Two recent media reports highlighted the dangers posed by novel nicotine delivery devices like vapes and liquid nicotine pouches. Last month, the Bombay High Court ruled that duty-free shops operating at the international departure or arrival areas of Indian airports cannot sell imported nicotine pouches which are banned under the Indian law. The court said that duty-free shops are not exempt from domestic health regulations even if they are freed from the taxes levied in the domestic markets of India.
Those who mounted a legal challenge to the government regulation sold imported nicotine pouch brands without holding the required import licences. The court rejected the petitioners’ plea that duty-free shops operate beyond the Indian customs barriers and, hence, were governed by Indian laws. That was a strange argument, in any case. If a traveller assaults an employee of the duty-free shop or even another shopper, would the Indian laws not apply?
The Indian government has banned the sale of electronic cigarettes, liquid nicotine vaporisers (vapes) and nicotine pouches for good reason. Nicotine is a highly addictive chemical, with several harmful health effects. It is considered to be as addictive as heroin and cocaine, by the World Health Organization (WHO), the American Psychiatric Association and the US surgeon general. On entering the blood stream via the lungs (vaping) or sub-lingual absorption, nicotine quickly activates brain receptors which trigger pleasure and reinforcement responses. The addictive effect is even stronger in the developing brains of children and adolescents, where even brief experimentation can entrap them in a deadly habit.
A nicotine pouch mainly contains nicotine, water, flavourings, sweeteners and plant-based fibres. As they come in various dosages, some have more nicotine than others. While the intent of the original developers of these products were to aid tobacco cessation, tobacco industry majors have acquired most of these companies. They wish to profit from a diversity of smoked and non-smoked nicotine-containing products to benefit from the addictions of smokers as well as non-smokers.
Indeed, the tobacco industry is as adept at coming up with variations in its products as the Covid-19 virus was in creating new variants. Earlier versions of modified cigarettes were presented as ‘low tar, low nicotine’ cigarettes and sold as ‘Milds’. Studies showed that the health effects continued to be as bad because smokers addicted to nicotine simply smoked more of them.
While the global public health community was united in their battle against smoking of tobacco leaf products, it became divided in the case of novel nicotine delivery products. A section argued that since there was no combustion and harmful particulate matter (PM 2.5), nitrosamines and carbon monoxide did not enter the body through smoked tobacco products, the nicotine delivery diseases did not pose the risk of cancer or cardiovascular disease. They argued that as nicotine satisfied the smoker’s craving without the harmful chemical add-ons from tobacco leaf, nicotine delivery devices should be regarded as ‘harm reduction’ products that would promote smoking cessation.
Public health agencies in the UK, Australia, New Zealand and some other countries accepted that argument. Recently, these countries have woken up to the dangers of youth addiction to vaping and the alluring marketing tactics of the marketing industry. These governments are now attempting to regulate against the addition of flavouring agents and sale to minors.
Many other public experts around the world, including a majority in India, did not buy that argument. Apart from the highly addictive nature of tobacco, nicotine is classified as a poison in pharmacology. It is used as a pesticide in agriculture. It can be lethal to humans in high doses. Children who accidentally consumed the nicotine that was stored at home by adult smokers of e-cigarettes, have died.
Nicotine harms the heart and blood vessels in many ways. It is a potent constructor of blood vessels. Among its immediate effects after ingestion or inhalation, consumption races the heart rate and raises the blood pressure. It can precipitate brain strokes and heart attacks. Research also shows that nicotine use correlates with lower sperm count, reduced sperm motility, impaired shape and increased DNA damage.
It is also not true that ‘nicotine-only’ products will free smokers from the risk of cancer. Recent studies have shown that nicotine can affect several important steps in the development of cancer, and suggest that it may cause aggravation and recurrence of the disease. Major cancer-causing chemical compounds such as tobacco-specific nitrosamines may be formed from nicotine in the body. A report from the National Institutes of Health in the US pointed to the “toxicological effects on tumour cell growth, angiogenesis , and malignancy”. It concluded “effects on cancer disease are important aspects in the evaluation of possible long-term effects from sources of nicotine, such as e-cigarettes and products for nicotine replacement therapy, which both have a potential for life-long use”.
The Indian Council of Medical Research, too, has recently released a report highlighting the health hazards of unregulated nicotine consumption.
Non-smokers are attracted to this allure of false claims of pleasure without penalties and are trapped into addictive behaviours. A recent BBC report cited recent data released by the UK Office for National Statistics revealing that there are more than 10 lakh people in the country who have never smoked but have taken up vaping.
The WHO’s globally-adopted Framework Convention on Tobacco Control has strong provisions to curb the use of tobacco leaf products but none to counter the threat of nicotine in its pure chemical form. The Pacific island nation of Palau has now petitioned the UN General Assembly to direct the conduct of a scientific study of the health harms of nicotine, so that national regulators are strengthened in their efforts to regulate the marketing of nicotine release products. India too should support that initiative.
K Srinath Reddy | Chancellor, PHFI University of Public Health Sciences; and Chair, Centre for Universal Health Assurance, Indian School of Public Policy
(Views are personal)
(ksrinath.reddy@phfi.org)
