Three years of vape ban: Experts say the move does more harm than good for smokers trying to quit

The Indian government, in September 2019, passed an act prohibiting the production and sale of electronic cigarettes, which also includes all forms of Electronic Nicotine Delivery Systems (ENDS) such as vapes or vape pens. According to the US Food and Drug Administration, these devices usually contain e-liquid--made of nicotine derived from tobacco, propylene glycol, vegetable glycerin, and other flavourings - which is heated to create an aerosol that the user inhales.

While vaping has been illegal in the country for three years now, it is not uncommon to spot youngsters vaping in public spaces in Indian metro cities. Data from Statista.com shows that during the period of 2014 and 2019, there was a consistent rise in electronic cigarettes and vape sales volume in India with over three million units in the year the products were banned. Moreover, various market reports predict the increasing use of e-cigarettes among urban Indian youth through devices that are easily available online.

According to the World Health Organisation, tobacco use accounts for 1.3 million deaths in India and bidi, cigarette and hookah are the major prevalent forms of consuming nicotine in the smoke form. While the economic costs of tobacco use is over Rs. 177 341 crore as of 2018, the production and sale of these products continue with little restrictions.

Samrat Chowdhery, president of Association of Vapers India (AVI) - a group of ex-smokers who have successfully transitioned to vaping, is of the view that cigarettes are actually lot more addictive and the cigarette companies are making a product, which will end up becoming highly addictive over the years. Moreover, the vape ban is creating a bigger problem in discouraging smokers to switch to an alternative to reduce their nicotine intake.

Restricts the number of accessible options to quit

For Chowdhery, switching to vapes in 2013 helped him cut down on his addiction to cigarette smoking and in fact, brought a positive impact on his life. "I tried nicotine gums, quitting therapies and other medicines, which affected my ability to function normally. Like many other ex-smokers and vape users, it's my personal experience and cannot be negated," he adds.

Vapes are largely marketed to be an alternative for those addicted to cigarette smoking and are trying to quit. When it comes to tackling tobacco or nicotine addiction, health experts appear to be divided over the theory that vapes are safer than cigarettes and highlight that it can have its own health hazards.

In tune with what Chowdhery explains, Dr Sonam Solanki, consultant pulmonologist and bronchoscopist, Masina Hospital states one could say that "vapes would be the lesser of two evils". She explains that e-cigarettes were designed to help patients who were already dependent on cigarette smoke to get them off the smoke and other known carcinogens to just nicotine (an addictive substance). The electronic device would help patients gradually taper down their dose of nicotine and get off that as well, which can also lead to accidental quitting.

When asked about methods of cessation, Dr Kedar Tilwe, consultant psychiatrist, Fortis Hospital Mulund, says it is possible to abstain from tobacco at once, but it requires the willpower and motivation of the patient to quit smoking. While adjunct medicines help in reducing cravings, Nicotine Replacement Therapy (NRT) and supportive Cognitive Behavioural Therapy and motivational enhancement therapy also help in the process.

"People tend to prefer gradual reduction with the help of nicotine replacement therapy. But highly motivated individuals do tend to respond to immediate cessation of tobacco use and also respond better to alternative treatment options," he adds.

When it comes to quitting, for those with a heavy addiction to cigarettes, there are NRT gums and patches in India promoted by the health ministry and are manufactured by different brands. These are basically low nicotine products which help in fighting cravings and easing nicotine withdrawal symptoms. While these products were recently categorised as essential medicines by the Centre, these products are priced at anywhere between Rs 300 and Rs 1000 or more depending on the brand and duration of use.

According to Chowdhery, while there are quit-therapies, it is not possible for a person smoking Rs 10 gold flake cigarette to afford a full-course of NRTs. Moreover, these are also products with low amounts of nicotine in them, similar to vapes, which also allow one to control their nicotine intake and are accessible. With a blanket ban on a device, which is largely used by people who are trying to quit, AVI says the government is restricting people's options to quit.

"Especially, when you do not have the infrastructure and the money to provide healthcare or support to smokers, then the least you could have done is to at least give them an option to transition to something less harmful," he adds.

‘Need for regulation'

Data from ‘India E-Cigarette Market Research Report 2019' shows that India has over 0.3 million vapers and this number is projected to reach 0.6 million by 2024, indicating a massive shift toward e-cigarettes from conventional tobacco products. At a time when youngsters are finding technological e-cigarette devices innovative and attractive, there are higher chances of them trying these products.

Vapes are available online and from different dealers in the cities in different flavours such as mango, mint, strawberry and watermelon among others. Experts are of the view that due to its illegal nature, there is now no check on the products entering the market and the ingredients used in making them. In such a situation it is unclear whether the constituents are toxic or not.

Dr Solanki says, "We would need years of data on the carcinogenic properties of the aerosols from the vapes. So far, we don't have such data. Each flavour is essentially a different chemical. Sweet and cinnamon flavours have been associated with diacetyl, and cherry flavour has been associated with benzaldehyde; both are irritants to the lungs. Chemical-induced lung injury is known to occur."

Chowdhery highlights three major drawbacks of a complete ban on vaping products, which now flourish in the black market. While before the prohibition, vendors had their own system in place to check the quality and delivery of products, the ban has lifted off the vendors of a responsibility to maintain the same.

This has encouraged the use of these products by teens too, as there is no method of age-confirmation during the sale, which has limited the scope to protect minors from nicotine intake. "So you have in fact, ended up increasing population level risk and have ended up creating attractiveness around these products among the youth with no correct information," he adds.

While countries in the European Union and China have detailed regulations in place when it comes to licensing, manufacturing and sale of e-cigarettes to ensure quality and safety standards, Indians are devoid of these checks and balances. "What we need is a good product-regulation in place to avoid the harm. If such regulations could be adopted, instead of a ban, the products would have gone through a certain level of standard checks, but now that's not happening," says Chowdhery.

(Disclaimer: This article is not intended as a substitute for professional medical advice, diagnosis or treatment. Mid-day Online does not in any way endorse the accuracy, completeness, efficacy or timeliness of any advice or line of treatment mentioned in this article. Readers must always seek the advice of a certified medical practitioner and/or a mental health professional before deciding on or starting any course of treatment.)

Also read: Getting poor sleep may have more impact on lung disease than smoking: Study