The worry over vaping

Regulation of vaping devices, rather than a ban could have been a better option


It is an argument that swings between two extremes. According to the Union health ministry, which banned e-cigarettes on September 18, they are not a safe alternative. Citing “available literature”, ministry officials have argued that these may act as “gateway products” among non-smokers, especially youth and adolescents, leading to use of conventional tobacco products. The government has also contended that though the use of electronic cigarettes as cessation aids is being promoted, their safety and efficacy have not yet been established. According to an ICMR white paper on Electronic Nicotine Delivery System published in May in the Indian Journal of Medical Research, e-cigarettes contain “highly addictive” nicotine solution and flavouring agents, and vapourisers, which are “harmful for health”. The authors of the paper also argue that the use of e-cigarettes has documented adverse effects such as “DNA damage, carcinogenesis, cellular, molecular and immunological toxicity, respiratory, cardiovascular and neurological disorders and adverse impact on foetal development and pregnancy”.

Smoking has been declining in the last two decades, and the rate of decline has increased by three to four times in countries where vaping is allowed. - Samrat Chowdhery, Founder-director, Council for Harm Reduced Alternatives and Association of Vapers of India

Vapers, however, say the ban has forced them into a “quit or die” situation. Take the case of South Delhi entrepreneur Kanav Rishi Kumar, 30. He took to smoking at 17. Kumar was able to quit cigarettes in January 2015 with the help of e-cigarettes. “It seems that the government is willing to risk my health and well-being in the name of someone who may or may not take up cigarette smoking after using e-cigarettes,” he says, adding that the ban has left the vaping community “upset” and “panicky”. Kumar, who was smoking a pack a day before quitting, says vaping made him feel much better, cleaner, and helped him to regain lost stamina and lung power. When he bought his first vaping device in December 2014, it cost him 04,000 plus 050 to 0100 per day for the liquid. “For the first month or so, I was using both the vaping device and cigarettes,” he says. “After that I was comfortable with vaping.”

Until the recent ban, he had not even considered going back to cigarettes, and had even reduced his nicotine dose in the device (from 18mg/ml to 6mg/ml). “Even as the news of the ban was playing on TV, I rushed to the market and bought as much vaping liquid as I possibly could. I think my stock might last until February,” he says. Others in the vaping community were considering buying from overseas. Those who may not be able to do so will end up switching back to cigarettes, he said. Samrat Chowdhery, founder-director of Council for Harm Reduced Alternatives (CHRA) and Association of Vapers of India, says that while smoking has been declining in the last two decades, the rate of decline has increased by three to four times in countries where vaping is allowed. “The US now has the lowest recorded smoking prevalence,” he says.

Before the ban, the vaping industry had also been advocating “harm reduction” and “quitting aid” as advantages of using e-cigarettes. An independent expert on addiction medicine, who did not wish to be identified, told THE WEEK that while there was enough anecdotal evidence on the use of e-cigarettes as a quitting tool, proper studies/clinical trials on the subject had not yet been done. “What has been established scientifically is that these products pose a lower risk than e-cigarettes, and are safer, ” he says. The expert said that the argument of the government and a section of the medical fraternity that all citizens should be free of nicotine addiction is purely moral. He also cited the heavy use of e-cigarettes in hospitals in the UK.

Says Chowdhery: “The UK now has the lowest number of smokers in Europe, and going by the decline in smoking, the country is aiming to be smoking-free by 2030.”

In the US, there is currently a backlash against vaping because of the rising number of cases of people who have developed severe lung illnesses after using vaping devices filled with tetrahydrocannabinol (the main active ingredient of cannabis) and nicotine. At least 530 cases and nine deaths have been reported in the American press; the cause of the illnesses and deaths have not been officially identified yet. While the state of Massachusetts has introduced a four-month ban, New York has banned most flavours of e-cigarettes barring menthol and tobacco, and California is planning to regulate e-cigarettes with new health warnings, awareness campaigns and weeding out of counterfeit products.

The adverse events caused by vaping have more to do with contaminated liquids in the devices, and not the standard e-cigarette concoction, says the medical expert. Those in support of vaping devices invoke the analogy of the device itself as “a glass”, one that could be filled with anything—water, milk, alcohol or as Kumar says, “even poison”—and argue for the need for regulation, rather than a blanket ban. The expert also says that while the government was right in fearing its use among youth and young adults, a complete ban would give grey market sellers an opportunity to push other illegal substances such as cocaine and heroin, too.

Kumar agrees, and adds: “The worst hit will be young professionals, typically in their early 20s, who were using vaping devices. Majority of them would not have the time, resources or even access to procure it from other sources. The ban will only push them to smoke cigarettes, and it clearly seems like the government does not care about their lives.”