KUALA LUMPUR: Local and international harm reduction experts recently shared the potential of vaping as an effective smoking cessation tool at a forum entitled Managing Smoking Addiction in Malaysia hosted by the Malaysia Society for Harm Reduction (MSHR).
The forum featured Advanced Centre for Addiction Treatment Advocacy (ACATA) president and local addiction therapy advocate and practitioner Dr Arifin Fii and international experts Dr Alex Wodak AM, Emeritus Consultant, St Vincent's Hospital, Sydney and Professor Dr Paul Newhouse, Director of the Center for Cognitive Medicine in the Department of Psychiatry at Vanderbilt University Medical Center, United States.
The session was moderated by Medicine Universiti Kebangsaan Malaysia (UKM) community health physician, health economics specialist, and MSHR chairman Professor Dr Sharifa Ezat Wan Puteh.
"Smoking epidemic is alarming as Malaysia recorded a prevalence of 40.2 per cent male smokers in 2020. It is confounded by widespread illicit tobacco," Dr Sharifah said in her opening address.
"The emerging innovations of less harmful and proven effective smoking cessation products such as vaping and heated tobacco products are readily available albeit poorly regulated in Malaysia," she said.
Dr Sharifa said the harm reduction concept is new in tobacco control but used methodically in drug replacement therapy.
She said much practised in a few developed countries, harm reduction tools using reduced-risk products (RRPs) are used in Japan, New Zealand, the United Kingdom, the United States and Australia, albeit some forms of regulations of the liquid, advertisement and labelling.
Dr Sharifa also said that the Generation End Game (GEG) proposed by the government, in addition to a total ban on smoking, also proposes a ban on reduced-risk products, unlike New Zealand, which allows vape use for 18 years old and above.
She said that total prohibition is not without risk, as this can result in the flourishing of illicit tobacco and vaping, as the demand might be tremendous.
"If vaping is allowed to be used amongst recalcitrant smokers that have no intention of quitting or those who do not respond to traditional methods such as NRTs, it can provide benefits in terms of reducing the harms of tobacco and lowering the population of smokers.
"Based on estimates, the rate of smokers in Malaysia will decrease from 4.88 million in 2019 to 4 million in 2025 for various reasons, including the use of vaping.
|These statistics are in line with data from several countries that allow the use of vaping as a strategy to reduce the risk of tobacco, in addition to nicotine replacement therapy.
"However, regulations of vape liquid are important, as tampering with illicit products might induce EVALI outbreaks, as the use of VEA and THC might become notoriously rampant," she said.
Dr Sharifa said MSHR believes that the GEG policy that is being mooted by the Ministry of Health (MoH) may work but prohibiting RRPs, would be counter-productive, as it positions vaping to be equally harmful as cigarettes.
She said smokers also do not have any alternative to switch to a safer alternative.
ACATA president Dr Arifin Fii echoes these sentiments.
"Much credible, undisputed evidence has shown the benefits of vaping as a smoking cessation tool. But unfortunately, these facts have not been considered in drafting the Tobacco and Smoking Control Bill, particularly the GEG policy.
"In my opinion, this is a clear indicator that not enough time was, and is, being allocated to review the Bill before implementation.
"We cannot afford to be careless in developing and implementing such an important policy, as the consequences can be dire.
"My recommendation is, therefore, to delay the implementation of the Bill and to use the time to study and consider all the data available carefully," he said.
Dr Arifin said vaping is never meant for recreational purposes for youngsters. The additional time would also allow Malaysia to study the viability of vaping as a harm reduction tool in the country.
He said vape risks are always compared with cigarette smokers and should not be compared with nicotine naive lungs.
Complete reviews must be based on other countries' data showing their success, such as the United Kingdom, New Zealand, and Japan," he said.
In elaborating on the effectiveness of vaping as a smoking cessation tool, Dr Alex Wodak AM, Emeritus Consultant, St Vincent's Hospital, Sydney, in his presentation, said conventional ways of trying to reduce smoking around the world are not successful.
"Everything changes when people are encouraged to switch to vaping. Vaping is at least 95 per cent less harmful than smoking.
"There are several reputable organisations that have made that estimate. Vaping is also the most popular way to quit smoking aid internationally and probably in Malaysia.
"We don't know for certain, but it seems probable that vaping is currently the most effective quit smoking aid we know of.
"If we look at the decline in smoking rates in countries with higher vaping rates, it speeds up as the vaping rate increase," he said.
He said that in 2013, Australia had a lower smoking rate than the United States (US), the United Kingdom (UK) and New Zealand.
Just a few years later, vaping has taken off in these other three countries and hasn't taken off in Australia. He said that the smoking rate is declining only 0.3 per cent in Australia and declining much faster in the US, UK and New Zealand.
In his presentation, Professor Dr Paul Newhouse, Director of the Center for Cognitive Medicine in the Department of Psychiatry at Vanderbilt University Medical Center, spoke about the current updates on the effects of nicotine on neuropsychiatric disorders and neurodegenerative diseases.
"Nicotine can make the brain work more efficiently, although the delivery method is highly titrated, low dose, and through safer dermal patches as none are delivered through inhalation.
"Nicotine essentially provides an extra boost of efficiency to the brain function.
"We are just beginning to explore the potential aspects of nicotine fully. Therefore, there is a need for more studies to be done within this space," he said.
Nicotine is used to treat diseases such as Alzheimer's, dementia, schizophrenia, and autism. The new potential is also in place on a clinical trial basis.