By Selvaraja Seerangam

Addiction to tobacco products is not an accident, it is an incident waiting to happen. Stories of how smoking slowly takes control of one’s life and the extraordinary journey that people undertake to free themselves from the shackles of this habit have been well documented for years. What makes smoking so highly addictive? Tobacco products contain a chemical called ‘nicotine’ and it is this substance that creates dependence, cravings, and unpleasant and unbearable symptoms once withdrawn.

Nicotine in higher amounts is a poisonous chemical. Although isolated, nicotine poisoning is known to occur among tobacco farmers who handle wet tobacco leaves. It is also an excellent pesticide, and it is for this reason that tobacco waste was popularly used in the past by farmers to control pests and insects on their farms. This practice is banned in most countries now solely because it can cause poisoning through farm products. Nicotine, in smaller amounts as found in cigarettes, enters the bloodstream within seconds once inhaled and causes the release of dopamine in the brain, a neurotransmitter that is behind the ‘pleasant’ feeling that smokers are all too familiar with.

There are chemicals in use today that have medicinal use. There are also hundreds of chemicals that share the same characteristics as nicotine that are poisonous in varying amounts, highly addictive, and subject to easy abuse. Thus, there is a need to distinguish these chemicals and categorise them clearly based on selected parameters and provide a regulatory framework that prohibits or sufficiently controls the production and distribution of these chemicals. This is what the Poisons Board under the Ministry of Health has been doing through the Poisons Act 1952, a piece of legislation that predates our country’s independence.

Nicotine has been classified as a Group C poison, meaning it is highly regulated and only licensed personnel can involve themselves in any transactions involving its production, dispensing, and sale. This classification by the Poisons Board and the licensing scheme implemented by the Ministry of Health have been highly effective in curbing any illegal practices involving nicotine. Nicotine in tobacco was of course exempted from this classification as otherwise, it would have meant a ban on cigarette smoking.

In recent years, when nicotine was found to have some medicinal use mainly in the form of patches, gums, and lozenges for smoking cessation therapies, this classification was useful in ensuring only licensed health personnel like doctors, pharmacists, and dentists had access to nicotine products for use on their patients.

Two announcements at the end of March sent shock waves in the country: the gazettement of liquid or gel containing nicotine as items to be subjected to excise duty and the exemption of nicotine preparations used in electronic cigarettes (e-cigarettes) and vaping devices from the Poisons List under the Poisons Act 1952.

It is very clear the government has decided to legalise the use of nicotine in e-cigarettes and the vaping industry as it is seen as an economic sector that can potentially provide a significant contribution to the revenue of the country. With about 3,000 vape specialty stores, 7,000 retail stores, an estimated 1.5 million vape users, and an industry that has grown into a RM2.5 billion enterprise in 2022 as reported by the Malaysian Vape Chamber of Commerce, it may be hard to ignore its existence and impact.

However, experience in other countries has shown that it poses a threat to public health, with many cautioning against dismissing vaping as a lesser evil compared to smoking. Vaping is a relatively new phenomenon that has caught many countries unprepared but even in countries that have quickly imposed some sort of legislation, it has not been enough to stem the tide of vaping epidemics that have swept across the population with the young being particularly vulnerable.

In 2019, the world witnessed an outbreak of EVALI (e-cigarette or vaping use-associated lung injury) that resulted in hospitalisations and death in several countries, particularly the United States. This underlines the fact that we are in uncharted territory, and we know very little about the long-term effects of vaping and the use of nicotine and other substances in vaping devices.

With the uncertainty of the passing of the Tobacco and Smoking Control Bill that includes the much-touted Generational End Game (GEG) plan, we are surely treading on dangerous grounds with an apparent policy vacuum that has unleashed a worrying situation. There is now no control over the use of nicotine in vaping devices, the age of the consumer, the amount of nicotine in the preparations, and the lack of any safeguard measures to protect the public from adverse effects resulting from the use of nicotine-filled vaping devices.

Having made a policy decision to regulate the vaping industry rather than ban it outright, the government must now very quickly put in place a legislative framework that addresses all the issues related to nicotine and its use in e-cigarettes and vaping devices. Along with that, it must build an enforcement mechanism that is robust enough to prevent loopholes and ensure all safeguard measures are implemented in the most effective manner. The new regulation must be flexible enough to incorporate changes and amendments to accommodate new scientific knowledge emerging from clinical studies being conducted worldwide while at the same being resilient enough to withstand the challenges brought on by innovation in the vaping industry itself.

--BERNAMA

Selvaraja Seerangam is Senior Lecturer, School of Pharmacy Faculty of Health and Medical Sciences Taylor’s University