May 8 - Irish experts reportedly told the Wall Street Journal that the country should not completely ban the sale of electronic cigarettes or e-cigarettes, but there could be more regulation on who can buy them.

The move comes after Australia announced it would ban recreational e-cigarettes, which are no longer sold in general stores and convenience stores.

The country's government is to raise product standards for e-cigarettes, including restrictions on flavors and colors, in response to a growing black market.

It would also require drug-like packaging, reduce the maximum allowable nicotine concentration and volume, and ban the use of single-use e-cigarettes.

In Ireland, the devices are about the size and shape of highlighters and are sold with nicotine vape inserted into them.

Ireland currently has no mandatory age limit on the sale and marketing of e-cigarettes, but a bill proposing to ban the sale and purchase of e-cigarettes by anyone under the age of 18 is due to be published in the coming weeks.

While it said it would continue to review new research, the HSE does not currently recommend e-cigarettes as a smoking cessation method. It said that based on the evidence to date, it had found it was less effective at quitting than nicotine gum or nicotine patches.

There are also no e-cigarettes on the Irish market that have been authorised by the Health Products Regulatory Agency (HPRA) as a smoking cessation medication.

However, the NHS in the UK does acknowledge that e-cigarettes can help with smoking cessation. Although it does not regulate them, it points out that nicotine fogging is much less harmful than smoking and is one of the most effective tools for quitting.

A general practitioner specializing in addiction medicine told the Wall Street Journal that he thought Australia's move to ban the sale of e-cigarettes was completely counterproductive.

'Safer than smoking'

Dr Garrett McGovern, who is also the HSE's addiction clinical lead, said the Australian ban would reduce people's use of e-cigarettes.

"There are people in my position who think it's a good thing. They haven't really embraced the idea of vaping. I'm not one of those people." 'he said.

"E-cigarettes are much safer than smoking and we do need to continue our strategy of trying to get Ireland as close to a smoke-free place as possible, and I believe e-cigarettes have a role to play, as do nicotine replacement therapy and counselling, and various other interventions."

"I think if we're going to do anything in Ireland, we have to look at how many people are vaping...... the vast majority of people using these devices are actually smokers trying to quit, so we should applaud them and we should put barriers in the way."

McGovern said he was in favor of restrictions, such as an age limit on buying e-cigarettes, which he said was long overdue.

"Any place that sells them is very tempting and very colorful in terms of candy, and that kind of thing is wrong. We need to tighten up on that."

But he added that if we go down a path where it's harder to reach them, we'll have more smokers.

E-cigarettes are battery-powered devices that heat nicotine to mix with flavorings and other chemicals to form aerosols that you then inhale. They are sold in some supermarkets and independent vape shops, as well as online.

According to the Irish Vape Providers Association (IVVA), about 200,000 people use e-cigarettes in Ireland, and the country spent about 70 million euros on e-cigarettes in 2018.

A number of organisations have called for the introduction of more regulations on the use and sale of e-cigarettes in Ireland.

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

In a statement on their website, it says: There is insufficient evidence to prove that e-cigarettes are an effective smoking cessation aid for smokers; Other methods, such as nicotine replacement therapy and prescription drugs, have been shown to be effective in helping people quit.

"More evidence is needed on the long-term health effects of e-cigarette use, which is increasing among young people thanks to clever marketing and can act as a gateway to smoking."

"There needs to be investment in smoking cessation strategies and we know this will have an impact in supporting people to quit."

There are also concerns about the growing number of teenagers using e-cigarettes recreationally.

In an interview with the Wall Street Journal, Professor Descox, a consultant in paediatric respiratory medicine at Child Health Ireland in Crumlin, said Australia had taken a bold step on e-cigarettes in response to the alarming rise in the number of teenagers vaping.

Ireland should consider adding restrictions on the sale of e-cigarette products beyond the current bill, but perhaps not beyond prescribing them exclusively.

"Of course, e-cigarettes are not as harmful as cigarettes, but they are not harmless either. There is emerging research suggesting that long-term use of e-cigarettes may increase the risk of heart and lung disease." 'he said.

research

The European Commission's Scientific Committee on Health, the environment and Emerging Risks found moderate evidence that e-cigarettes were a gateway to smoking among young people.

It also found insufficient supporting evidence for the effectiveness of e-cigarettes in helping smokers quit.

However, McGovern says the evidence supporting the gateway theory is very shaky.

'The idea that you do one thing and then you do another downstream is really nonsense,' he said.

In 2020, a review by the Health Research Council (HRB) found that teenagers who used e-cigarettes were three to five times more likely to start smoking than those who had never used them.

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

Cox says some Irish surveys have also shown an increase in e-cigarette use among teenagers.

"One study reported a 50% increase in the number of 15-17 year olds in Ireland from 2015 to 2019. Teenagers who vaped were inhaling harmful substances that could have long-term effects on their lungs and heart."

"In addition, teens who use e-cigarettes are four times more likely to continue smoking tobacco products, which is really concerning."

But McGovern believes teens dabbling in e-cigarettes does not necessarily mean they will continue using them or continue smoking cigarettes.

The Tobacco Free Institute of Ireland conducted a review of 1,949 students aged 15-16 in 2019. It found that 39 percent had tried e-cigarettes and 16 percent were current users.

In contrast, 32 percent of respondents said they had tried smoking, while 14 percent said they were currently smoking, including 5 percent who smoked daily.

Prescribing only e-cigarettes means you can rely on them as a smoking cessation treatment, Professor Luke Clancy, founder and current director general of the Smoke-free Institute of Ireland, told the Wall Street Journal.

"One of the great strengths of the Australian system is that you need to be a smoker to get in trouble, and if that happens it means our kids won't get addicted." 'he said.

"Many of those who manufacture and sell them have been stressing how important they are for smoking cessation. The HSE does not recommend their use for smoking cessation because there is insufficient evidence. And also because the product is not guaranteed to be a drug."

"So if they do that here, what would that do, would make sure that e-cigarettes are what they say they are and that they have the ingredients that they say you can rely on them. That would be a good thing."

He said he would like to see e-cigarettes with medicinal properties made freely available to people who want to quit smoking.

Government act

The HRB review was conducted to help inform the Ministry of Health's policy on e-cigarettes.

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

The bill would ban anyone under the age of 18 from buying or selling e-cigarettes, and would not allow them to be sold in vending machines or pop-up shops.

The bill would also ban e-cigarette advertising within 200 metres of public transport, cinemas and schools.

The bill would also, for the first time, introduce a requirement that anyone wishing to sell e-cigarettes obtain a license, which would have to be renewed annually and could be revoked for violating tobacco control laws.

Announcing the proposals last year, the health minister, Stephen Donnelly, said: These measures are designed to protect our children and young people from starting to use e-cigarettes.

"Recognizing that nicotine is a highly addictive drug, we are taking action today to make these products less accessible to our young people and to remove advertising for these products from our children's daily lives."

However, Cox believes the bill does not go far enough.

"Teenagers and young adults are clearly being targeted by e-cigarette companies because of their custom. We risk a new generation of young people becoming addicted to nicotine." 'he said.

"In addition to banning the sale of e-cigarettes to anyone under the age of 18, Ireland needs to tighten restrictions on flavoring, advertising, marketing and packaging of e-cigarettes. The government should ban all flavors except tobacco flavoring and restrict the advertising, marketing and packaging of e-cigarettes in the same way as tobacco products."

Clancy agrees that the bill needs to go further, including banning flavoring and single-use e-cigarettes.

"The pollution problems caused by plastic e-cigarettes are well known, and the other aspect is that they're electronic devices. That means they're batteries, that means they're using scarce lithium that's necessary for the important things in life, and they're just putting it into these things that are thrown away." 'he said.

"These are electronic devices that should be disposed of, just like you would dispose of an old cell phone, and they're just throwing them away, which is pollution."