Making sense of the growing vape problem: Is regulating its use the solution?

SINGAPORE: Regulating the use of e-vaporisers, or vapes, in Singapore may help curb the rising number of cases, but more information is needed first, experts said.

While regulation is possible, many questions remain unanswered, said smoking cessation specialist Sean Ang.

Among these is the role that these devices play, he told CNA’s Heart of The Matter podcast.

“Are they a replacement for cigarettes in only existing smokers? Or do you want them to take over cigarettes as the dominant form of nicotine consumption? Or are they to be treated purely as a medical aid to help a person quit smoking?” he asked.

The most important piece of the puzzle when it comes to regulating vapes is finding out more about users in the local population, said Associate Professor Bibhas Chakraborty from Duke-NUS Medical School, who also joined the podcast.

“We have certain research findings from other populations. But what works here may not be exactly same as what might have worked in other countries,”

“This research needs investment. And this research will help us personalise the efforts … We need to survey them, we need to provide certain kinds of support, we need to experiment on them, provide alternatives to them. And then only we know definitely what might work for this country.”

The import and sale of e-cigarettes have always been banned, but in 2017, the law was extended to cover the purchase, use and possession of such devices. Six years on, the problem of vaping has worsened.

Last year, 4,697 people were caught using and possessing vapes, up from 1,266 people in 2020. About one in three people caught last year were under the age of 18.

“If we look at regulation, to lift the ban totally, as a knee-jerk reaction, I think that's wrong,” Mr Ang said.

“Because once you open the floodgates, you can't really close it.”

NOT A “FREE-FOR-ALL” PRODUCT

In whichever way vapes are regulated, it should “never be a free-for-all product” that can be bought at convenience stores, Mr Ang said.

“I have to be convinced, scientifically, that it's a less harmful product. It has to be part of a certain measure, or a certain protocol that helps people reduce their tobacco consumption,” he said.

In the case that they are used as medical aids, their use will be managed by healthcare professionals, he said.

He added that measures to prevent young people from getting their hands on vapes must be “extremely clear” and that the rules are only as effective as their enforcement.

VAPING AMONG YOUTH

Mr Ang started working with adults looking to quit smoking as a pharmacist in 2010 and later progressed to dealing with teenagers aged 13 to 17. He said that as the years went by, it became more apparent that vaping was "becoming a thing".

He had to quickly find out more about vaping and its appeal so he could deal with those who said their friends were also doing it and that it was a tool to help them quit smoking.

“I started to ask myself questions - why is it becoming a thing among the youth? And that's where I started to delve a lot deeper into the world of vaping,” he said.

He found out through videos on YouTube that there was a movement overseas, with people claiming that vaping was healthier than smoking. They were also doing tricks with vape smoke.

The reasons for young people picking up vaping and smoking overlap, one of which is the “challenge” factor, in which teenagers try to smoke or vape in school without getting caught, Mr Ang said.

“Getting caught outside school is too mainstream. The challenge is to smoke or to vape within a restricted environment and not get caught,” he said.

Assoc Prof Chakraborty added that vaping is perceived to be “cool and trendy”.

“Social media has a lot to do with that perception. This leads to peer pressure, particularly among the youth,” he said, adding that these are very important issues and are not easy to address.

IS VAPING LESS HARMFUL THAN TRADITIONAL CIGARETTES?

So is vaping safer than traditional smoking?

“Long story short, we're not sure yet," said Assoc Prof Chakraborty.

“Smoking versus vaping may have some differences in exactly what diseases it can cause but definitely we know that both are bad for health.”

Longer-term research is needed to determine this, he said.

Even if the differences remain to be studied, it is a “myth” that e-cigarettes are safe, he added. Mr Ang said there are still many chemicals produced from vaping that even scientists are learning about.

“It's just a lot about the marketing, they feel that it's healthier,” he said, adding that users will not know how much nicotine they are inhaling.

HOW SHOULD SINGAPORE DEAL WITH VAPING?

Mr Ang noted that the vape industry and its popularity are moving quicker than regulation can catch up. He added that the authorities have not decided what role they want it to play and how they may slowly let it in.

“The culture that we have here in healthcare is a lot more conservative, which means that we are going to be more cautious. We are going to look at what happens everywhere else in the world before making a decision,” he said.

As far as he is concerned, this is the right way to tackle the problem.

“I'm interested in anything that will help in my patient's health, but to open the floodgates and put my patients at a higher risk -now, I'm not going to do that,” he said.

Assoc Prof Chakraborty said that beyond researching the motivations of vapers, the authorities have to build a system that will help them cope.

“You have to understand the addiction issue rather than dealing with it in a very heavy-handed way. We have to be more compassionate,” he said.