The Emergence of New Nicotine Products in Malaysia

Abstract

Tobacco cigarettes still dominate the global nicotine market; however, a diverse range of nontherapeutic alternative nicotine and tobacco products are now sold in many countries. Among these new products, much attention has focused on electronic vaping products, sometimes called "e-cigarettes." These devices produce an aerosol by heating a liquid that the user inhales. Typically, the liquid contains propylene glycol, glycerol, or a mix of the two. Flavors and nicotine are also usually added, although some people vape nicotine-free liquid, while others vape nicotine liquid without added flavoring. Internationally, regulation of vaping products varies from little regulation to complete bans. In Malaysia, vaping products that do not contain nicotine are regulated as consumer products, while those that contain nicotine must be approved as a medicine before they can be sold. As no vaping products have been approved as medicines in Malaysia, only nicotine-free vaping products may currently be sold legally. Despite this restriction, it is estimated that over 600 000 adults in Malaysia vape, with 3.2% of adults reporting current use. 1 What role vaping products should have in tobacco control policy is a matter of robust debate in the tobacco control field. Toxicological studies of the harmful chemicals in vapor compared with cigarette smoke suggest that the cancer risk of cigarette smoking is around 250 times that of vaping. 2 Biomarker studies also show that smokers who switch to vaping have lower exposure to key carcinogens than smokers who continue smoking. 3-5 There is also evidence from clinical trials that they can assist smokers to quit. 6-8 Conversely, these products are not risk-free, as they still expose users to harmful chemicals, are addictive if they contain nicotine, and the pleasant flavors may be attractive to young people. As with all new technologies, we also do not have evidence on the risks of long-term use. Hence, balancing the potential risks and benefits is complex. Vaping has also been linked recently to an outbreak of a serious acute respiratory syndrome in the United States, with some cases diagnosed with lipoid pneumonia. 9 Over 530 cases and 8 deaths are being investigated by health authorities, 10 who are yet to identify an exact cause of the condition, although most cases have admitted to vaping illicit cannabis oil products. Many of the leftover samples tested that contained tetrahydrocannabinol also contained high levels of vitamin