South Africa needs clear legislation against the use of e-cigarettes

Dr Dominique Stott, Executive: Medical Standards and Services at PPS.

The City of Cape Town recently warned they will escalate their efforts to clarify legislation around alternative smoking devices, such as hookah pipes (commonly known as hubbly bubblies) and e-cigarettes this year.

Dr Dominique Stott, Executive: Medical Standards and Services at PPS, hails the move and says that other South African metropolitan areas should follow this example.

She says that there is not enough evidence currently available to suggest that these devices need to be banned completely, but it is vital to develop and enforce proper legislation around the availability and usage of these two devices. “As there are no current regulations for the development and usage of e-cigarettes, there is the danger that the device itself, or the contents of the vapour cartridge, may be contaminated by toxic substances.”

According to Dr Stott, there is a place for these devices to serve as a substitute for heavy long-term smokers who find it impossible to give up the habit. “However, making them widely available in an uncontrolled environment to non-smokers and teenagers may create a different set of problems, as any device that encourages smoking requires legislation.”

She explains that alternative smoking devices are currently being advertised as a ‘safer option’ of smoking, with unproven health claims, which creates a false sense of security regarding the long term effects. “The reality is that despite being marketed as a healthy alternative the devices still contain nicotine, which is addictive and when stopped still causes withdrawal symptoms. This means that it is easy for a user of the device to easily move back to traditional cigarettes, regardless of the dangers associated with them.”

Dr Stott says that the development of e-cigarettes was based on the principle of providing the same effect of smoking nicotine when the vapour was inhaled, without the 7000 toxic substances in traditional cigarettes - of which at least 70 are known to be carcinogenic. “The ‘smoke’ produced is actually a vapour made up of propylene glycol (an inert substance considered harmless for oral ingestion) and nicotine.”

Despite the purported benefits, Dr Stott says the common side effects that have already been attributed to alternative smoking devices include: nausea, headaches, breathing difficulties, red eyes, dizziness and a number of other health-related problems.

She says that using e-cigarettes is still classified as smoking. “Many insurance companies now conduct blood and urine tests to ensure that those who say they are non-smokers really are. Due to the well-known side effects of nicotine and the associated risks of smoking (such as heart disease, strokes, cancer and lung risks) an individual’s insurance premium may be doubled, depending on the type of insurance product.”

Dr Stott points out that the devices have been marketed as a fashionable alternative to cigarettes and have gained in popularity with the development of flavoured vapours. “Through the glamourising of e-cigarettes by tobacco companies, smoking may become as popular as it was 20 years ago. Despite TV adverts for cigarettes being banned in 1999, there is no similar control over the marketing of e-cigarettes. All the ground gained by public health campaigns to end smoking are in jeopardy as a result.”

Stronger regulation of e-cigarettes could also ensure that only those over the age of 18 would be able to purchase the devices, any unsafe substances would be prevented from being used in them and greater protection of second-hand (passive) smokers would be developed.

Norway, Brazil and Singapore have completely banned the devices, with the UK banning sales to under-18s. Due to the concern raised by the World Health Organisation (WHO) regarding their usage, the United States has regulated e-cigarettes as tobacco products. Australia regulates the import, sale and marketing of the devices and New Zealand requires them to be registered as a pharmaceutical.

“Now that the tobacco industry is buying into the e-cigarette industry, these devices will not disappear off the market. However, it would be promising to see similar regulations enacted in South Africa to protect consumers, especially those inhaling second-hand smoke from this seemingly ‘better’ option to cigarettes,” concludes Dr Stott.