Hong Kong needs to clear the air on e-cigarettes for the sake of its smokers

PUBLISHED : Wednesday, 11 July, 2018, 7:02pm
UPDATED : Wednesday, 11 July, 2018, 10:14pm

I refer to the Hong Kong government’s legislative proposal to amend the Smoking and (Public Health) Ordinance (Cap 371), to regulate e-cigarettes and heat-not-burn products and subject these products to the same regulation as conventional cigarettes.

I am a psychotherapist working in Singapore, with a speciality in quit-smoking interventions and the research surrounding e-cigarettes and heat-not-burn products.

It is my view and the predominant view of the global scientific community and health care experts dealing with smoking, that such products must not be treated in public health policy the same way as conventional cigarettes. That is because scientific studies have shown these products are materially (90 to 95 per cent or more) safer than conventional cigarettes. Further, these alternative products help smokers to quit, and are therefore an effective nicotine replacement therapy.

Existing quit-smoking nicotine replacement therapy options (gums, patches, lozenges, nicotine nasal and other aerosol sprays) and conventional cigarette control measures have failed to significantly reduce conventional cigarette use in developed societies, including Singapore and Hong Kong, over the past 15 years.

Recent evidence in Japan and South Korea suggests that the quantity of cigarettes sold has decreased between 10 per cent and 17 per cent annually, and this has followed the recent introduction of heat-not-burn products. Also, British public health experts said more than 20,000 UK smokers a year have quit, plausibly after using e-cigarettes.

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Although much discussed, there is as yet no definitive scientific evidence that these alternative products have a material “gateway effect”, causing youth and existing users to start smoking when they would otherwise have remained smoke-free.

The evidence shows an association between smokers and e-cigarette users because such people are subject to the same risk factors – but one does not cause the other. In the same way, alcohol does not cause smoking, although people who drink tend to smoke.

Regulating e-cigarettes and heat-not-burn products too strictly will reduce their use by smokers seeking to quit, and will encourage a “black market” business in these products, removing them from legitimate control and effective regulation by the government.

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It is clear that regulations should prohibit their use by children, and ensure that these products are as safe and free from toxins as commercially practicable and reasonable. However, such regulations would differ substantially from the regulation of cigarettes. The EU directive, as adopted by the UK legislation and regulations, provides an example of an effective and efficacious regulatory approach.

Over-regulation of e-cigarettes and heat-not-burn products in Hong Kong risks depriving smokers of an opportunity to avoid premature morbidity and mortality, as well as depriving their non-smoking loved ones – who are exposed to the mainstream and sidestream smoke – of the same.

Andrew da Roza, Singapore