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US-FDA proposes restrictions on menthol cigarettes and e-cigarettes

19 November 2018

The US Food and Drug Administration (FDA) has announced new measures to protect youth by preventing access to flavoured tobacco products and banning menthol in cigarettes. This will include a ban on fruit and candy-flavoured e-cigarettes sold in convenience stores and gas stations.

In announcing these measures, the Commissioner of FDA said, “I believe these menthol-flavored products represent one of the most common and pernicious routes by which kids initiate on combustible cigarettes. The menthol serves to mask some of the unattractive features of smoking that might otherwise discourage a child from smoking.”

E-cigarette makers, such as Juul Labs, have targeted youth with their marketing tactics. Juul has reportedly captured 75 percent of the e-cigarette market in the US and is popular among young people who are now promoting it themselves, via social media.

E-cigarette use poses serious risks to the health of young people. A 2016 Surgeon General’s reportconcluded that youth use of nicotine in any form, including e-cigarettes, is unsafe, can cause addiction and can harm the developing adolescent brain. Some of the harmful ingredients in e-cigarettes include ultrafine particles that can be inhaled deep into the lungs, flavourants such as diacetyl, a chemical linked to serious lung disease, and heavy metals such as nickel, tin and lead. Another harmful effect of using e-cigarettes is the ‘wet lung’ effect.

A January 2018 report by the National Academies of Sciences, Engineering and Medicine concluded, “There is substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults.”

New data being released today by the CDC and the FDA underscores that youth e-cigarette use has reached epidemic levels and that flavors are a critical factor – including the menthol and mint flavors.

A statement from the Campaign for Tobacco Free Kids (CTFK) said, the FDA’s actions on e-cigarettes are a step forward but do not go far enough. It stops short of banning the flavors that have made e-cigarettes so popular with kids. They say, the FDA should stop sales of all flavored e-cigarette products that have not been subject to public health review by the agency and enforce rules prohibiting the sale of new or changed products without prior FDA review. By enforcing this pre-market review requirement, the FDA can prevent manufacturers from continuing to introduce products that appeal to kids.

According to a Reuters report, Juul is actively expanding to Asian countries such as Indonesia, India, South Korea and the Philippines. Expansion into Asia would provide the fast-growing firm with new markets at a time when it faces increased regulatory scrutiny in the United States. For now Juul, valued at $16 billion, is available only in the United States, Canada, the UK and Israel. One Juul pod contains as much nicotine as a traditional pack of 20 cigarettes.

According to Reuters, e-cigarettes have been available in Indonesia since 2013 and are a small, but growing market. The Indonesian customs estimate there are about 300 unsupervised liquid makers in Indonesia, producing various liquid products to more than 4,000 vape stores and 900,000 smokers.

Juul is exploring sales in Indonesia and has filed trademark applications in Malaysia and Singapore, and opened its first Asia office in Singapore in July.

The day the FDA announced its restrictions on flavouring and e-cigarettes in the US, a different tune was heard in Manila – the e-cigarette proponents was pushing their harm reduction message to Asia. The second Asia Harm Reduction Forum was strategically held in the Philippines while legislators are drawing up laws on e-cigarettes. The keynote Speech was delivered by Congressman Anthony M. Bravo, a proponent of e-cigarettes, while another supporter, Congressman Rodel Batocabe was a panel speaker. See Table 1 for AHRF speakers.

Table 1: 2nd Asia Harm Reduction Forum, Manila 15 November 2018

2018 AHRF, Manila 2017 AHRF, Jakarta
Philippines Key note speech: Anthony Bravo of Coop-NATTCO Party Tom Pinlac, president, The Vapers Philippines
Prof. Jay Jazul, University of Santo Tomas Ron Sison & Jay Jazul, HARAP, University of Santo Tomas
Indonesia Dr. Amaliya, University of Padjajaran, YPKP Public Health Observer Foundation

Prof. Achmad Syawqie Yazid,

Founder/ chair of YPKP, Indonesian Public Health Observer Foundation

  Dr. Khamami Zada, Nahdatul Ulama Research Center Dimas Jeremia, chairman of MOVI, Indonesian Vape Retailers
  Dr.Amaliya, University of Padjajaran
  Muhamad Ikhlasul Amal, Director at Indonesian Institute of Sciences (LIPI)
Singapore Prof. Tikki Pangestu, Visiting Prof, Lee Kuan Yew School of Public Policy, National University of Spore Donald Low, Lee Kuan Yew School of Public Polic, National University Singapore
  Andrew Da Roza, addiction psycho therapist
Malaysia Prof. Dr. Shamsul Bahri Md. Tamrin, University Putra Msia Azrul Hafriz, MOVE, Malaysian Organization of Vape Entity
Thailand Asa Saligupta, ENDs Cigarette Smoke Thailand (ECST)
Shakrit Rimpanit, Cessation Clinic Doctor of Saint Mary Hospital
India Mr. Samrat Chowdery, Association of Vapers India Rajesh Sharan, Molecular Biology, North Eastern Hill University, India
Nilesh Jain, Founder/ Managing Director of
Australia Jeannie Cameron, JCIC International
New Zealand Dr. Marewa Glover, Director, Center of Research Excellence: Indigenous Sovereignty & Smoking*
Japan Dr. Hiroya Kumamaru, Vice Director, AOI Universal Hospital Nobuhiko Harada, Partner at Nishimura & Asahi Law Firm
South Africa Dr. Kgosi Letlape, President, Health Professionals Council of S Africa
USA Prof. Helen Redmond, Silver School of Soc Work, New York Univ
Sweden Mr. Atakan Erik Befrits, COO of INNCO

Dr. Amaliya from Indonesia was quoted to have said, say, “The ‘quit or die’ approach in Indonesia does not work for some smokers. This is rather odd for quitting is not a health priority in Indonesia, which remain tobacco friendly with about 65 million smokers, and cheap cigarettes which are freely available.

Dr. Marewa Glover, from New Zealand is heading up an initiative funded by the Foundation for Smoke Free World, which is funded by Philip Morris International.

Four countries in the ASEAN region, Brunei, Cambodia, Singapore and Thailand, have banned electronic cigarettes (e-cigarettes). Elsewhere about 30 countries have either banned or restricted e-cigarettes.

According to the WHO, there are clear health risks related to ENDS use and secondhand exposure to nicotine and various toxicants, and there is insufficient evidence of ENDS as effective cessation devices.

For write-up on 1st Asia Harm Reduction Forum: