Suspend removal of liquid nicotine from list of controlled substances, say experts

16 Jun 2023 10:20am
Health experts and non-governmental organisations (NGOs) are urging the government to suspend the exemption of liquid nicotine from the list of controlled substances under the Poisons Act 1952 - BERNAMA
Health experts and non-governmental organisations (NGOs) are urging the government to suspend the exemption of liquid nicotine from the list of controlled substances under the Poisons Act 1952 - BERNAMA

KUALA LUMPUR - Fresh from their disappointment over the delay in the passing of the Control of Smoking Products for Public Health Bill 2023, aimed at, among others, controlling the sale and purchase of tobacco products and tobacco substitutes and smoking devices such as vape, health experts and non-governmental organisations (NGOs) are urging the government to suspend the exemption of liquid nicotine from the list of controlled substances under the Poisons Act 1952.

They told Bernama the decision to refer the Bill to the Parliamentary Special Select Committee on Health must be followed up with urgent measures to protect the health of the community particularly children as currently there is no law in place to control the threat posed by electronic cigarettes or vape.

The Control of Smoking Products for Public Health Bill 2023 was tabled at the Dewan Rakyat for first reading by Health Minister Dr Zaliha Mustafa on Monday (June 12) but she later announced it will be referred to the Parliamentary Special Select Committee on Health for further scrutiny. The current meeting of the Dewan Rakyat, which started on May 22, ended yesterday.

In fact, some of the experts suggested that the meeting be extended by a few more days to enable the Bill concerned to be debated and passed immediately.

Said family medicine specialist Dr Suhazeli Abdullah: "There are no clear laws or regulations in this country governing the sale and purchase of vape and this is why we (health experts and NGOs) are hoping the (Control of Smoking Products for Public Health) the Bill will be passed (as soon as possible). According to a study done by MOH (Ministry of Health), the public is also hoping (for the Bill to be passed) but it has yet to become a reality.” In the wake of current developments, he and other experts are hoping the government will defer the exemption of liquid nicotine from the list of controlled substances pending the passage of the proposed Bill.

"The Bill has to be passed and the new law implemented, failing which the nation risks producing a (new) generation of nicotine addicts,” he told Bernama.

Dr Suhazeli, who has been vocal on social media on issues related to vaping, said the Bill may only be debated and passed at the next Dewan Rakyat meeting in October.

Until the new law is passed, the public will continue to be exposed to the health hazards posed by e-cigarettes or vape. Health director-general Datuk Dr Muhammad Radzi Abu Hassan told the media so far this month (June), MOH has received 17 cases related to e-cigarette or vaping product use-associated lung injury (EVALI), a severe pulmonary illness. In the United States, more than 2,800 people were hospitalised with EVALI in 2019 and early 2020, and at least 68 deaths were recorded.

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In Malaysia, the National Poison Centre recorded 77 poisoning cases due to nicotine exposure from e-cigarettes from 2015 till last year. This year alone, seven such cases were reported, five of them involving children.

Commenting on this, Dr Suhazeli said although vaping is relatively new compared to conventional smoking, studies on the use of vape products have already been carried out locally and overseas, with more and more of them showing evidence of their harmful effects. "It was reported recently that a 16-year-old girl with a three-year vaping history had died, with the probable cause of death being EVALI. "Imagine, within a period of (nearly) 10 years (since 2015 when vape products became available commercially in this country), a new disease EVALI has emerged. Vaping can cause damage to the lungs. This is an alarming situation and we don’t want this situation to worsen in the absence of proper control,” he said.

Although most of the current studies on vaping focus on its short-term impact on health as it only entered the global market in 2004, it will not be wrong to assume its effects will worsen with long-term use considering the chemical exposures that may result from vaping.

A 2021 US study titled "Characterising the Chemical Landscape in Commercial E-Cigarette Liquids and Aerosols by Liquid Chromatography-High-Resolution” found that e-cigarette aerosol contains over 2,000 types of chemical substances that may be hazardous to health. DUAL USERS Citing a US report titled "A Systematic Review of Health Effects of Electronic Cigarettes”, Dr Suhazeli said it is proven that the use of vape products can cause damage to human cells as well as various health complications due to the reactions from the mixture of chemical substances found in the vape liquids.

Vapers, he said, can also become highly addicted to nicotine, adding that earlier studies have shown that liquid nicotine dependence can be more serious than dependence on narcotics such as morphine and heroin.

Dr Suhazeli and other experts Bernama interviewed also dismissed claims by the vape industry that vaping is a better and safer way to help smokers quit smoking. The experts said that compared to conventional cigarettes, e-cigarettes, in fact, cause users to inhale a higher quantity of nicotine. Hence, vape users remain addicted to nicotine. Not only that, they end up becoming dual users, that is, they use both conventional cigarettes and e-cigarettes. A report by the US Department of Health and Human Services in 2020 showed the use of vape products did not prove effective in stopping the smoking habit. The World Health Organisation also came up with similar findings in 2021.

"Each (conventional) cigarette has an average of 10 to 12 milligrammes (mg) of nicotine. Every cigarette has a filter at its base so smokers get to inhale less than two mg (1.1 to 1.8 mg) of nicotine. But that amount is enough to cause nicotine addiction.

"When it comes to vaping, users inhale directly without any filter. Studies have found that 15 inhalations can cause a user to swallow as much as 15.4 mg of nicotine,” Dr Suhazeli pointed out.

He said the nicotine enters the lungs, seeps into the bloodstream and goes directly to the brain.

"Within 10 seconds, the effects of the nicotine kick in. Imagine what will happen if they vape dozens of times a day,” he added.

A user vaping 10 times a day will end up inhaling 154 mg of nicotine, seven times more than conventional smokers do.


Bernama also spoke to two youths who are nicotine addicts and get their "fix” from both conventional cigarettes and vape.

Razak Soleiman, 18, a student at a private institution of higher studies in the Klang Valley who has been vaping for four years, said when he runs short of pocket money he opts for conventional cigarettes as they are cheaper.

"We can get a vape for less than RM15 but it’s only sufficient for 800 inhalations. For addicts like me, we need more but refills can be expensive. I can buy a cigarette stick for 50 sen,” he said.

Nazim Ahmad, 27, who works in the private sector, said he has been smoking since he was in Form Two but later he also took up vaping as it was the trend among young people. He said he enjoyed conventional smoking more than vaping as it gave him more satisfaction, adding that he can finish a packet of 20 sticks of cigarettes in a day.

Meanwhile, Prof Dr Mohammad Haniki Nik Mohammed, who is head of the Sustainable SmokeFree Campus Community Flagship at the International Islamic University Malaysia, said the Malaysian government spent RM6.2 billion to treat patients suffering from smoking-related diseases in 2020. The amount is expected to rise to RM8.8 billion by 2030.

He also said vape industry players are making use of a 2015 report by Public Health England that vaping is 95 percent safer than smoking, adding that the narrative was not backed by scientific proof. "In fact, current studies have found that vape usage is not as safe as claimed by the industry,” he said. Translated by Rema Nambiar -- BERNAMA smoking, vape, Control of Smoking Products for Public Health Bill 2023, ministry of health, moh

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