Electronic Nicotine Delivery Systems (ENDS), popularly called electronic cigarettes, are available in many shapes and sizes, including the prominent brand JUUL, which resembles a flash drive and contains roughly the same amount of nicotine as in an entire pack of cigarettes. In four years of JUUL’s introduction, it has captured more than 70 per cent of the US e-cigarette market.

ENDS includes a battery, an atomiser and a cartridge, which contains liquid nicotine, propylene glycol and flavours to attract kids and youth. And these products, though unapproved under Indian law, are available mostly through e-commerce sites because of the lack of awareness and poor implementation of law.

Punjab was the first Indian State to declare ENDS as unapproved under the Drugs and Cosmetics (D&C) Act in 2013, when few knew of it. The product was seized in about five districts and court cases were launched against seven violators contravening the D&C Act. Violators were penalised in districts Mohali and Sangrur. Court cases were also launched in the State of Haryana. In Punjab, the State cyber crime cell issued notices to e-commerce sites selling ENDS.

Presently, more States, including Maharashtra, Karnataka, Kerala, Bihar, Uttar Pradesh, Jammu & Kashmir, Mizoram, Himachal Pradesh,Tamil Nadu, Puducherry and Jharkhand, have formally declared ENDS as unapproved products, though the D&C Act is applicable pan-India and Haryana booked violators even without a formal declaration. Presently, there is an ongoing case in the Delhi High Court discussing the country’s approach to e-cigarettes. This, even as there is an existing advisory from the Union Health Ministry (August 2018) against ENDS, including e-cigarettes, heat-not-burn devices, vape, e-sheesha, e-nicotine and flavoured hookah.

In the US too, the Surgeon General released an advisory on the e-cigarette epidemic among youth, in December 2018.

Regulation is not the way out

But there is a strong propaganda being created by the tobacco industry in favour of e-cigarettes with the seemingly harmless name of vaping. Today, some of the most popular e-cigarette brands are owned by Big Tobacco. We shouldn’t fall into this trap of the tobacco industry and go for regulation of e-cigarettes under any Act, as the tobacco industry wants us to. Remember, we have not been able to regulate tobacco in decades, in spite of very good provisions in law. The tobacco industry will always find ways and means to circumvent existing laws.

Cigarette smoking rates among teens have dropped over the last few decades, but the use of e-cigarettes, also called vaping, has risen in this age group.

There is ample scientific evidence available about the harmful health effects of nicotine and that is the reason it is unapproved in India under the D&C Act, except as nicotine gums and patches, which are approved for cessation. Nicotine is also banned under the Poisons Act in many States. So there is no need to promote an unapproved product with known lethal dose of 0.5 mg/kg body weight. Deaths have been reported in kids due to accidental ingestion of liquid nicotine in refills. All airlines have prohibited carrying of e-cigarettes because of incidence of bursting batteries.

Several studies have revealed many ill-health effects relating to the use of e-cigarettes, including cardio-vascular and lung diseases. Users are exposed to harmful chemicals like benzene, ethylene oxide and acrylamide, collectively called as volatile organic compounds and linked to cancer and nervous system damage, among other health effects. E-cigarette users also inhale large amounts of toxic metals, including lead, in the aerosols, these metals leak from the e-cigarette coils. They also promote dual usage, i.e. they may continue to be used as tobacco cigarettes.

E-cigarettes are not currently approved by the Food and Drug Administration (FDA) as a quit smoking aid. The US Preventive Services Task Force, a group of health experts that makes recommendations about preventive healthcare, has concluded that evidence is insufficient to recommend e-cigarettes for smoking cessation in adults, including pregnant women.

The food and drug administration of all States in India need to follow the advice of the Central government and implement the D&C Act strictly to save children and youth from an impending epidemic. State cyber crime cells too need to ensure that these products are not sold by e-commerce sites mostly visited by youngsters.

The writer is Deputy Director/Chief Chemical Examiner with the Department of Health and Family Welfare, Punjab, Chandigarh.

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