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New e-inhalation products and potential health risks: The case for regulation

New e-inhalation products and potential health risks:
The case for regulation

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New e-inhalation products and potential health risks: The case for regulation

  1. 1. 10/25/2016 New e-inhalation products and potential health risks: The case for regulation Dr. Martina Pötschke-Langer, Dr. Katrin Schaller Unit of Cancer Prevention, WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ)
  2. 2. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Overview • The new growing market for electronic inhalation products • Potential health risks • The case for regulation
  3. 3. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Electronic inhalation products 1 2 3 4 5 6 Components of an e-cigarette 8 (1) (Rechargeable) battery (2) (Manual) switch (3) Vaporizer (4) Mouthpiece (5) Air-permeable insulating material (6) Heating coil (7) Wick (8) Liquid container 7
  4. 4. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products One way e-cigarettes http://www.riccardo-zigarette.de/Riccardo-Einwegzigarette:::91.html R200 TT one way e-cigarette http://www.ttzig.eu/index.php?page=shop.product_de tails&flypage=flypage.tpl&product_id=1&category_id= 1&vmcchk=1&option=com_virtuemart&Itemid=240 Electronic inhalation products
  5. 5. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Refillable e-cigarettes http://www.red-kiwi.de/products/e- zigarette-red-kiwi-es-504-t/ http://www.red-kiwi.de/products/e- zigarette-red-kiwi-rocket-ii-s-line/ red kiwi Rocket II S-Line red kiwi ES-504 T http://dampferins el.de/zubehoer/a kkus/444/ego- akku-650mah- strass?c=1238 e cig battery ego-k electronic http://www.dhgate.com/store/product/colourful- eGo Akku 650mAh Strass Electronic inhalation products
  6. 6. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products New e-cigarette for youth www.supersmokerbluetooth.de Electronic inhalation products
  7. 7. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products http://www.steamo.de/epipe/ http://www.besserdampfen.de/Akkutraeger/1507/Vision-E-Kross http://future-smoke.de/Omar- FARBEN-MOD-fuer-Ihre-E- Pfeife-FS852-und-FS852M http://future-smoke.de/12er-Pack-FS- Einwegzigarre-V2-FS-Cuban-18-mg http://www.123e-zigarette.de/E-Zigarre/Profi-e-Zigarette-Elektrische- Zigarre-E-Zigarre-mit-24-Depots-S::52.html Electronic inhalation products Pipes and cigars
  8. 8. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products www.kaya-shisha.de • Same principle as e-cigarettes • Sometimes different mouthpiece • 500 – 1500 puffs • Also as refillable pens http://www.wasserpfeife-shisha.comar http://www.shisha-dreams.de/E-Shisha/Shisha-EMPIRE-E- Shisha/Shisha-Empire-E-Shisha-nachfuellbar::2313.html Electronic inhalation products E-Shisha
  9. 9. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products • Mostly without nicotine • On the internet also availablbe with nicotine E-Shisha Electronic inhalation products http://www.hookah-shisha.com/p-13147-starbuzz-e-cig-tobacco-free-electronic-cigarette.html
  10. 10. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products http://www.stern.de/digital/homeentertainment/elektronisch-kiffen-vergessen-sie-die-e-zigarette-der-e-joint-ist-da-2119011.html E-Joint • No tobacco • No nicotine • No THC • E-Joints with cannabis concentrate announced by the manufacturer Electronic inhalation products
  11. 11. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Pack design– attractive to youth Liquids for e-inhalation products
  12. 12. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Huge range of flavours – attractive to youth Liquids for e-inhalation products Example: E-cigarette liquids http://www.riccardo-zigarette.de/Riccardo-Liquid:::73.html
  13. 13. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Huge range of flavours - attractive to youth http://shisha-swag.de/index.php?PHPSESSID=8cf6ac5577d0c9d29e4ad4c3b77a06f0 Liquids for e-inhalation products Example: E-shisha liquids
  14. 14. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Liquids Ingredients • Propylene glycol • Glycerol • Flavours • Nicotine http://flavourart.de/index.php Potential health risks
  15. 15. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Propylene glycol © Foto: Bundesamt für Gesundheit (BAG), CH Potential health risks • Authorized as ”E 1520“ for oral intake (food additive) and dermal application (cosmetic) in low dose • Inhalation: irritation of respiratory system • Unknown long-term effect (inhalation) Refs: Agency for Toxic Substances and Disease Registry (ATSDR) (1997) Toxicological Profile for Propylene Glycol; Moline JM et al.(2000) Health effects evaluation of theatrical smoke, haze and pyrotechnics, Report; Choi H et al., PLoS One 5: e13423; Bundesinstitut für Risikobewertung, Advisory opinion No. 016/2012 of 24 February 2012
  16. 16. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Glycerol • Authorized as food additive (humectant, stablilizing agent) • Unknown long-term effect of repeated inhalation Potential health risks
  17. 17. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Flavours • Some flavours are allergic (menthol, vanilline, eugenol, linalool, anis alcohol) • Unknown long-term effect of repeated inhalation © Fotos: Bundesamt für Gesundheit (BAG), Schweiz Hutzler C et al, Chemical hazards present in liquids and vapors of electronic cigarettes, Arch Toxicol, published online 11 june 2014 Potential health risks
  18. 18. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products • Formaldehyde • Acetaldehyde • Acroleine • Metals (nickel, chromium, lead) • Appear to be produced during heating Refs.: Trehy ML, et al., J Liquid Chrom Rel Tech, 2011. 34(14):1442-1458; Laugesen M Safety Report on the Ruyan® e-cigarette Cartridge and Inhaled Aerosol. 2008; Goniewicz ML, et al., Tob Control, 2013, in press ; Uchiyama S et al., J. Chromatography A, 2010. 1217(26):4383-4388; Sobczak A et al., Poster presented at the SRNT conference. 2013; Goniewicz ML et al., Poster presented at the SRNT conference. 2013.Williams M et al., PLoS One, 2013. 8(3):e57987; IARC. Agents Classified by the IARC Monographs, Volumes 1-107. 2013 last update: 10 April 2013;; DFG, MAK- und BAT-Werte-Liste 2008; Hutzler et al., 2014 Arch Toxikol published online Potential health risks Carcinogenic substances in vapour
  19. 19. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Nicotine • Toxic • Harms the unborn • Tumor promoting • Possibly carcinogenic • Addictive Grando SA , Connections of nicotine to cancer Nat Recv Cancer 2014, published online 15 May 2014 Counotte DS et al, The yin and yang of nicotine: harmful during development, beneficial in adult patient populations FrontPharmacol 2012 (3): 180. doi: 10.3389/fphar.2012.00180 Benowitz NL, Clinical pharmacology of nicotine Clin Pharmacol Ther 2008 (83/4):531-541 Potential health risks
  20. 20. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Emissions • Nicotine • Particles (PM2,5) • Flavours • Carcinogens • Much less than in secondhand cigarette smoke • Nevertheless impairs the air (carcinogens! particles!) © Fotos: Bundesamt für Gesundheit (BAG), Schweiz Schober W et al, Use of e-cigarettes impairs indoor air quality and increases FeNO levels of e-cigarette consumers, Int J Hyg Environ Health 2014, Feb 27; Schripp T et al. Does e-cigarette consumption cause passive vaping Indoor Air 2013; 23: 25–31; Hutzler C et al, Chemical hazards present in liquids and vapors of electronic cigarettes Arch Toxicol, pubished online 11 june 2014 Potential health risks
  21. 21. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Intoxication Potential health risks • Increasing reports on intoxication of children • Symptoms are mild and transient – so far • Risk of overdosing (too many puffs, too deep inhalation) Cantrell FL, Adverse effects of e-cigarette exposures J Community Health: published online 15 Dec 2013; Ordonez J et al., Electronic cigarette exposures reported to poison centers, Meeting Abstract 242. Clin Toxicol 51:685–685; Hua M et al., Health-Related Effects Reported by Electronic Cigarette Users in Online Forums, J Med Internet Res (2013)15:e59
  22. 22. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Directive 40/2014/EU Directive 40/2014/EUNot included Not included Not included Not included Regulation by and beyond directive 2014/40/EU
  23. 23. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Regulation by directive 40/2014/EU Proposal leaflet + package! • Helvetica, black, 9 Point • Hazard symbols Directive 2014/40/EU, article 20 electronic cigarettes (4) Member States shall ensure that a) unit packets of electronic cigarettes and refill containers include a leaflet with information on:
  24. 24. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products www.easysmokers.ch Directive 2014/40/EU, article 20 electronic cigarettes 3 g) electronic cigarettes and refill containers are child- and tamper-proof, are protected against breakage and leakage and have a mechanism that ensures refilling without leakage Regulation by directive 40/2014/EU Proposal Only pre-filled containers that can‘t be opened (such as ink cartridges)
  25. 25. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Proposal A precise list of banned additives (according to art.7(6)) • Vitamins/ additives implicating health benefits: fruit flavours • Flavours associated with energy and vitality: green tea, coffee, energy, etc. • Additives that facilitate inhalation or nicotine uptake: Menthol. It can be assumed that the physiological effects of menthol are the same for e-cigarette use as for tobacco cigarettes. www.germanflavours.de Directive 2014/40/EU, article 20 electronic cigarettes 3 c) the nicotine-containing liquid does not contain additives listed in Article 7(6) Regulation by directive 40/2014/EU
  26. 26. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Regulation beyond directive 2014/40/EU Objective Protection against health hazards of inhalation of the chemical mixture of electronic inhalation products Proposal Sales ban to minors (<18 years) Protection of youth
  27. 27. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Proposal • Standardised packaging • Standardised product design • Ban of flavours that are attractive to youth Objective Protection against new lifestyle products that may facilitate initiation to nicotine and tobacco products http://www.supersmokerbluetooth.de Protection of youth Regulation beyond directive 2014/40/EU www.happy-liquid.com, www.flavourart.nl
  28. 28. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Proposal • Ban of e-cigarette use in non-smoking areas Objective • Protection against indoor air pollution • Prevention of the renormalisation of smoking Regulation beyond directive 2014/40/EU Protection against emissions
  29. 29. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Objective • No hazardous waste • Promotion of recycling Proposal • Obligation to repurchase • Special tax for the environment (?) Regulation beyond directive 2014/40/EU Protection of the evironment
  30. 30. 18.07.2014| Dr. M. Pötschke-Langer New e-inhalation products Directive 40/2014/EU Directive 40/2014/EUNot included Not included Not included Not included Regulation by and beyond directive 2014/40/EU

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New e-inhalation products and potential health risks: The case for regulation

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