Experts call for changes to regulation of e-cigarettes and heated tobacco products
Experts believe that regulations governing sale, prohibition of indoor use, advertising limits, and label warnings should be implemented.
Current regulation of electronic cigarettes and heated tobacco products should be revised to create distinct regulatory regimes for the two product categories, according to research published in BMJ Open.
Electronic cigarettes, also known as electronic nicotine delivery systems or heated tobacco products, are devices that contain tobacco and heat it to produce an emission containing nicotine and other chemicals. They have been marketed as a way for smokers to quit combustible tobacco for the last decade.
Globally, national health authorities regulate these products differently, and the precise benefit/risk ratio is unknown due to a dearth of comprehensive data and evidence about their usefulness and hazards as a smoking cessation therapy.
As a result, a research team from France and Switzerland set out to collect the perspectives of international tobacco control and smoking cessation experts through a series of surveys conducted between December 2018 and March 2020.
They queried 268 persons with relevant clinical, public health, or research skills from 15 countries and received replies from 92 participants in the first round and 55 participants in the second round of their Delphi survey.
These surveys sought responses to comments or recommendations regarding e-cigarettes and heated tobacco products, with an emphasis on four categories: regulation, sale, use, and general issues.
In response to questions about e-cigarettes, respondents agreed that the components of e-liquids should be disclosed on the product, a defined upper limit on nicotine concentration should be specified, and a statement should be made about the lack of evidence regarding the long-term safety and addiction potential of these products.
Additionally, they stated that e-cigarettes should not be regulated as consumer products but rather as a new category of nicotine delivery or tobacco products, with or without specific regulation, and that they should not be sold in general stores but rather in specialised shops, tobacco shops, or pharmacies with age restrictions.
On heated tobacco products, the experts concluded that because they possessed the same addictive potential as traditional cigarettes, they should be controlled as tobacco products, with comparable warning warnings as cigarettes, and advertising should be prohibited.
Additionally, the experts recommended:
- Indoor public areas should prohibit the use of e-cigarettes and heated tobacco products.
- Implementation of a dedicated e-cigarette tax
- Heat-treated tobacco products should not be taxed less than normal cigarettes.
Overall, experts agreed that dual use of e-cigarettes and heated tobacco products (dual usage) was more likely than quitting smoking, and that electronic nicotine delivery systems were likely to be used to provide illegal narcotics.
Additionally, e-cigarettes were deemed to be less harmful and addicting for tobacco smokers than heated tobacco products.
The authors acknowledged that their study had limitations, including a low response rate for the first survey, a non-random selection of experts that limited the generalizability of the findings, and a dearth of experts from numerous geographic regions, including Asia, Africa, and South America.
Nonetheless, they claimed, the study featured an international panel of renowned experts in tobacco control and smoking cessation, and the questionnaires covered a variety of issues that would likely be raised by healthcare professionals and policymakers in this sector.
“Experts in tobacco control and/or smoking cessation recommend that electronic nicotine delivery devices and heated tobacco products be regulated differently.” the authors conclude.