TOBACCO PLAYBOOK DÉJÀ VU: E-CIGARETTES

Transcription

1 TOBACCO PLAYBOOK DÉJÀ VU: E-CIGARETTES LAURA DE LA RAMBELJE AND PATRICIA HEILER, MICHIGAN DEPARTMENT OF COMMUNITY HEALTH MICHIGAN CANCER CONSORTIUM, NOVEMBER 5, 2014 These slides are the property of the presenter. Do not reproduce without express written consent. 1

2 WHAT IS AN ELECTRONIC CIGARETTE? o Allows user to inhale vapor containing nicotine and/or other substances. o Disposable or rechargeable and/or refillable. o Contain a cartridge filled with liquid nicotine, flavorings and glycerin or propylene glycol. o When coil heats, it converts the contents of the cartridge into vapor. These slides are the property of the presenter. Do not reproduce without express written consent. 2

3 WHAT ARE E-CIGARETTES NOT? E-cigarettes are NOT an approved U.S. Food and Drug Administration (FDA) quit tobacco device and should NOT be marketed as such. E-cigarettes are NOT a safe alternative to other forms of tobacco. despite this, we are seeing a lot of false claims These slides are the property of the presenter. Do not reproduce without express written consent. 3

4 E-CIGARETTES IN MICHIGAN Currently legal for minors to purchase e- cigarettes, e-hookah, their components, and refills. E-cigarettes and their components are not currently subject to the Tobacco Tax. Various e-cigarette bills have been introduced in the Michigan legislature to curb youth access. Governor Snyder and Michigan s Chief Medical Executive, Dr. Matthew Davis, have called for e- cigarettes to be treated as tobacco products. These slides are the property of the presenter. Do not reproduce without express written consent. 4

5 HEALTH CONCERNS Accelerating demand: ever use among adult current and former smokers increased four-fold youth never-smokers who had used an e-cigarette tripled; twice as likely to intend to smoke conventional cigarettes Poison: Between 2010 and 2012, the American Association of Poison Control Centers report rising incidents of exposure: to e-cigarette devices from 29 to 447; and to nicotine refill fluid from 1 to 12. MI: 31 incidents of poisoning in 2013, and 20 thus far in Nicotine exposure, whether through inhalation, ingestion, or skin contact, can be hazardous to the health and safety of children, young people, pregnant women, nursing mothers, people with heart conditions and the elderly. These slides are the property of the presenter. Do not reproduce without express written consent. 5

6 HEALTH CONCERNS Primary, Secondhand, Thirdhand Vapor Exposure: Some studies have indicated adverse health impacts for both the user and bystander, but additional studies are needed to confirm this. Propylene Glycol Secondhand and Thirdhand Nicotine Glycerin/glycerol Reported Impacts to FDA: Pneumonia Congestive heart failure Disorientation Seizure Hypotension, and others These slides are the property of the presenter. Do not reproduce without express written consent. 6

7 HEALTH AND SAFETY CONCERNS Lack of quality control 2009 FDA tests cartridge ingredients from two leading brands of e-cigarettes, finding: levels of cancer-causing and toxic chemicals, including diethylene glycol, an ingredient in antifreeze. In some cases cartridges labeled as containing no nicotine had nicotine. Lack of regulation FDA is not regulating the manufacture of e-cigarette components or contents at this time. These slides are the property of the presenter. Do not reproduce without express written consent. 7

8 SAFETY CONCERNS Lack of regulation Consumer Product Safety Commission is not regulating the manufacture of e- cigarettes or components. As Big Tobacco enters market, expect quality to improve. E-cigarette Risks Explosions Fires Poisoning Enables discreet use of other drugs (heroin, marijuana, crack cocaine) Hazardous Waste & Litter These slides are the property of the presenter. Do not reproduce without express written consent. 8

9 SOCIAL CONCERNS Social norm reversal. Marketed to maintain addiction. Playing out of Big Tobacco s playbook: Back on TV. In the workplace. In schools. False health claims. These slides are the property of the presenter. Do not reproduce without express written consent. 9

10 WHERE IS THE PUBLIC HEALTH COMMUNITY? Public Health Community divided, but consensus emerging. Campaign for Tobacco-Free Kids AHA Policy Statement Dr. Davis, Michigan s Chief Medical Executive Tobacco Companies are heavily invested in harm reduction strategies. Voluntary associations are concerned: norm reversal, secondhand vapor exposure, long-term use, evidence-base vacuum, youth initiation, dual use or addiction exchange rather than cessation, other carcinogens, safer safe. These slides are the property of the presenter. Do not reproduce without express written consent. 10

11 CLINICAL CONCERNS Not FDA-regulated for safety Not FDA-approved for cessation Studies show no better outcome than approved medications, and likely much worse Promote dual use or shifting addiction from conventional cigarettes to e-cigarettes Health impacts largely unknown; studies ongoing Attractive to youth; gateway phenomenon Poison and children These slides are the property of the presenter. Do not reproduce without express written consent. 11

12 WHAT S A CLINICIAN TO DO? Educate patients and staff! Reminder that e-cigarettes are not FDA-approved cessation medication, and are not even regulated for safety Evidence-based medication: 7 FDA-approved medications or nicotine-replacement therapy Use the 5 As: Ask about e-cigarettes and other forms of tobacco use Advise, Assess, Assist, Arrange Michigan Tobacco Quitline QUIT-NOW ( ) Fax referral available Your support matters! These slides are the property of the presenter. Do not reproduce without express written consent. 12

13 WHAT ELSE CAN BE DONE? NEW! Tell the FDA about faulty tobacco products! Contact Angela Clock at Tobacco-Free Michigan for the latest on legislative activity: Contact MDCH Tobacco Section for other questions: Laura de la Rambelje These slides are the property of the presenter. Do not reproduce without express written consent. 13