A recent UNODC report shows that e-cigarettes are used to deliver an increasingly large number of illicit drugs. —The Star
TOBACCO companies and their front groups make an offer too good to be true: if you cannot quit smoking, you can shift to this “less harmful” product – electronic cigarettes – and still get the same buzz, “calmness” or feeling of “reward” or “contentment” that nicotine brings through its actions on your brain.
But tobacco companies have a long history of deception.
Touted by the industry as tools for tobacco “harm reduction”, e-cigarettes can actually carry the amount of nicotine in 40 conventional cigarettes, based on studies by the Australian government. And unlike conventional cigarettes, these products can be consumed continuously and on demand, without signal or prompt for the user to ever stop. While individual cigarettes are consumed in as little as a few minutes (10-15 puffs per cigarette), it is not uncommon for teens to take a few days or mere hours to consume an e-cigarette pod that provides 10,000-15,000 puffs.
E-cigarettes represent unfettered access to addictive nicotine whose harshness is masked by a diversity of flavours. Furthermore, experience in New Zealand, the United States, and Australia shows that a significant fraction of e-cigarettes often have higher nicotine levels than what is declared on the product label.
These intrinsic factors that increase attractiveness, addictiveness, and toxicity are undesirable attributes of any harm reduction tool. These changes make e-cigarette consumption more difficult to control, prolong a person’s exposure to the hazards of nicotine, and reduce the product’s viability as a legitimate harm reduction option.
In a Johns Hopkins University study on online marketing of e-cigarettes in the Philippines, common themes of their marketing are relative safety (“95% less harmful”), innovation, and luxury. What stands out, however, is the industry’s heavy use of flavours in promoting these products.
Flavours promoted include mint/menthol, sweet/fruity flavors, tobacco, and concept descriptors (“Island Breeze”/”Ocean Rush”/”Winter Splash”) – flavours that strongly appeal to younger demographics. Advertising imagery and promotion and marketing materials of e-cigarettes also portray these products as stylish, tasteful, sexy and fresh, and advertised through product placements on film, television, and serialised entertainment media.
The tobacco industry in the United States has been successfully litigated for targeting children and teens with e-cigarette advertising. While we’re unaware of similar cases being filed in the Asia Pacific, experience in Philippines and Vietnam shows that these products are pushed by the tobacco industry especially at times when laws on product communications are underdeveloped and regulations are weakly enforced.
In online spaces like TikTok and Instagram where advertising restrictions are difficult to enforce, regional influencer networks engage with each other, propelling a wider variety of e-cigarette content onto a broader, more global audience than their usual demographic as individual creators. In a separate analysis of e-cigarette content on YouTube and Instagram, the vast majority of online conversations promote use of e-cigarettes, and there is very little room for discussion on harm or even the lack of age restrictions to access these products.
This level of interference presents a clear and present danger; as the tobacco industry erodes e-cigarette regulations across different countries, other bad actors profit by lacing these products with illegal, highly addictive substances like “spice” (synthetic cannabinoids; found in 1 in 4 vapes sold to students in the UK), etomidate (responsible for at least one teen death in Hong Kong) and cannabis (intercepted as Cannabis vape carts in the Philippines).
A recent UNODC report shows that e-cigarettes are used to deliver an increasingly large number of illicit drugs, and Singapore has moved to approach its e-cigarette problem as a drug problem, instead of a tobacco issue.
Universiti Sains Malaysia’s National Poison Centre (PRN) has reported a sharp rise in vape-related poisonings, with 81% involving psilocybin (“magic mushroom”) vapes, mostly used by teenagers and young adults which often contain dangerous synthetic drugs rather than psilocybin.
These products can trigger seizures, hallucinations, vomiting, neurotoxicity, disruptive impulse control and behavioural changes after just one or two puffs. Between 2020 and 2024, the PRN recorded 76 suspected illicit vape exposure cases, with such products accounting for 65% of cases in 2022, 79% in 2023, and 68% so far in 2024.
The PRN also recorded 40 cases of nicotine poisoning of children aged five years and below between 2015 and 2023 The cases of poisoning are becoming more frequent. The harm and problems associated with nicotine and e-cigarettes are piling up. This is not harm reduction but harm introduction.
Malaysian’s Health Ministry has announced there will be a ban on e-cigarettes; however, for now the ban on these harmful products have been relegated to the state level where enforcement is difficult.
It remains to be seen how Malaysia will recover its public health gains as it joins the eleventh Session of the Conference of the Parties (COP11) to the WHO Framework Convention on Tobacco Control (FCTC) in Geneva, Switzerland, from Nov 17 to Nov 22.
As a Bureau Member to the COP, Malaysia has an opportunity to provide leadership and demonstrate it will take the highest standard to curb a problem that has ballooned into a youth scourge in every country that legalised e-cigarettes.
Regulations have not caught up, and the tobacco industry continues to interfere in e-cigarette regulations as tenaciously as it does with global tobacco control. Just recently, WHO and the Convention Secretariat warned all Parties to the WHO FCTC, about how the tobacco industry continues to promote electronic smoking devices as less risky alternatives. As expected, the tobacco industry disingenuously appropriates the concept of “harm reduction” in the process of promoting its newer but still harmful products.
This confluence of product, marketing and promotion, and regulatory factors conspire to create an environment where youth are uniquely susceptible to being recruited into a lifetime of nicotine addiction through electronic cigarettes. As such, it is even more important now, at COP11 for all Parties, to embrace a culture of transparency.
As Parties to the WHO FCTC work towards the tobacco endgame, governments should ensure that their obligations under the WHO FCTC are clearly aimed at reducing nicotine addiction; focus should shift from controlling the harms of recreational nicotine products to phasing out and eliminating these products and the industry that produces them.
Recently the Maldives announced endgame law to protect their children and youth. Children born from January 2007 will not be able to purchase e-cigarettes.
Parties owe it to today’s youth to consider generational endgame strategies, phasing out of current tobacco products, including electronic smoking devices, and other more effective strategies that do more than preserve the tobacco industry’s bottom line.
Liza Ali is president of the Malaysian Women’s Action for Tobacco Control and Health (MyWATCH), an NGO advocating tobacco control measures contained in the WHO Framework Convention on Tobacco Control (FCTC). Dr Ulysses Dorotheo is executive director of SEATCA, a multi-sectoral non-governmental alliance promoting health and saving lives by assisting Asean countries to accelerate and effectively implement the WHO FCTC.
