaping. “An e-cigarette ban hampers my right to a safer life.”

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