May 14th, 2016

Who cares about a few thousand dead? Defending EU limits on the strength of nicotine e-liquids

graveyard

Not that many dead – what’s all the fuss about…?

Updated 16 May 2016

Apparently, there are still people in public health trying to defend the EU Tobacco Products Directive as it applies to vaping! It’s a ludicrous measure, that protects the cigarette trade, has costs and risks that vastly outweigh the non-existent benefits. ASH (London) appears relaxed about the nicotine strength limit: New EU rules on nicotine strength not a problem for most vapers it declares this morning (16 May 2016).

ASH claims that because ‘only’ nine percent of current vapers use liquids over the limit set by the EU Tobacco Products Directive, concerns raised in Parliament (Lords debatePrime Minister’s Questions) are unjustified:

Concerns raised in Parliament [4] about the EU rules are not borne out by the ASH Smokefree GB Adult Survey. Only 9% of vapers report using e-liquid containing 19mg/ml or more of nicotine (the limit set by the EU Tobacco Products Directive is 20mg/ml).

Or maybe Parliament is right and ASH is wrong…? How might one respond to this defence of the indefensible? 

Further to the New Nicotine Alliance letter to the government calling for a focus on multiple unintended consequences of this policy car crash, this is a good moment to analyse the completely pointless and damaging restriction on nicotine liquid strengths to 20mg/ml.

Five ways in which the 20mg/ml nicotine strength limit will cause harm

1. Nine percent of a big number is a still a big number

There are about 2.2 million vapers in Britain (ONS), so nine percent of them amounts to about 200,000 vapers affected.  It doesn’t need too many of these to relapse to smoking or stay as ‘dual users’ rather than going on to quit smoking for the toll of harm to be very high. What advice do those calling for complacency about the Directive have to address the concerns of this ex-smoker and current vaper, for example?

Click for this tweet on twitter

And the answer is…?

Big numbers are in fact a lot of individual stories of triumph and adversity – and it is what regulation does to individuals that we should care about.  In the section below, I have put together a “Desk-murder calculator” so we can try out a few assumptions and see what sort of impact might have on those affected with some more precise numbers.

I don’t want to sound alarmist calling it “desk murder”: but if a bureaucrat, politician or activist presses for a measure and people’s lives are ended prematurely as a result through a foreseeable causal mechanism for which there are no compensating benefits, then what else should one call it? Desk-manslaughter m’lord?

2. Counting the vapers but think of the smokers

It’s not only the nine percent of current vapers (2.2m) who should concern us as above. It is also the current smokers who don’t vape (7.5m of 8.8m smokers – ONS) who we should be concerned about. Perhaps it is the ones who have tried e-cigs but gone back to smoking that we should be most bothered about.

There was a paper out last week that made a relevant point – vaping isn’t yet working for most smokers. So we have to ask, how does throttling the nicotine delivery help?

Pechacek TF, Nayak P, Gregory KR, et al. The Potential That Electronic Nicotine Delivery Systems Can be a Disruptive Technology: Results From a National Survey. Nicotine Tob Res Published Online First: 3 May 2016. [link]

Conclusions
Since many current smokers who have tried ENDS reject them as a satisfying alternative to regular cigarettes, ENDS will not replace regular cigarettes unless they improve.

Implications
Since about one-half of recent former smokers are trying ENDS with about one-fourth continuing to use them, and many reporting that these products have helped them quit regular cigarettes, the potential impact of ENDS on population quit rates deserves continued surveillance. However, since most current smokers who have tried ENDS reject them as a satisfying alternative to regular cigarettes, the potential of ENDS becoming a disruptive technology replacing regular cigarettes remains uncertain. ENDS need to improve as a satisfying alternative or the attractiveness and appeal of the regular cigarette must be degraded to increase the potential of ENDS replacing regular cigarettes.

How does insisting It’s likely that the continuing smokers or people who have tried vaping and gone back to smoking will be attracted into vaping by four things:

  • good quality vaping devices or better than they tried first time (these may already exist for many smokers put off by 1st and 2nd gen devices)
  • stronger liquids that replace more of the nicotine lost from smoking – especially while learning
  • the ease of use and familiarisation
  • a better understanding of the benefits

So perhaps some smokers who tried vaping but went back to smoking used a poor device (e.g. bought from a supermarket) or just couldn’t get it to work or were put off by deceitful public health propaganda.  Next time they try, they might find they are held back by the liquid strength.

3. Blocking the transition pathway from smoking to vaping

If you just look at the stock of vapers, you may be missing something important about the flow of switchers from smoking to vaping, and that is that to get over the learning hurdle and initial unfamiliarity. Most smokers use stronger liquids when they first switch to vaping then reduce later.  If you just count the ‘stock’ of vapers, you are missing the impact of this limit on the ‘flow’ from smoking to vaping. That matters a lot. Some evidence….

Farsalinos KE, Romagna G, Tsiapras D, et al. Characteristics, Perceived Side Effects and Benefits of Electronic Cigarette Use: A Worldwide Survey of More than 19,000 Consumers. Int J Environ Res Public Health 2014;11:4356–73. [link]

Both former and current smokers initiated EC [e-cigarette] use with high nicotine-containing liquids. More than one-fifth of the population initiated use with more than 20 mg/mL nicotine concentration, with higher prevalence in former smokers, supporting the hypothesis that nicotine plays an important role in the success of ECs as smoking substitutes

Farsalinos KE, Romagna G, Tsiapras D, et al. Evaluating nicotine levels selection and patterns of electronic cigarette use in a group of ‘vapers’ who had achieved complete substitution of smoking. Subst Abus Res Treat 2013;7:139–46 [link]

During initiation and smoking cessation – users rely on stronger liquids

Based on these observations, the authors conclude:

Conclusions
In conclusion, high nicotine-containing liquids are probably essential for initiating and maintaining smoking abstinence in a group of motivated vapers. Although less dependence was reported relative to smoking, prevalence of nicotine use was high even after several months of EC use. Public health authorities should consider the evidence from this and other studies that ECs are used as long-term substitutes to smoking by motivated exsmokers and should adjust their regulatory decisions in a way that would not restrict the availability of nicotine-containing liquids for this population

4. Coping responses to the Directive may push higher strength liquids

Smaller tank sizes encourage stronger liquids.  The forthcoming and completely pointless EU limit of 2ml on the size of a tank may reverse the gradual trend to consumption of weaker liquids but higher volumes. It may be that more consumers will prefer to have a day supply of nicotine in the smaller tank, rather than fuss around with refills while out and about.

The burden of regulation may push more DIY. Because of immensely burdensome paperwork obligations of the directive, it is possible that the e-liquid market will cleave in two. There will be a few relatively simple regulated unflavoured nicotine liquids falling under the TPD, with a much larger range of non-nicotine flavoured liquids that fall outside the scope of the directive. Users will mix them post-sale. Users will wish to have access to strong nicotine bases that they can dilute with flavoured non-nicotine liquid. If they can’t get these they will access the products cross-border for example via the internet from China. This is extremely easy to do: see Regulators and the compliance fallacy – buying 99% nicotine e-liquid from China

5. 20mg/ml is a barrier to innovation

The wholly pointless restriction to 20mg/ml closes down possible options for innovation – some of which may be valuable for safety reasons or improving appeal. By its nature, we don’t know what future innovation might be, but stronger liquids could be used in miniaturisation, in systems for varying the strength without changing liquids, in lowering energy consumption, in providing customised products for more nicotine-dependent smokers, or for relapse prevention. The products of the future will reach further into the population of smokers because their appeal – part of which is nicotine pharmacokinetics – will improve through innovation.

Desk-murder calculator

I’ve pulled together a tool for rough modelling of the scale of these effects.  It relies on a couple of assumptions, which can only be guesswork – so they are better understood as “what-ifs” scenarios, not predictions that give us a sense of what might be at stake. Assumptions are:

  1. What proportion of vapers currently using over the EU limit will relapse back to smoking or not continue from dual use to exclusive vaping? For illustrative purposes, I have assumed 1 in 10, and, therefore,  9 out of 10 will find some way to cope or adjust.
  2. What proportion of smokers would not find their way through a transition from smoking to vaping because of this threshold (this is a compounding of three fractions: the proportion who will try, the proportion would use > 20mg/ml, and the proportion of these who don’t make the transition because of the EU limit). For illustrative purposes, I have assumed 1 in 500 smokers.
  3. Data from ONS and other assumptions borrowed from Department of Health [commentary on these here and here respectively]. I’ve assumed that the health cost of a relapse or failure to quit is the same value, but negative, that the Department of Health places on a successful quit.

Here’s how the numbers play out…

Screen Shot 2016-05-15 at 06.15.05

To summarise, on these assumptions the impact of limiting the strength of nicotine liquids to 20mg/ml will approximately be:

  • 35,000 people harmed
  • 42,000 years of life lost, equivalent to the loss of life you’d achieve from killing about 1,000 people of UK average age
  • Social cost (economic value of lost life) of about £2.5 billion

Just another busy day at the office in public health!

In a sane world, these costs would be entered in the Department of Health’s Impact Assessment and the measure declared unlawful and withdrawn immediately.

Of course, I don’t know if these assumptions are right – but does anyone in public health know any better or believe these assumptions should be set to ‘zero’? The point is that these small numbers, like 9%, turn out to cause huge impacts under reasonable-sounding assumptions. And with this handy tool, anyone can enter their own estimates of how much harm they are defending.

If you want to play with the spreadsheet – it is available here in Google Sheets. You can copy it or download to Excel (and other formats) via File > Download as> Microsoft Excel (.xlsx). Note now updated to allow input of benefits – see below.

Concerns raised in Parliament went far beyond the strength limits

The debate in Parliament was wide-ranging – see Hansard for the transcript and covered far more territory than the strength and containers size limits.  Condensed write up by Dick Puddlecote here: The Lords realise it’s not about health.  The only good thing about the EU directive is that it isn’t as bad as the FDA.

The right question is…

The right question is “what is this nicotine limit supposed to achieve?”. No-one has any idea, the justifications for it have been endlessly dismissed by experts, and no-one with any credibility should still be defending it.

Adding ‘benefits’ to the desk-murder calculator

In the comments, Gummy Bear rightly complains there is no ‘benefits’ section in the desk-murder calculator. I have taken the challenge head-on and added this I just haven’t filled in the data but others – ASH perhaps – can do that if they wish. I have no idea what assumptions to make about benefits – zero being the most generous as I suspect that even where benefits are hoped for, things will actually get worse.

Screen Shot 2016-05-15 at 11.54.48 Even for these purported benefits, it is quite possible that they would end up negative, as compensating behaviour would turn a hoped-for benefit into unintended harmful consequences.

The right answer is…

The risk from this pointless limit on nicotine strength is more vapers relapse back to smoking and fewer smokers will quit by switching to vaping.  But all this harmful meddling can be entirely avoided by scrapping the limit and not messing with the efforts and choices of thousands of people as they go about quitting smoking, or simply doing what they choose to do.

Why is the European Union, aided and abetted by the British government and a medicine regulator, blocking an adult free exchange between a willing buyer and willing seller that harms no-one else? Leave aside the illustrative calculation of harm to health, a gratuitous and pointless denial of free choice is a wider and more insidious harm.

Other writing on this

47 comments to Who cares about a few thousand dead? Defending EU limits on the strength of nicotine e-liquids

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  • […] becomes law on Friday, is “not a problem” for most vapers. It’s now clear that the hard-hitting post Clive Bates made a couple of days ago was in fact a blast at his former organisation, and I have to […]

  • […] Bates has just written an excellent post about the stupidity of those in “public health” who stubbornly insist on supporting the […]

  • […] Clive Bates: Who cares about a few thousand dead? Defending EU limits on strength of nicotine e-liquids http://www.clivebates.com/?p=4056 […]

  • William

    Early Day Motions are useless, as they have no legal binding whatever. It can also backfire on a MP, if the suggestion later is found out to be a bad idea. Forget about asking your MP to support EDM 1441.

    On the other hand, bombard the HOL with requests to support Lord Callanan’s motion when it comes up for discussion in early June.

  • Seb Thirlway

    Clive,

    Thank you for your continued hard work exposing all the junk science and nonsense.

    Please publicise the latest UK development today: Lord Callanan’s proposed amendment to the SI which implemented the TPD.

    https://www.planetofthevapes.co.uk/news/politics-campaigns/2016-05-19_breaking-news-house-of-lords-vote-could-defeat-uk-tpd.html

    Could this be a chance to derail the TPD, if only in the UK? Only if everyone contacts Lord Callanan (and any other members of the HoL they may have a connection with) expressing strong support!

    The only Commons activity I can find is an Early Day Motion (no. 1441), which has only attracted 9 signatures so far. Writing to your MP (as well as to Lord Callanan, of course) urging them to sign it can’t hurt!

  • Chris Price

    Clive – “Look at the new ASH briefing on vaping at figure 11 and 12 and be shocked how many smokers think the damaging agent is nicotine.”

    It’s not just the public: a survey of British and Swedish doctors found that 44% of the British doctors believed nicotine is associated with cancer; and an even greater number thought nicotine was one of the more harmful compounds in cigarette smoke.

    With doctors relying on propaganda for their information, medical negligence or malpractice is assured, and stone age medicine has a good future here. We can probably thank the BMA for some of that.

    • Jonathan Bagley

      Haven’t there been recent papers claiming nicotine causes cancer? Here for example
      http://www.nature.com/news/e-cigarettes-affect-cells-1.15015

      Maybe that’s not what the paper is claiming, but it’s the message the casual reader of press reports will take away.

      That they appeared as vaping became popular and not during the previous two decades of nicotine patches, inhalers and gum is surely not a coincidence.

      • Chris Price

        Yes indeed.

        Luckily, NICE have found it difficult to lie, and clearly state that nicotine has no association with cancer: see NICE PH45.

        Your guess is as good as mine on whether we would see that advice if it didn’t also benefit pharma. Probably not.

  • GE

    Clive
    I agree with what you say. However, it is my opinion that the nicotine limit, etc will have & has had an even greater impact. This limit is a reflection of what the lay person beliefs is damaging about smoking from ignorance & propaganda. Thus, the figure of 9% vapers using above 20mg \ 1ml is due largely in my opinion to the conflation between nicotine & smoking. I believe a lot more vapers would be using higher strengths if they new this would stop them smoking – would reduce number of dual users as well as those successfully switching. You are talking many thousands/ millions dead eventually as a result of the ‘nicotine fallacy’.

    • Clive Bates

      That’s a very good point. This is the time to be breaking apart the misguided conflation between the drug nicotine and the harms of smoking, not adding to it.

      Look at the new ASH briefing on vaping at figure 11 and 12 and be shocked how many smokers think the damaging agent is nicotine.

      • Chris Robinson

        I’m even more shocked at how many vapers think nicotine is the damaging agent. I blame the junk science and media reports. I’m fully aware that here in Australia the figures for smokers will be worse, but I expect our vapers are probably better informed because we have to do some research to even buy the things.

      • Guy Eaton

        Thanks Clive – yes, this conflation arising from ingnorance & deliberate attempts to mislead is one of the major problems in this debate. The propaganda that it is the nicotine that is bad for you in smoking is well illustrated by the expression ‘ nicotine stained fingers’, rather than correctly stating ‘tar stained fingers’! The TPD 2 / Article 20 is the perfect manifestation of this not least that EC are not even tobacco products & target nicotine levels!

    • Chris Price

      The EU will not rest with the TPD2 as it is, nor will they allow vaping to escape tax-free. Their aim is to remove as great a part of the THR threat to revenues as they can get away with, without a successful legal challenge being made. Therefore, they will gradually strangle vaping with tax additions, more and more advertising regulations, and further regulatory assaults designed to reduce sales, once a preferred direction becomes clearer to them in around four or five years, when the practical effect of TPD2 can be seen and evaluated.

      The EU claim that 700,000 a year die from smoking. This figure is probably grossly exaggerated (at least in terms of those who die a substantial amount early, from conditions that are certain to have been caused by smoking)- but assuming their figures are correct, for this exercise, then I believe they will eventually be killing about half of smokers, by strict enforcement of the Snus ban and what may morph into a de facto ecig ban once legal challenges are seen to be without merit.

      They probably kill around 10% of this figure already by means of the Snus ban (in Sweden, 66% of tobacco users are snusers and only 33% are smokers – and the morbidity / mortality numbers are falling toward reflecting only the number of smokers). (This is hard to measure precisely as there is a 40 to 50 year timelag in the length of time to peak presentation numbers with serious smoking-related morbidities such as cancer and emphysema.)

      My view is that, given full and true information, and if promoted by government honestly, and allowing for unhindered technical developments and full, honest advertising rights, then at least half of smokers would switch to a THR product of some kind at some point in time. I know this is a ‘perfect’ scenario and therefore hypothetical – but if government at EU or UK level does not permit that situation, then government is responsible for the ensuing deaths, however many they may be.

      All we do know is that the death toll is going to rise significantly.

  • Jeff C

    How are you disappointed with TW? The courts decision was not announced until the 4th of May this year…. 16 days before the TPD finally comes into force.

  • Irish Lass

    Well, I am pretty disgusted, Clive.

    I have asked and ASKED and ASKED, but no response to my questions about the outcome of the TW case.

    TW also ignored my queries. No update on the TW Challenge “Latest News” web page since Feb 2016.

    Hurrumph! “Oh, please, do sign this petition and support TW’s case” …….and then we will not tell you what happens and will ignore all your attempts to find out.

    FINALLY, after several MORE Google searches, I found out that they lost their case. (For anyone else out there who may have been wondering.)

    Disappointed in you, TW and the EU Court.

    • Clive Bates

      Well, that was a particularly busy week. We also had the FDA deeming regulation to contend with and trying to get the most from the RCP report, which came out the previous week. But there was a lot of TW-related activity on twitter (including from me) and FB. TW issued a press release, and Google allows anyone to find the judgement in an instant.

      I have now updated my TW case page – thanks for the prompt – Totally Wicked legal challenge to the Tobacco Products Directive e-cigarette measures.

      To be honest, your post betrays a sense of entitlement that I don’t think is appropriate. It would probably be better to reserve your ‘disgust’ and ‘disappointment’ for the legions of well-funded people and organisations working against vapers and tobacco harm reduction, not your allies, even if they fall short of your expectations.

    • Fiona Hodge

      This does seem a little odd. The news of the outcome of TW’s case was all over social media at the time, along with TW’s press release.

      Granted, perhaps TW might’ve placed it on their news page (if it isn’t there), but it isn’t Clive’s responsibility to keep people updated.
      He puts a remarkable amount of work into the issue, and his word carries weight in a community that readily ignores the general public.

      The TW outcome carried huge implications. We know that the EU won’t give us justice. As soon as this news came through, Clive sprang into action, with NNA, to find other ways to fight the injustice of the TPD.

      Berating him for not personally ensuring people know another organisation’s news because they fail to do their own simple Google search for the results smacks of ingratitude for his invaluable contribution to our fight for justice and freedom of choice.

    • Sue Wilson

      Did I misinterpret your post? – I thought it was saying ….. I signed a petition, so, I’ve done my bit and you are all now beholden to me

  • […] Clive Bates has, and he isn’t happy at all with his former organisation. […]

  • Grayem

    Despite a lot being written about how addictive nicotine is, I am still unconvinced. I did have a bit of a problem going from smoking RYO to vaping, but not from giving up nicotine in my liquids. I no longer miss having that little cylinder between my fingers either. I did some research a couple of years back and there was more than a few instances where it was claimed that nicotine was far more addictive or only addictive when tobacco was in the equation, I think it was something to do with a chemical called acetaldehyde.
    There’s far too much written about the psychology of addiction for me to believe that the main reason people find it hard to give up smoking has to do with the activity itself rather than the nicotine playing around with dopamine levels.
    I recently read an article that seems to suggest that the body can clean itself of nicotine affects in a matter of two or three days, but to use it just once after that puts you back onto the craving cycle again.
    I probably have to accept that although I can give up nicotine, but in order to stop me vaping they’ll have to pries the mod out of my cold dead hands.

    • Chris Robinson

      Don’t forget that tobacco contains more addictive alkaloids than just nicotine. Anatabine, cotinine and myosmine for example are known to be highly addictive, as is one that has known high risk factors for cancer – tobacco specific nitrosamine that is formed during the tobacco curing stage. E-liquid contains either none of these elements, or only very slight trace amounts. The same can be said for NRT products.

      These compounds collectively are know as TSA (tobacco specific alkaloids). As vapers we understand far more about these issues having experienced our addiction first hand. It’s the presence of these alkaloids in tobacco that make it exceedingly difficult form some people to give up smoking. Vaping lets us separate issues of habit and nicotine from the issues of TSA addiction so that we can deal with it.

      Disappointingly, health groups, ANTZ, and even health professionals seem to be largely ignorant of the issues and the real mechanisms of tobacco addiction. If they weren’t they’d understand why vaping could turn out to be the end game for tobacco world wide.

      TSA study (rats): http://www.ncbi.nlm.nih.gov/pubmed/19366487

      • jredheadgirl

        Vaping tobacco has been an effective harm reduction strategy for me. I’ve been combustion-free for over 2 1/2 years now as a result of coming across a tobacco vaporizer (that has since become unavailable in the U.S.). If it were not for this tobacco vaporizer I would still be smoking. For me it has been more effective than using (3rd generation) e-cigarettes alone. Now I no longer smoke and another strange thing has occurred: I no longer inhale. I believe that strength and flavor (sorry, flavour..lol) has played a huge role in this change of behavior on my part.

        I believe that if more smokers were to become aware of this option there would be millions of smokers (ie., the ones not sold on e-cigs in their current form) that would (willfully) switch to vaping entirely. Of course, in order for such a harm reduction product/strategy to become effective, it first needs to be available on the market.

        Prohibition of choice hurts smokers and vapers.

        Furthermore, from my personal experience I have found that when I vape real tobacco I often tend to vape less (ie., as compared to using one of my high powered liquid vapes) as I feel more of a sense of satisfaction.

        Instead of repeating the mantra of the prohibitionists, those of us who care about freedom of choice and harm reduction need to understand that tobacco will always be a part of the equation.

  • Chris

    Would you care to come and talk to our State and Federal policy makers here in Australia? Currently they are busy prosecuting some vape store owners under the laws that were devised to prevent the sale of chocolate and candy cigarettes (It looks like smoking!) and revising those laws to specifically include all vape devices.

    Currently the the Federal Health department is having a closed door consultation with “experts” (all anti vape) about proposed regulations. Vapers and advocacy groups have not been invited. Probably because they know it would end in bloodshed. (I joke)

    Essentially, black market nicotine for vapers is the only option, and chop chop for smokers with cigarettes taxed to rise to $40 a packet over the next few years. Yep, tax cigarettes out of existence, but don’t give people a useful alternative. Make criminals out of all of us. It’s not going to get better. At the moment the EU and UK policy makers look almost enlightened by comparison. All this in a climate where two people die every hour of smoking related disease in Australia. No-one has been killed by vaping in Australia, ever.

    We are watching the situation carefully in the UK and in the US because our politicians tend to go for the safe option and do what everyone else does, not being terribly open minded or innovative in any way these days. I fear for the future really – I’m smoke free for 3 years and I started with 24mg/ml liquid.

  • […] Apparently, there are still people in public health trying to defend the EU Tobacco Products Directive as it applies to vaping! Amazing. It’s a ludicrous measure, that protects the cigarette…  […]

  • Gummy Bear

    What is missing in the desk murder calculator is a “benefits” section. It would include “Number of people not dying from overdosing on 24mg e-liquid thanks to the restriction”, “Number of people not being fatally poisoned after spilling the contents of a 5ml tank” or “number of children not becoming addicted to nicotine because of the restriction”. I would expect big numbers there, potentially up to zero.

  • Andrew Thompson

    The products of the future with appeal that will reach further into the..M/blockquote<

    ..what? The last sentence of point 5 seems to be missing an end. Great suspense value, but the information value is lessened.

    • Clive Bates

      Ah, yes… now fixed…

      The products of the future will reach further into the population of smokers because their appeal – part of which is nicotine pharmacokinetics – will improve through innovation.

  • Chris Price

    All good stuff.

    My favourite bits are the calculator section, though, under the heading Harm To Lives Of Vapers. Repeated a couple of times here is the line: ‘Loss of life due to arsing about not quitting’, or similar.

    At last – someone who tells it like it is.

  • Roger Hall

    I recall (although I’m struggling to find the link) that during the TPD discussions I read a great deal of the background information and in particular all the minutes that were published via the MHRA, I believe, of the Nicotine Containing Products Working Group set up by the Commission on Human Medicines. The Dept of Health as you recall wanted medical licensing of e-cigs as per the original EU Commission proposal. Within these minutes/reports I recall reading that on the question of a staggered nicotine threshold it was clearly advised that a staggered nicotine threshold would not be in the best interests of Public Health. In other words to reinforce their case for 100% medical e-cigs they considered that a staggered nicotine threshold would be detrimental. Roll on the final TPD decision and medical e-cigs were defeated, yet a staggered nicotine threshold was the compromise, despite it being on record that this would indeed be detrimental to public health. I remember writing about this on UKV at the time. As your blog identifies the nicotine threshold is undoubtedly not in the best interests of Public Health and this was known and considered prior to the TPD. Sadly, the MEPs were more interested in a compromise with the Commission and subsequently the won vote to classify them as consumer products was simply bypassed at the Triologue with onerous clauses and requirements which served the same Commission objective. The 20mg limit has nothing whatsoever to do with Public Health, but as with anything within the EU the motives for these Regulations lie elsewhere. The evidence regarding snus and how the EU still continues to ban it outside of Sweden is testimony to the fact that Public Health is way down the agenda insofar as the EU is concerned. They simply don”t care!

  • Doug Neaves

    I would imagine that an assessment has been carried out on the source of nicotine that may enter the black-market?

    Black-market nicotine would also consist of nicotine based insecticide and neonicotinoid based insecticide, what is the percentage?

    How many extra deaths would this result in?

    In all probability it would focus armchair regulators and public health bods minds, if the position previously held by Pierrepoint was reinstated. To my eternal shame, I admit to mentally, appending the phrase “short drop” to the names of the most egregious public “health” drongos and the gaggle of EU officialdom, that in true banana republic style, all use the title El Presidente. (It was considered rather uncivilised if the head separated from the body during a hanging, so rotund people had “short drop” written after their name, in order to prevent any “mishaps” at their hanging.)

    I never have been a fan of the EU, the TPD maintains governments addiction to tobacco, or rather tax derived from tobacco. Varenicline may help. The TPD will result in needless deaths. The FDA deeming regulations will result in needless deaths. How can we help the US vapers and smokers as well as the European vapers and smokers? History tells us that US politicians get a bit uppity, if a “state or states” try to leave the union. The EU politburo elites have taken a rather bolshie attitude to the UK seeking independence. So the way of killing two birds with one stone, so to speak, and save lives on two continents, is to leave the EU. This will focus minds. We will always have close ties with Europe, remember, our forefathers are forever part of the soil of Europe.

    • john Walker

      Doug
      Just wondering, is there much nicotine insecticide still being made?

      • Doug Neaves

        John

        Verboten in the EU before the TPD, strangely enough, or thankfully. It was still available in the US, but I have not checked recently. China, India probably. I found a can in the garage the other day, that is what reminded me of it. It could be a manmade catastrophe.

  • Sue Wilson

    Of course the black market will be the route that confirmed vapers will have to resort to. BUT those sources are not subject to testing and regulation and the risk of using contaminated liquids is increased. All we need is some real harm to occur to someone who’s used a black market product and the adverse publicity might be just what is required to put everyone of from ever trying vaping.

    • Gummy Bear

      I am not terribly concerned about contaminated e-liquid. In Australia we have a legal restriction to 0mg. So the manufacturers sell most of their liquids as “doublers”, i.e. double-strength flavour but no nicotine. 15ml of doubler are sold in a 30ml bottle, so that you can fill it up with unflavoured base that you bought overseas.

      Some companies that sell nicotine liquid actually are Australian producing in Australia. They just can’t sell it from here to Australian customers. So they ship the stuff to New Zealand, where their partner company puts in into a DHL bag and sends it back to Oz to the customer. It’s insane, but there is nothing sleazy or rogue about it.

      The damage this regulation does is that it becomes harder for a newbie to get started. If you haven’t got a vaping friend who can help you find all the information you need you are likely overwhelmed. So vaping hasn’t taken off here in the same way that it did in the UK.

  • Anonymous

    It surprises me that any thinks this was anything other than a deliberate shackling of the industry. The TPD has attacked every element of what makes vaping a viable proposition, and it is hard to imagine that this was the result of faulty reasoning. It us equally hard to imagine that trying to correct that reasoning will have any money impact on policy. At policy level both in Europe and the US the process has always been about stopping vaping, never about “regulating”. To that end we have the perfect mobilisation of vested interests, viscous ideologues and credulous idiots.
    Everything you write in the above post is correct, and what would be refreshing now is for one defender of the TPD or deeming by the FDA, to come out and say “yes we know, that’s why we did it”.
    In my opinion it is not current, but future vapers who have been thrown under the bus. Most of us will find a way, Black and grey markets will arise and we will continue to vape. For future switchers switchers I cant imagine anything TPD compliant would be of much use, and those that made and support the policy are fully aware of that.
    For current vapers to fight against this we need to fully embrace and engage in black market activities, be open and visual using non compliant devices and juices and let our continued enjoyment of good health attributed to vaping, give the lie to this abhorrent policy.
    To my mind the process of attracting new switchers has become a project over generations now, and should take encouragement from how attitudes to sexual orientation and recreational drug use have changed over generations.
    All we can do is be visible and proud.

    • Fiona Hodge

      Yes, we will continue to vape (though many current 2nd generation/high street users may not). However, that doesn’t mean our experience will be unaffected. The very fact that ecigs are subjected to such stringent regulations is another nail in the coffin of the acceptability of vaping. “No smoke without fire” attitudes will abound & we will be dismissed as people partaking of such a risky activity, it demands strict regulatory treatment.
      There will be fewer vapers around (with more quitting than starting) and those who persevere will be a minority to be restricted in public places.
      Regulators are doing their level best to make vaping a fad that they can phase out & consign to history.

      • Jonathan Bagley

        “No smoke without fire” attitudes will abound & we will be dismissed as people partaking of such a risky activity, it demands strict regulatory treatment.

        I think that’s a very important point, Fiona. In my experience, the Golden Age of vaping has been and gone. There are very few non residential buildings, buses, planes and trains, hotels ( inaccurately named, public spaces) where vaping is allowed. It is only our good fortune that vaping, particularly without flavourings, is fairly undetectable when done carefully.

  • Anonymous

    “The right question is ‘what is this nicotine limit supposed to achieve?'”

    This is the right question about every proposed vaping regulation, on both sides of the Atlantic.

    * How is a 2ml tank inherently less harmful than a 5ml tank? How would any person in the real world be made safer by the latter being illegal?

    * What harm can befall a person using 24mg e-liquid that will not befall them if they use 20mg?

    * How is any young person materially harmed by vaping zero-nic e-liquid?

  • Fiona Hodge

    If anything, those estimates of relapse & failure to switch are extremely conservative, especially the latter. I believe that the arbitrary limit will have a devastating effect on future uptake and continuance of use.

    The impact on those currently making their own is also massive. It is ridiculous to suppose that we will shift to buying 18mg unflavoured in 10ml quantities, at the prices those will command, to mix with flavours. Black market higher strength nicotine will be the only option available to us (with the risks attached to lack of quality controls) for us to avoid the 2000%+ increase in cost of eliquid.

    Unreasonable laws, taxes and prices will always lead to smuggling and the black market.

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