EXCLUSIVE
Recharging Leon Alegria and Damian Duncan enjoy their electronic cigarettes at their local pub. Photo Sahlan Hayes
Australia could become the first major nation to outlaw smoking, with a federal government funded trial about to test the viability of electronic cigarettes as a safer, permanent replacement for tobacco.
Medical experts, cancer groups and anti smoking lobbyists battled for decades to rid cigarettes from public spaces.
”E cigarettes” are battery powered devices that simulate the effects of smoking by heating a nicotine liquid into vapour, which the user then inhales and exhales.
The “E cigarette” Photo AFP
While the gadgets have been hailed as a safer substitute for cigarettes, there is no comprehensive scientific research into the health risks of inhaling vapour.
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The Sun Herald can reveal that as part of its anti smoking reform agenda, the previous Labor government committed more than $1 million to a pioneering study that, by 2015, will determine whether or not e cigarettes could be utilised to phase out traditional cigarettes altogether.
But while Labor took on ”big tobacco” in the High Court to introduce world first plain packaging laws and vowed to ban all political donations from tobacco companies, it is uncertain if the Coalition is equally committed.
Coral Gartner, who will shortly lead the trial of 1600 smokers at the University of Queensland’s centre for clinical research, said ”These types of products have the potential to be beneficial to public health if they are used to completely replace the traditional cigarette. It would be a shame not to explore how they could be used to maximise public health while trying to minimise potential unwanted effects such as making smoking appear glamorous.”
Some e cigarette ”tanks” resemble actual cigarettes but many are ornate, pipe like vessels available in numerous shapes and sizes.
The tanks, e liquids and other accessories can be legally bought in Australia but users are forced to order their nicotine from overseas because it remains classified as a ”dangerous poison” that can only be sold under licence.
While the conventional smoker’s sole accessory is a $2 lighter, the e cig brigade can spend a fortune assembling the perfect kit. E liquids aside, there are a range of fancy extras such as e cigarette desktop holders and luxury ”drip tips” the mouthpieces attached to the top of device.
For the real enthusiast, such as Damian Duncan, nothing is more important than the e cigarette device. He has splashed out on the ”Cadillac” of tanks the Wizard Evolved DA20. It was custom built in Romania and set him back $1000.
”When you consider I was spending almost $300 a week on cigarettes, I view it as a good investment,” he said.
E cigarettes have been successfully launched overseas, with celebrities such as Katy Perry and Leonardo DiCaprio pictured puffing away on their own tanks.
With US sales set to exceed $1 billion by the end of the year, cigarette company Philip Morris USA is about to muscle in with its own e cigarette brand, MarkTen.
As usage increases, health implications remain hazy. In May, the French government triggered outrage among its nation’s 1 million e cigarette users by banning the devices in public spaces.
That ruling appeared justified a fortnight ago when a study claimed to have found previously undetected carcinogenic chemicals in e cigarette vapours, ”sometimes at levels even higher than in traditional cigarettes”.
In March, a US study of 12 e cigarette brands found that while certain carcinogens and toxicants were present, levels were between nine and 450 times lower than in cigarette smoke.
Australian Medical Association president Steve Hambleton said Australia was the global leader in tobacco control and should not let its guard down.
”Plain packaging is having real impact now, as is the pricing strategy. The end for tobacco is coming,” he said.
While Dr Hambleton described nicotine replacement therapy as a ”positive measure” in helping people quit, he warned that the unregulated e cigarette industry was becoming ”a recruiting tool” for the next generation of smokers.
While e cigarette manufacturers frequently refer to their products as a quit smoking aid, many have adopted the same marketing techniques tobacco companies once used to glamorise their brands.
The internet is awash with ”handcrafted” e juice liquids for sale, with hundreds of novelty flavours. At least three Australian online suppliers have emerged in the past month. Fantazia states ”We wanted to find the prettiest, most girly vaping products out there! If it has bling, glitter or pretty colours, if it’s glamorous, stylish, cute or cool then we want it for the store and for ourselves, too.”
A NSW Health spokeswoman said it would continue to monitor international evidence ”as it developed”.
Smoke without fire and ire
A nicotine laced fog pours from Damian Duncan’s mouth as he lounges inside his local pub. At first it appears he’s flouting the law, smoking in a public bar. But these are no ordinary gaspers. ”This is smoke without fire,” he says. ”It has saved my life.”
Electronic cigarettes are a smoke free substitute for the real thing. They don’t fall under tobacco legislation because they don’t contain any. Some can contain nicotine, some are flavoured. Until lawmakers decide exactly what they are, users can happily puff away in public, despite concerns about long term use and passive risk.
While not completely odourless, the vapour from an e cigarette smells nothing like tobacco and disappears within seconds of being is it a genuine saviour for smokers, or an equally addictive lesser of two evils?
Kevin and Jo Husband, from Campbelltown, tried patches, lozenges and even $1000 hypnotherapy without success.
”No doubt about it, this is the miracle cure,” Mr Husband said. ”I’ve not had a cigarette since November last year.” He added that while detractors would no doubt ”scoff” at the fact he was still consuming nicotine, ”at least I’m no longer pumping the other 4000 chemicals and carcigans into my blood stream. I feel great.”
Another e cig convert, Andrew Washbourne said he had been a ”40 a day” slave to tobacco since he was 11 ”I would rather go hungry and buy smokes than food.” He feels like a new man ”I can actually walk up the stairs again.”
Clarifications
The original headline of this article has been changed to more accurately reflect the story.
Dr Gartner is an independent researcher.
Funding, while obtained through the federal government and signed off by the then health minister, was awarded via the National Health and Medical Research Council through a competitive peer review process with no political involvement.
Neither was there any political involvement in the design of the study.
The study will conduct tests to see if electronic cigarettes are more effective for quitting smoking, when used as either a short term aid or long term substitute for cigarettes, than existing nicotine replacement therapy products.
How e-cigarettes have become a ‘very wild west’ industry in canada
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On the third floor of a midtown Toronto low rise building, above a sushi restaurant and an acupuncture clinic, is a cramped, greyish room where anyone can walk in and freely buy something the Canadian government has deemed illegal.
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Looking more like an insurance office than a retail store, this is home to a roughly 7 foot tall black and opaque glass cabinet filled with e cigarettes that dispense nicotine devices strictly banned by Health Canada.
The cigarette shaped electronic devices convert a liquid nicotine mixture into vapour, delivering a smoke like hit of nicotine, without the actual smoke. In this back room, e smokers can choose from a variety of e liquid flavour cartridges from banana cream and Earl Grey tea to an ersatz version of du Maurier cigarettes and their preferred strength of nicotine. All without the dangerous cocktail of 4,000 chemicals, such as carbon monoxide and arsenic, found in real cigarettes.
We re very busy, says the salesman manning the AMK Trading showroom, who adds the electronic device has helped him to kick his own heavy smoking habit for the past three months.
E cigarettes have become an exploding industry, worth nearly $2 billion in the U.S. alone, a market that some analysts project will eventually surpass that of traditional cigarettes.
But here, Health Canada has not approved nicotine e cigarettes, creating a regulatory grey zone, forcing manufacturers and sellers to either flout the law, or steer clear of the country altogether.
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E cigarettes with non nicotine liquid another popular variety are legal. But no electronic cigarettes with nicotine have been authorized by Health Canada, the agency, which regulates nicotine under the Food and Drugs Act, said in an emailed statement. Currently, the importation, advertisement and sale of these products is illegal in Canada.
Unhealthy cigarettes you can buy at the corner store but to get a vastly safer nicotine product that has helped countless people finally quit smoking, you have to break the law with underground shops or online sellers. Ideally, everyone would simply quit nicotine, says Arthur Slutsky, a Toronto based pulmonary physician and co founder of a non electronic cigarette replacement device Nico Puff. But, he says, it makes no sense to block healthier alternatives to cigarettes the dirtiest delivery system for nicotine that we know of.
For those people who can t stop smoking, I don t think there is any question that switching to something, a cleaner nicotine delivery system, is definitely beneficial.
While Health Canada prohibits any advertising or sales, the underground e cigarette market is thriving. Andrea, a Toronto woman in her 30s who requested that her last name not be published, says the electronic devices have helped her to stay away from traditional cigarettes since she bought an e cigarette kit online a month ago.
I used to smoke about half a pack to a third of a pack a day, she says. I haven t bought a pack of cigarettes since then.
The e cigarette was created in 2003 by Chinese inventor Hon Lik. Most devices are sleek barrels, resembling a cigarette, cigar or pen. They typically use a battery powered heating element to convert a liquid made of propylene glycol, vegetable glycerine (two common food additives) and nicotine into vapour. A puff (also called vaping ) produces something that feels like and resembles smoke similar enough to keep many smokers content but vanishes instantly, and leaves no odour.
E cigarettes are cheaper than real cigarettes, too. The kits range in price from $30 to as much as $100. A 30 millilitre bottle of e liquid which might last a pack a day smoker a month can cost around $15 to $20.
It s impossible to determine how large the market for e cigarettes is in Canada, with much of the market comprised of small, privately owned companies who don t report their sales.
We ve ended up with this very wild west sort of market, where we re keeping out the legitimate players, said University of Ottawa law professor David Sweanor, who works on tobacco control and health issues.
But in the U.S., where nicotine e cigarettes are legal, sales will approach $1.7 billion this year, according to Wells Fargo analysts. There, major tobacco firms such as Altria are getting in on the game, and e cigarette firms like NJOY have drawn high profile investors, such as Sean Parker of Napster and Facebook fame. Celebrities, including Leonardo DiCaprio and Katherine Heigl, have been flashing the devices at parties and on talk shows, lending a cool factor that has not been associated with public puffing in some time.
The public health community has found itself divided over e cigarettes, with some welcoming the potential to help smokers quit a far more dangerous habit, but some anti tobacco activists pointing to a lack of rigourous scientific study on the risks of e cigarettes or their success in weaning smokers off cigarettes.
You re talking about inhaling a chemical stew into your lungs, said Melodie Tilson, policy director for the Ottawa based Non Smokers Rights Association. It s not just water vapour. It s propylene glycol, which is generally recognized as safe for oral consumption, but it doesn t mean that it s safe for inhalation. Still, she says, Canadians should be able to legally buy e cigarettes to help them quit smoking, provided there are limits on things like marketing to minors. We don t think it makes sense that these products not be available, she said.
We ve ended up with this very wild west sort of market, where we re keeping out the legitimate players
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Carl Phillips, an epidemiologist and former professor at the University of Alberta, where he researched tobacco harm reduction, says there is plenty of evidence showing that e cigarettes are 99% less harmful than smoking.
At least 25 studies over the years examined the chemical effects of e cigarettes, and we do know enough to be confident that they are low risk, he says.
Where it ranks among hazards, it s down in the range of eating french fries or eating dessert or not getting quite enough exercise, says Mr. Phillips, who is based in New Hampshire and is the scientific director for the Consumer Advocates for Smoke free Alternatives Association. Not necessarily good for you, but in the range of everyday hazards that we accept without too much worry.
He estimates that the device has helped millions of people to quit smoking worldwide, and thinks there is an urgency to Canada ending its ban on nicotine e cigarettes. About 37,000 Canadians every year die from smoking tobacco, according to the Lung Association.
By prohibiting a smoker from switching, Mr. Phillips says, you ve done more harm in terms of putting that person at risk of dying prematurely, than could possibly done by the actual use of the product itself.
The e cigarette market is building with a speed that makes it difficult for study, and regulation, to keep up. But Canada s response has been particularly slow Last month, the European Union considered new regulations for e cigarettes, and opted for a lighter touch than the pharmaceutical style restrictions that were originally proposed. The American Food and Drug Administration has announced plans to regulate them under the Tobacco Act.
In Canada, however, the regulatory environment remains at least officially unresponsive, and hostile.
Health Canada warns Canadians not to purchase or use electronic smoking products, as these products may pose health risks and have not been fully evaluated for safety, quality
and efficacy by Health Canada, the government says.
You can smoke in the car, smoke in your bed, you could smoke it at the bar, without having the smell of it
Daniel David, president of the Electronic Cigarette Trade Association, says his own company, Evape, has received as many as six Health Canada cease and desist notices from Health Canada, but he has yet to face any repercussions.
He responds to each one with a letter arguing that he is not making any health claims or smoking cessation claims. He further argues that his product shouldn t fall under the Food and Drugs Act, because of the minimal nicotine content, and should instead be treated as a legal smoking alternative, he says.
I do send fairly detailed letters back really explaining our position, and usually what happens is they just drop it.
But the confusion and hefty expense to satisfy Health Canada s requirements have prompted other Canadian cigarette replacement companies to focus on markets beyond our borders, instead.
Montreal businessman Vincent DeBlois says he moved his company, Zen E Cigarettes, to Maine last year after getting into a legal tussle with Health Canada over the devices.
Dr. Slutsky says his product, Nico Puff, which is still in development but uses dry powder rather than electronics, doesn t have the thousands of chemicals cigarettes do. But the process to sell it in the Canadian market is too costly, and lengthy, at four to five years, he said. When the product is ready to launch, it won t be in Canada.
Something s wrong with that from a health perspective, he says.
Presumably Health Canada is anxious about studies that show minors are taking up vaping as well as adults, sparking worries that the devices could serve as a gateway for cigarette use. Last month, U.S. Centers for Disease Control reported that the percentage of high school students who reported ever using an e cigarette rose from 4.7% in 2011 to 10% in 2012. But Mr. Phillips says there is no evidence that e cigarettes lead people to smoking. Teens, he said, are trying them perhaps instead of trying cigarettes because more people are becoming aware of the devices.
E cigarettes recently helped Steffen Hem quit smoking, but he too is cautious about the devices.
It doesn t give off bad breath, doesn t stick to your clothes, says the 29 year old Torontonian. You can smoke in the car, smoke in your bed, you could smoke it at the bar, without having the smell of it. And you could smoke it at your desk at work.
Mr. Hem used e cigarettes for about six months, slowly weaning himself off nicotine by gradually reducing the strength.
It just doesn t seem healthy The smokers, we don t know what we re smoking, when we re smoking the stuff. And if the government would actually regulate it, we would know what s in there.
When his e cigarette broke a month ago, he was able to finally go cold turkey it was his eighth time quitting his nicotine habit entirely since he picked up smoking at 14.
Health Canada is being incredibly risk averse when it comes to e cigarettes, says Mr. Sweanor. That cautiousness is not only keeping smokers away from a less harmful alternative, it is also holding back Canadian entrepreneurs from participating in a booming industry, said Mr. Sweanor, who figures the market here may be already worth more than $150 million.
The global market for cigarettes is $800 billion, and most of those smokers don t want cigarettes, says Mr. Sweanor.
We could have a self financing public health revolution, that could make billions of dollars. This could create companies that make Google and Facebook look poor by comparison. We have stymied the ability of Canadians to take part in this.