The New Zealand experience with electronic cigarettes Hayden McRobbie MB ChB PhD Clinical Director, The Dragon Institute for Innovation Professor in Public Health Interventions, Queen Mary University of London
Disclosures Hayden McRobbie has received honoraria for speaking at smoking cessation meetings, and attending advisory board meetings, that have been organized by J&J and Pfizer
Tobacco Control in New Zealand Three key objectives: to reduce smoking initiation to increase quitting to reduce exposure to second-hand smoke Current strategies Smokefree environments Standardised packaging Advertising ban (including at point of sale) High price (around US$18 a packet) Fully funded Quitline, face-to-face stop smoking services, stop smoking medicines
Daily Smoking Prevalence of daily smokers (2016/17) 13.8% which is approximately 550,000 adult smokers Māori 32.5% Pacific 21.8%
Prevalence 17% Ever use Vaping Reasons for use Top 5 reasons for vaping among vapers who vape at least monthly I want to reduce the 29% Smells better than Cheaper than tobacco 35% 36% 3% Current use* Less harmful to my I want to quit smoking 46% 49% 0% 10% 20% 30% 40% 50% 60% *vape daily, weekly, monthly or less often than monthly 65% reported using nicotine containing e-cigarettes HPA 2016 Health and Lifestyles Survey
Vaping - Current Legislation The Medicines Act 1981 Nicotine is scheduled as a substance Illegal to sell an e- cigarette (+/- nicotine) while making a therapeutic claim without approval Smoke-free Environments Act 1990 (SFEA) Covers nicotine containing e- cigarettes and e-liquid that are manufactured from tobacco Prohibits the sale of tobacco products for oral use (other than smoking) Products that look like a tobacco product cannot be sold to people under the age of 18, regardless of nicotine content Does not prohibit vaping in smokefree places Personal importation Individuals can import up to three months supply of nicotine-containing products for their own use, but cannot sell or supply these products to anyone else.
Timeline Ministry of Health undertakes public consultation 250 submissions received New coalition government June 2016 August 2016 March 2017 September 2017 October 2017 Cabinet Social Policy Committee (SOC) agrees, in principle, to nicotine e-cigarettes being lawfully available for sale and supply, with appropriate controls Considered again at SOC; agree to start the process to start legislative changes Technical Expert Advisory Group on Electronic Cigarette Product Safety established to support the introduction of an electronic regulatory scheme
Proposed Changes regulate nicotine and non-nicotine e-cigarettes and e-liquid Prohibit sale, and supply in a public place, to under 18 year olds Prohibit vaping in workplaces and other areas where smoking is not allowed Allow all retailers to display e-cigarettes and e-liquid at pointof-sale Limit advertising and promotion to point-ofsale for all retailers, and broader instore display in R18 settings Restrict the use of vending machines to R18 settings Develop light-touch product safety requirements
Public Consultation Vapers / Vaping 39% Organizations 250 submissions Non-vapers 61% 100% % agree with allowing sale of nicotine EC 84% % agree with R18 restriction 90% 97% 37% % agree with tobacco-like ad restrictions 65% * 14% % agree to point of sale display ban 43% * 23% % agree to prohibit use in smokefree areas 58% * 87% % agree to good manufacturing standards 84% 98% Agree with legalizing the sale and supply of nicotine e-cigarettes * Statistically significant difference
Ministry of Health Position Statement The Ministry of Health believes e-cigarettes have the potential to make a contribution to the Smokefree 2025 goal, and could disrupt the significant inequities that are present. The potential of e-cigarettes to help improve public health depends on the extent to which they can act as a route out of smoking for New Zealand s 550,000 daily smokers, without providing a route into smoking for children and non-smokers. http://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/e-cigarettes
Ministry of Health - Key Messages The best thing smokers can do for their health is to quit smoking for good E-cigarettes are intended for smokers only Smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes to stop smoking. Stop smoking services should support smokers using e-cigarettes to quit There is no international evidence that e-cigarettes are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it When used as intended, e-cigarettes pose no risk of nicotine poisoning to users, but e-liquids should be in child resistant packaging https://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/vaping-e-cigarettes
Electronic Cigarettes: Information for health care workers The following information can be useful when talking about electronic cigarettes (e-cigarettes) with patients. The information does not replace the e-cigarette advice provided on the Ministry of Health s (the Ministry s) website. Rather, it aims to support that advice with more specific details relating to particular common issues. This information will be updated regularly.
Heat not burn (HnB) products Ministry of Health vs. Philip Morris (March 2018) PM was charged with selling Heets contrary to section 29(2) of the SFEA, which reads No person shall import for sale, sell, pack or distribute any tobacco product labelled or otherwise described as suitable for chewing, or for any other oral use (other than smoking). The Ministry s argument was that the words other than smoking refer to an ignited product, which HnB are not The defence argues that s 29 was never meant to capture inhalation based products The judge agreed with the defence, stating: it can be said that the use of Heets while it may have associated risks in itself, is not as harmful or potentially harmful as ordinary cigarette use. This finding would fit squarely with the purposes stated in s 3A (1)(a) and (c) and s 21 (b) of the Act. http://www.districtcourts.govt.nz/all-judgments/2018-nzdc-4478-moh-v-morris/
Moving forward The SFEA needs to be amended to account for these new products Need for proportionality in regulatory controls The greater the harm the more tightly regulated Need for some degree of flexibility Adjustments may be required in the light of new evidence Strengthen surveillance
Thank you hayden@thedragon.institute