Sweden has found nicotine alternatives are better way to kick smoking

When the city of Brookline passed a generational ban on tobacco products in 2020, it was an extraordinary legal maneuver. The age-gating of goods on an incremental level prevents anyone born after January 1, 2000 from buying any tobacco-related products within city limits. 

It is a policy dreamed up by many in public health who have sought to replicate it elsewhere, including in New Zealand, Malaysia, and, now, the UK.

Now, however, a constitutional challenge in the Massachusetts courts is revisiting whether the health ordinance is legal to enforce. And it’s about time.

Despite already increasing the age limit to purchase tobacco from 19 to 21 and banning flavored tobacco products throughout the state, proponents are claiming that a full generational ban is a sure-fire way to eliminate youth use. But we know it isn’t, as the numbers already show us.

While it shouldn’t need restating, prohibition never works. In 2020, Massachusetts became the first state to ban all flavored tobacco products, again in effort to curb youth use. However, according to the Massachusetts Illegal Tobacco Task Force, the ban resulted in increased interstate smuggling of tobacco products, more tobacco-related police interactions, and a loss in tax revenue for the state. 

Ultimately, the flavor ban did not eliminate consumer use of flavored tobacco products. It just shifted where consumers purchased their goods. Which means the estimated 587,000 adults who smoke in Massachusetts likely had to turn to alternative sources to purchase tobacco products they prefer. 

When a product is banned, then consumers often go to the illicit market to find their desired products. This poses great concern, as the illicit market does not have to abide by product regulations and certainly is not performing age verification on purchases.

California followed in Massachusetts’ footsteps by banning flavored tobacco products in 2022, and further saw an extreme increase in the illicit market where brands known to be trafficked in by Mexican cartels. This suggests that tens of millions of packs are illegally entering California. It’s doubtful that this is the public health “win” tobacco control activists are looking for. 

While Brookline is the first in the US to pass a generational tobacco ban, there are international examples of similar policy. Both New Zealand and Malaysia have attempted to implement a generational tobacco ban, but have since pulled back after backlashes showed up in polling and disagreements over taxation. The Conservative government in the United Kingdom has plans to implement such a ban, but has also faced severe backlash from its more liberty-oriented  grassroots.

Rather than put all our cards on failed generational policies, it would be better to look globally towards policies that have helped reduce smoking prevalence. Sweden is a great example, as the World Health Organization announced that they are likely to become the first smoke-free country. 

Interestingly, Sweden is not succeeding using bans and prohibition, but rather through the concept of harm reduction. The Swedish government has recognized that nicotine alternatives, such as vaping, nicotine pouches, and snus, are significantly less harmful than smoking combustible tobacco and have therefore encouraged its citizens to make the switch. As a result, Sweden reduced its smoking rate by 55 percent in the last decade and has the lowest incidence of cancer within the European Union. 

While the desire to reduce youth use of tobacco products and overall smoking prevalence is a noble and important goal, it will be imperative that policymakers understand the serious unintended consequences of prohibition. 

As other countries have shown us, embracing tobacco harm reduction, not prohibition, will be the best strategy to improve public health in Massachusetts. That’s a great idea in any generation.

Originally published here

Rokok saat ini masih menjadi salah satu masalah kesehatan publik berbagai negara di seluruh dunia. Di dalam satu batang rokok, terkandung berbagai zat berbahaya yang dapat membawa berbagai penyakit kronis, seperti kanker dan penyakit jantung, yang tentunya memiliki dampak yang sangat besar tidak hanya bagi individu yang menggunakannya tetapi juga secara sosial.

Sudah menjadi rahasia umum bahwa, di Indonesia sendiri, rokok juga merupakan salah satu penyebab berbagai penyakit kronis yang dialami oleh saudara-saudara sebangsa kita. Di Indonesia sendiri ada 112 juta jumlah perokok aktif, dan merupakan salah satu negara dengan jumlah perokok tertinggi di dunia (databoks.katadata.co.id, 05/06/2023).

Angka 112 juta sendiri tentu bukan angka yang kecil, dan sudah sebaiknya dapat kita tekan agar jumlah tersebut berkurang secara drastis. Karena banyaknya angka tersebut, tentunya biaya kesehatan yang disebabkan oleh rokok di Indonesia juga tidak kecil. Pada tahun 2019 lalu misalnya, diestimasi penyakit yang disebabkan oleh rokok telah menelan biaya hingga 16,3 triliun rupiah (kemkes.go.id, 29/4/2021).

Karena memiliki dampak yang sangat berbahaya, maka tidak mengherankan berbagai negara di dunia memberlakukan serangkaian kebijakan yang ditujukan untuk menanggulangi dampak tersebut. Kebijakan tersebut diberlakukan dalam berbagai bentuk, mulai dari mengenakan biaya cukai yang tinggi, mengatur peredaran dan penjulaan produk-produk hasil olahan temabaku, hingga pelarangan total seluruh kegiatan produksi dan konsumsi rokok.

Negara kita sendiri sudah memberlakukan berbagai kebijakan yang ditujukan untuk mengurangi jumlah konsumen rokok. Beberapa diantaranya adalah kebijakan cukai produk hasil olahan tembakau yang semakin meningkat, dan juga aturan kewajiban bagi para produsen untuk menunjukkan bahaya rokok di depan setiap bungkus rokok yang dijual di berbagai tempat.

Adanya berbagai upaya tersebut sekilas memang terlihat berpotensi dapat menggurangi jumlah perokok. Diharapkan, jika harga rokok semakin mahal, dan edukasi publik melalui gambar yang menunjukkan bahaya rokok semakin gencar, maka insentif seseorang untuk menghisap produk hasil tembakau tersebut dapat semakin berkurang, dan akan dapat semakin menekan jumlah perokok di Indonesia.

Tetapi, pada kenyataannya, jumlah perokok di Indonesia semakin meningkat dari tahun ke tahun. Pada tahun 2011 misalnya, ada sekitar 60,3 juta perokok aktif di Indonesia. Tetapi, dalam jangka waktu 10 tahun, pada tahun 2021, jumlah perokok di Indonesia meningkat 8,8 juta orang menjadi 69,1 juta (kemkes.go.id, 3/6/2022).

Hal ini tentu bukan sesuatu yang mengherankan, mengingat bahwa rokok mengandung nikotin yang membuat para penggunanya mengalami kecanduan. Untuk mengatasi kecanduan tentu tidak bisa hanya melalui peningkatan harga dan juga sosialisasi bahaya dari produk tersebut.

Salah satu cara yang saat ini digunakan untuk menanggulangi dampak negatif dari rokok, seperti Inggris misalnya, adalah melalui produk-produk alternatif yang jauh lebih tidak berbahaya untuk menggantikan rokok. Diantaranya yang cukup sering dipakai adalah rokok elektrik, atau yang dikenal dengan nama vape.

Berdasarkan penelitian dari lembaga kesehatan Inggris misalnya, vape atau rokok elektrik merupakan produk yang 95% jauh lebih tidak berbahaya bila dibandingkan dengan rokok konvensional yang dibakar. Maka dari itu, National Health Service (NHS) Inggris misalnya, menyatakan bahwa vape merupakan alat yang bisa digunakan oleh para perokok untuk membantu mereka untuk berhenti merokok (nhs.uk, 10/10/2022).

Namun, penggunaan vape sebagai alat yang dapat digunakan untuk membantu perokok untuk berhenti merokok sendiri masih mengalami banyak tantangan di Indonesia. Hal ini disebabkan berbagai hal, mulai dari informasi yang kurang diketahui oleh masyarakat, maupun banyak masyarakat yang lebih terbiasa menggunakan rokok konvensional yang dibakar dibandingkan dengan rokok elektrik.

Untuk itu peran berbagai lapisan masyarakat untuk membantu mensukseskan upaya untuk mengurangi jumlah perokok di Indonesia adalah hal yang sangat penting, dan tidak hanya oleh lembaga pemerintah. Salah satunya adalah organisasi masyarakat yang memiliki jumlah anggota yang besar.

Organisasi masyarkaat, terlebih lagi yang sudah memiliki jutaan anggota, memiliki potensi yang sangat besar untuk mensukseskan upaya tersebut. Berita baiknya, sudah ada organisasi yang mendukung upaya tersebut, salah satunya adalah organisasi keagamaan Nahdlatul Ulama (NU).

NU sendiri merupakan organisasi massa Islam terbesar, bukan hanya di Indonesia, tetapi juga di dunia. Lembaga Kajian dan Pengembangan Sumber Daya Manusia (Lakpesdam) Pengurus Besar Nahdlatul Ulama (PBNU) menyampaikan misalnya, mendukung kebijakan yang berbasis ilmu pengetahuan dalam kaitannya dengan rokok (republika.co.id, 18/5/2023).

Lakpesdam PBNU sendiri juga menyampaikan bahwa, pengurangan resiko tembakau dengan memanfaatkan produk tembakau alternatif di Indonesia sangat penting untuk dimaksimalkan. Hal ini karena jumlah perokok di Indonesia sangat tinggi, dan dibutuhkan solusi untuk mengatasi hal tersebut (vapemagz.co.id, 6/11/2023).

Sebagai penutup, adanya dukungan untuk langkah harm reduction untuk mengurangi dampak negatif rokok, dan juga dukungan untuk melakukan riset dan penelitian, dari organisasi yang sangat besar seperti NU tentu merupakan sesuatu yang harus kita apresiasi. Dengan demikian, diharapkan upaya harm reduction di Indonesia dapat semakin sukses dan ke depan jumlah perokok di Indonesia dapat semakin berkurang.

Originally published here

Banning products will not make them go away. It will only create incentives for illicit markets to offer them to adult or high school students alike.

In 2013, Vermont became a New England leader by loosening its laws on cannabis possession, making it the first to do so by a legislative vote. 

Reporting on these events for Vermont Watchdog, I noted how this move was praised by many social justice advocates after years of abuse of narcotics of all types, and the recognition by then-Gov. Peter Shumlin and lawmakers that prohibition was not an answer.

Now, a decade later, Vermont has a thriving cannabis industry that is both legal and safe, offering jobs and removing the stigma of both patients and consumers who want to responsibly enjoy cannabis.

On another front, while prohibition has fallen by the wayside for cannabis, state lawmakers are entertaining another kind of prohibition on flavors for adult vapers. Modeled after similar efforts in Massachusetts, S.18, which passed the Vermont Senate earlier this year, would outlaw any legal vaping products available in flavors like mint or menthol. 

Though earlier testimony has focused on the availability of such products to underage youth, it would be counterfactual for Vermont to install a flavor ban aimed at adults — presumably in order to deprive minors from accessing these products — while maintaining a legal regime for cannabis, which comes with its own risks for young adults.

The fact remains that vaping devices — much like cannabis products — are not available to anyone under 21 years of age. Completely cutting off adults who would like to switch away from traditional cigarettes by using more attractive and less harmful flavored vaping devices would be a ruinous policy that would only cause more harm.

There are an estimated 16% of Vermonters who are daily smokers. As a good measure of faith, why not incentivize these individuals to switch to less harmful nicotine alternatives? If the only nicotine alternatives available to adults who want to quit smoking are tobacco-flavored, how would this be any real incentive?

Banning products will not make them go away. It will only create incentives for illicit markets

to offer them to adult or high school students alike, without regard for a safe and legal system that exists for a similar product like cannabis.

If state legislators want to make an impact and reduce smoking, the best course of action is to offer adults a regulated and safe market of flavored vaping products, while maintaining a policy of zero-tolerance for any retail shop or convenience store that sells to youth. Whether that be stiffer penalties or loss of licenses, there can be no acceptance of young people gaining access to these products. Hence, we should view this as an appropriate issue of age-gating products, much like we do for alcohol, cannabis and other goods.

With adequate checks and administration, Vermont adults deserve a system where they can legally acquire their flavored vaping products, rather than stoop to using the black market either in-state or across the Vermont border. That is a certain way to provide greater consumer choice, uphold the rule of law, and ensure that kids will not have access to these products.

Originally published here

Starting Monday, electronic cigarette products will be banned inside public places in Illinois.

Kristina Hamilton of the American Lung Association said the association has been leading the charge to encourage states to expand their smoking bans to include e-cigarettes. A coalition of partners across Illinois have been working with the association for several years to prohibit vaping indoors, she said.

“We are very excited that the ban is finally taking effect on Jan. 1,” Hamilton said.

Shortly after the law was signed, Elizabeth Hicks with the Consumer Choice Center warned the measure may push Illinoisans back to cigarettes, leaving taxpayers to pick up the tab.

“Taxpayers unfortunately also suffer in addition to consumers,” Hicks said. “The annual Medicaid costs for smoking-related illnesses in Illinois is over $2 billion, which is one of the highest throughout the country.”

The Illinois Department of Public Health said in a statement that banning indoor use of such products “sends a strong message that e-cigarettes are not a safe alternative to smoking.”

Read the full text here

Ontario plans to double the tax on vaping items. Yes, some vapers may quit. But others will go back to smoking

If you are a smoker in Ontario trying to quit — and if you are a smoker, you should be trying to quit — making the switch to lower-risk vaping products is about to get much more expensive. In his fall economic statement earlier this month, Ontario Finance Minister Peter Bethlenfalvy announced the province would be partnering with the federal government to double the tax burden on vape products.

Right now a 30mL bottle of vape liquid faces a federal tax of $7. Under the new policy, that will double to $14. Those who prefer pre-filled pods will see the tax rise from $1 per unit to $2. In the partnership with Ottawa, the province gets to keep half of the tax revenue generated from the scheme.

Ontario has justified the move as an attempt to curb the prevalence of vaping, especially among young people. That’s certainly an important goal, but minors should never have access to vape products and adults who sell to them or help them get around that rule should be prosecuted.

But many adults are using vape products to quit smoking, which means making vaping more expensive could be a serious net negative for public health. Vaping with the goal of quitting smoking is a huge step in the right direction for people’s health. Public Health England estimates that accessing one’s nicotine through vaping brings a 95 per cent reduction in health risk compared to getting it from tobacco. Most of the danger of smoking come from inhaling combusted materials. Vaping all but eliminates that danger, which is why making it more expensive is a big health policy mistake.

A 2017 study from researchers at the University of California found, using U.S. census data, that vaping had indeed contributed to a significant increase in smoking cessation. Moreover, vaping outperforms other smoking cessation methods. The U.K. National Health Service website spells out that “You’re roughly twice as likely to quit smoking if you use a nicotine vape compared with other nicotine replacement products, like patches or gum.”

So why would Ontario want to make vape products more expensive for smokers, and what will be the effect of these tax hikes?

Vape prices are clearly going to rise. In a 2020 working paper published by the National Bureau of Economic Research, six U.S. economists analyzed sales data from 35,000 U.S. retailers and found that for every one-dollar increase in taxation vape prices rose between $0.91 and $1.16. The tax is almost entirely passed on to consumers.

How will vapers respond to these price hikes? Many will go back to smoking. The same NBER study showed that a $1-increase in vape taxes increased cigarette sales by a whopping 10 per cent.

So the tax hike will make what has been shown to be an effective cessation tool more expensive, which will likely push former smokers back to smoking — even as our federal government claims to be steadfast in its commitment to have fewer than five per cent of Canadians smoke by 2035.

In 2007, 31 per cent of Canadians identified as regular smokers. By 2020, that number was down to just 11 per cent. That’s certainly good news. We all know the devastating impact smoking can have. Approximately 48,000 Canadians still die each year from tobacco-related illnesses. But while that decline in smoking is clearly something to celebrate, making it harder for those who are still smoking to quit isn’t.

If we’re to have any shot at achieving the smoke-free 2035 goal, we should see vaping as a tool that will help us get there. Heavy-handed tax hikes create more smokers, and no one wins if that happens.

Originally published here

Baru-baru ini Codeblue melaporkan bahawa kerajaan telah membuat keputusan untuk mengeluarkan klausa generasi penamat daripada Rang Undang-undang (RUU) Kawalan Produk Merokok untuk Kesihatan Awam 2023 kerana ia tidak berpelembagaan, atau dianggap bertentangan dengan prinsip kesamarataan dalam Perlembagaan Persekutuan. 

Generasi penamat merujuk kepada peruntukan larangan dalam RUU ke atas mereka yang lahir selepas 2007 daripada membeli dan menggunakan produk tembakau serta vape.

Sehingga kini belum ada sebarang kenyataan rasmi daripada Kementerian Kesihatan Malaysia (KKM), namun kenyataan bekas menteri, Khairy Jamaluddin, terhadap kewujudan dua menteri dan “the gaffer” sebagai penghalang kepada RUU itu menguatkan lagi kesahihan laporan tersebut.

Keputusan tersebut sudah tentu bukan tindakan yang mudah. Kerajaan berisiko mendapat imej politik yang negatif tetapi itulah perkara yang tepat dan mesti dilakukan.

Menurut Peguam Negara Ahmad Terrirudin Mohd Salleh cadangan larangan berasaskan umur tersebut dianggap sebagai tidak berpelembagaan kerana bertentangan dengan jaminan kesaksamaan dalam Perkara 8 Perlembagaan Persekutuan.

Dalam erti kata lain, sepatutnya setiap orang adalah sama rata bawah undang-undang dan berhak mendapat perlindungan yang sama. Undang-undang mesti adil untuk semua generasi dan setiap kumpulan masyarakat. 

Undang-undang tidak boleh memberikan kelebihan hanya kepada satu generasi dan mengetepikian generasi yang lain.

Semasa RUU itu pertama kali diperkenalkan pada 2022, perbincangan mengenai hak asasi atau hak kesamarataan tidak diberikan perhatian secara terperinci, atau ruang untuk membahaskan secara terbuka dan selamat tidak ada.

Apabila terdapat ahli parlimen, pakar perubatan, ahli ekonomi atau mana-mana pihak cuba menyuarakan pandangan atau mewacanakan dasar ini tersebut secara kritis, mereka dilabel dengan pelbagai gelaran yang negatif.

Bahkan terdapat ahli parlimen yang tidak berani untuk membincangkan isu berkenaan secara terbuka kerana risau mereka akan dilabel dan dimalukan di media sosial atau khayalak ramai.

Dengan mudah – dan sering kali – golongan yang menyokong generasi penamat menggunakan hujah tiada kebebasan mutlak dan mengatakan ia memudaratkan masyarakat dan alam sekitar tanpa mengambil kira hak pengguna untuk membuat pilihan.

Selain tidak berperlembangan, RUU berkenaan juga dikhuatiri tidak boleh dikuatkuasakan dengan efektif.

Presiden Persatuan Kedai Kopi Petaling Jaya Keu Kok Meng dalam perbincangan meja bulat anjuran Pusat Pilihan Pengguna mengatakan di kedai kopi, dia tidak nampak penguat kuasa datang untuk melarang orang merokok dan walaupun ada undang-undang mengenainya.

Saiz perdagangan tembakau haram Malaysia yang tertinggi di dunia juga menjadi kerisauan sama ada dasar berkenaan boleh dilaksanakan atau tidak. 

Pada Mei 2023, rokok yang diniagakan secara haram merupakan 55.3 peratus daripada pasaran domestik.

Semasa Covid-19, sekitar Mac 2020 Afrika Selatan mengenakan larangan ke atas penjualan produk tembakau selama lima bulan walaupun terdapat kelaziman perdagangan haram dalam pasaran tembakau. 

Kesan daripada itu dalam tinjauan bertajuk Market impact of the COVID-19 national cigarette sales ban in South Africa menunjukkan 93 peratus daripada perokok masih berjaya membeli rokok. 

Purata harga rokok pula melonjak sebanyak 250 peratus berbanding sebelumnya kerana peningkatan dalam pembelian melalui pasaran gelap.

Kurangkan jumlah perokok

Meskipun keputusan berani kerajaan menarik semula generasi penamat wajar diiktiraf, sehingga kini masih belum ada undang-undang yang mengawal selia vape secara sah dan jelas. 

Terutamanya bagi memastikan keselamatan pengguna dan mengelakkan salah faham atau mitos mengenai produk pengurangan kemudaratan berkenaan.

Kerajaan perlu segera memperkenalkan undang-undang pintar untuk mengawal selia vape bagi memastikan keselamatan pengguna dapat terjamin dan kanak-kanak bawah umur dilindungi. 

Ketiadaan undang-undang seumpama itu mendedahkan pengguna kepada risiko produk yang tidak memenuhi peraturan kesihatan di pasaran.

Ketiadaannya juga menyebabkan orang ramai tidak mendapat maklumat tepat mengenai vape yang 95 peratus lebih selamat berbanding rokok dan mampu menjadi alternatif terpenting untuk mengurangkan perokok secara berkesan di Malaysia.

Public Health England menganggarkan vape adalah 95 peratus kurang berbahaya kepada kesihatan pengguna berbanding rokok biasa. 

Salah satu kajian penyelidikan terkini daripada Institut Psikiatri, Psikologi & Neurosains (IoPPN) di King’s College London, pengambilan vape boleh membawa pengurangan ketara dalam pendedahan kepada toksin yang menggalakkan kanser, penyakit paru-paru dan penyakit kardiovaskular.

Ini adalah masa terbaik untuk kerajaan menamatkan mitos mengenai vape dan mengiktiraf pengurangan bahaya tembakau sebagai strategi utama untuk mengurangkan perokok di Malaysia.

Originally published here

Questions abound over the tabling of the Control of Smoking Products for Public Health Bill 2023 for its second reading in the Dewan Rakyat tomorrow.

This comes after a health ministry briefing for MPs, scheduled to be held at 5pm today, was postponed indefinitely.

The health ministry has also postponed a media briefing on the bill scheduled for this afternoon in Parliament. No reasons were given for the postponement.

A source close to the matter told FMT that the tabling of the bill has been postponed.

At the time of publication, health minister Dr Zaliha Mustafa and the ministry’s communication team have yet to respond to queries on whether the tabling of the bill, also known as the Generational End Game (GEG) bill, had been postponed.

Last week, Zaliha announced that the Cabinet had decided that the bill would be tabled for its second reading on Oct 10.

The GEG bill seeks to ban the use, purchase and sale of cigarettes and vape products to those born after 2007.

Read the full text here

Fred Roeder, Managing Director of the Consumer Choice Center, strongly condemns the UK Prime Minister Rishi Sunak’s recent proposal to introduce a generational ban on smoking, as reported by The Guardian.

The ban, coupled with a blanket prohibition on disposable vapes, is a regressive step that threatens to fuel the black market and infringe upon the rights of adult smokers to make their own informed choices.The UK has long been a champion of evidence-based policies, particularly in the realm of tobacco harm reduction.

However, the proposed generational ban on cigarettes, combined with the ban on disposable vapes, marks a departure from this pragmatic approach. By depriving adults of their right to choose how they consume nicotine, these measures risk driving millions of consumers towards unregulated and unsafe alternatives, undermining public health objectives in the process.

Mr. Roeder emphasizes that the UK’s smoking rates have steadily declined thanks to a comprehensive strategy that embraces harm reduction policies. By promoting alternatives such as e-cigarettes and other reduced-risk products, the UK has successfully encouraged smokers to transition away from traditional combustible cigarettes.

Read the full text here