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International consensus sought on e-cigarettes

Wednesday September 8th 2021

A group of pharmacologists and public health researchers are calling for tighter regulations on the purchase and use of e-cigarettes and related heated tobacco products.

Dr Ivan Berlin of Pitie Salpetriere-Charles Foix University Hospitals in Paris, France, and colleagues believe that the negative health effects of combusted tobacco products are "undeniable and well-known".

Writing in BMJ Open today, they state: "In the last decade, alternative nicotine delivery systems have been marketed with the aim of helping smokers quit by switching to these new products."

These devices deliver nicotine similarly to nicotine replacement therapies in most cases. They are not considered medications and regulation varies greatly by country.

The researchers set out to provide a consensus on electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs). They analysed survey results from 92 individuals with clinical, public health or research expertise in tobacco control and/or smoking cessation in 15 countries.

For ENDS, the consensus was that components of e-liquids and an upper limit of nicotine concentration should be defined, safety and addiction warnings should be given, and a specific tax should be implemented.

"ENDS should not be regulated as consumer products but either as a new category of nicotine delivery or tobacco products and should not be sold in general stores but in specialised shops," they report.

For HTPs, the respondents believe these products have the same addictive potential as cigarettes so should be regulated as a tobacco product with similar warning messages as cigarettes. In addition, "their advertisement should not be allowed" and "taxes on HTP should not be lower than those for cigarettes".

For both ENDS and HTP "use should not be allowed in indoor public places". In summary, respondents felt that different regulations should be in place for ENDS and HTP.

The authors conclude: "The results of this survey may be useful for health authorities, decision makers and researchers on tobacco use and cessation."

Berlin, I. et al. International expert consensus on electronic nicotine delivery systems and heated tobacco products: a Delphi survey. BMJ Open 8 September 2021; doi: 10.1136/bmjopen-2020-045724

[abstract]

Tags: Cancer | Drug & Alcohol Abuse | Europe | Heart Health

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