IRELAND SHOULD NOT completely ban the sale of electronic cigarettes or vapes, but there could be more regulation when it comes to who can purchase them, experts have told The Journal.

It comes after Australia announced it will ban recreational vaping, with e-cigarettes no longer being sold in general and convenience stores.

The country’s government will increase the product standards for vapes, including by restricting flavours and colours, in order to tackle the growing black market. 

It will also require pharmaceutical-like packaging, a reduction in the maximum allowed nicotine concentrations and volumes and a ban on single-use vapes.

In Ireland, these devices are about the size and shape of a highlighter and are sold with the nicotine e-liquid already inside them.

There is currently no mandatory age restriction on the sale and marketing of e-cigarettes in Ireland, however a Bill that proposes banning the sale and purchase of e-cigarettes by anyone under the age of 18 will be published in the coming weeks. 

While it says it will continue to review new studies, the HSE does not currently recommend vaping as a method of quitting smoking. It says that based on evidence thus far, it has found it to be less useful for smoking cessation than nicotine gum or patches.

There are also no e-cigarettes on the market in Ireland authorised by the Health Products Regulatory Authority (HPRA) as a medication for smoking cessation.

However, the NHS in the UK does recognise e-cigarettes as an aid to smoking cessation. Though it does not prescribe them, it states that nicotine vaping is “substantially less harmful than smoking” and is “one of the most effective tools for quitting smoking”.

A GP specialising in addiction medicine told The Journal that he believes that Australia’s move to ban the sale of e-cigarettes is “totally counterproductive”. 

‘Safer than smoking’

Dr Garrett McGovern, who is also the HSE clinical lead on addictions, said the ban in Australia “is going to reduce the uptake of people vaping”.

“There are people in my position who believe that that’s a good thing. They’ve not really bought into the idea of vaping. I’m not one of those people,” he said.

“Vaping is immeasurably safer than smoking and we really do need to continue with our strategy of trying to get Ireland as close as we can to a smoke free-place and I believe vaping has a role, as do nicotine replacement therapies, as does counselling, and all sorts of other interventions.

“I think if we’re going to do anything in Ireland, we’ve got to look at how many people are vaping… The vast majority of people using those devices are actually smokers trying to quit, so we should applaud those and we shouldn’t put barriers in the way.”

McGovern said he is in favour of restrictions being put in place, such as an age restriction on purchasing e-cigarettes, which he said “should have happened a long time ago”.

“Any place that sells them where they are very enticing and very colourful in terms of sweets and that sort of thing is wrong. We need to tighten up on that aspect.” 

But he added that if we “go down a road that is going to make it more difficult to access them, we’re going to have more smokers”. 

Vapes are battery-powered devices that heat nicotine mixed with flavourings and other chemicals to create an aerosol that you then inhale. They are sold in some supermarkets and independent “vape shops” as well as online.

According to the Irish Vape Vendors Association (IVVA), approximately 200,000 people use vapes in Ireland, with around €70 million spent on e-cigarettes in the country in 2018. 

A number of organisations have called for more regulations around the use and sale of e-cigarettes to be introduced in Ireland. 

The Irish Cancer Society has said that while e-cigarettes are less harmful than combustible cigarettes, health risks remain.

In a statement on their website, it says: “There is not enough evidence e-cigarettes are an effective quit aid for smokers; while other methods, such as Nicotine Replacement Therapy and prescription drugs have been proven to be effective in helping people to quit.

“There is a need for greater evidence on the long-term health consequences of e-cigarette use. As a result of clever marketing, e-cigarette use is increasing among young people and may act as a gateway to smoking.

Investment is needed in smoking cessation strategies we know will make a difference in supporting people to quit smoking.”

There are also concerns around the increase in adolescents who are vaping recreationally.

Speaking to The Journal, Professor Des Cox, a consultant in paediatric respiratory medicine at Children’s Health Ireland in Crumlin, said Australia has “taken a bold approach to vaping to tackle the alarming increase in teenagers vaping”.

Ireland should look at introducing increased restrictions on the sale of vaping products beyond the current bill but perhaps not as far as having them as prescription only.

“Certainly vaping is not as harmful as tobacco cigarettes but they are not harmless. There is emerging research which shows that long-term vaping may lead to an increased risk of heart and lung conditions,” he said.

Research

The European Commission’s Scientific Committee on Health, Environmental and Emerging Risks found that there was moderate evidence that electronic cigarettes are a gateway to smoking for young people.

It also found there to be weak evidence for the support of electronic cigarettes’ effectiveness in helping smokers to quit.

However, McGovern said the evidence to support the gateway theory is “very flaky”.

“This idea that you do something and then downstream you do something else so one causes the other is nonsense really,” he said.

“I treat heroin users. Nearly all of them would have taken cannabis at some stage before they took heroin. They also smoked, but nobody called smoking a gateway to other drugs which is astonishing really. If you think that cannabis was a gateway to heroin use, you really don’t understand the sort of social determinants of that drug.”

In 2020, a review from the Health Research Board (HRB) found that teenagers who use e-cigarettes are three-to-five times more likely to start smoking tobacco cigarettes compared to those who have never used e-cigarettes.

The HRB also said that e-cigarettes as a smoking cessation device are not regulated or approved, and their safety beyond 12 months is not yet known.

Cox said a number of Irish surveys have also demonstrated an increase in the number of teenagers vaping.

“One study reported a 50% increase in the number of 15-17 year olds vaping from 2015 to 2019 in Ireland. Teenagers who vape are inhaling harmful substances which potentially have long-lasting effects on their lungs and heart.

“Also, teenagers who vape are four times more likely to go on and smoke tobacco products which is a real worry.”

But McGovern argues that teenagers “dabbling” with e-cigarettes does not necessarily mean that they will use them continuously or go on to smoke cigarettes.

A review carried out by the TobaccoFree Research Institute Ireland surveyed 1,949 students aged between 15-16 in 2019. It found that 39% had tried e-cigarettes and 16% were current users.

This compared to 32% of respondents who said they had tried smoking, while 14% said they were current smokers, with 5% smoking daily.

Professor Luke Clancy, the founder and current director general of the TobaccoFree Research Institute Ireland, told The Journal that making e-cigarettes prescription only would mean you could “rely on them” as a smoking cessation treatment.

“The big advantage of the Australian system would be that you would need to be a smoker before you go to that trouble and if that were to occur, it would mean that our children wouldn’t become addicted,” he said.

“A lot of people who make them and sell them keep stressing how great they are for stopping smoking. They are not recommended by the HSE for smoking cessation and that’s because there isn’t enough evidence. It’s also because the products aren’t guaranteed as medicine.

“So what that would do, if they were to do it here, would be to guarantee that the e-cigarettes were what they said they were and they had the constituents that they said, and you could rely on them. That would be a good thing.”

He said he would like to see vapes of medicinal quality become freely available for people who want to stop smoking.

Government Bill

The HRB review was conducted to help inform Department of Health policy regarding e-cigarettes. 

The Government’s Public Health (Tobacco and Nicotine Inhaling Products) Bill, which will ban the sale of e-cigarettes to children, is expected to be published this summer.

The sale and purchase of e-cigarettes by anyone under the age of 18 will be prohibited under the Bill, while they will not be permitted to be sold from vending machines or pop-up shops. 

Advertising for e-cigarettes on public transport, in cinemas and within 200 metres of schools will also be banned under the Bill.

The Bill will also introduce, for the first time, a requirement that anyone who wishes to sell e-cigarettes must obtain a licence which must be renewed annually and can be revoked for breaches of tobacco control law.

Announcing the proposals last year, Health Minister Stephen Donnelly said: “These measures are designed to protect our children and young people from starting to vape.

“We recognise that nicotine is a highly addictive drug, and we are acting today to make these products less accessible to our young people and to remove the advertising for these products from our children’s everyday lives.”

However, Cox believes the Bill doesn’t go far enough.

“Teenagers and young adults are clearly being targeted by vaping companies for their custom. We are at risk of a new generation of young people becoming addicted to nicotine,” he said.

“In addition to banning the sale of e-cigarettes to anyone under 18 years, there needs to be increased restrictions on the flavourings, advertising, marketing and packaging of e-cigarettes in Ireland. The government should ban all flavours except tobacco flavouring as well as restrict the advertising, marketing and packaging of e-cigarettes in the same way that tobacco products are.”

Clancy agreed that the Bill needs to go further and include a ban on flavours, as well as a ban on single-use e-cigarettes.

“The problem of pollution that the plastic e-cigarettes are causing is well recognised, and the other aspect of it is they are electronic devices. That means they’re batteries and that means they’re using lithium that is scarce and needed for important things in life and they’re just putting it into these things which are being thrown away,” he said.

“These are electronic devices that should be dealt with, like you would your old phone, whereas they just throw them away and this is polluting.”