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The illegal vape market in Malaysia is worth about RM2 billion and has doubled in the past one year.

Our young are repeatedly enticed to dwell on something we mistakenly assume as safe, hip and trendy.

Such new and in-trend items include smoking, bubble tea drinks, high salt fast food and these are not without detrimental effects.

Most of these adverse effects do not come into play early, the long-term effects are only seen after decades and are difficult to prove in small scale studies. Hence most go unnoticed, despite regular warnings and advice. Unfortunately, legislation has not been very successful in curtailing prevalent culture, and the long-term healthcare cost and effects are tremendous.

One example is vape, or electronic cigarette (termed e-cigarette/e-cig). The difference between vape and e-cigarette is small, and most would use these terms interchangeably. An e-cig is usually small and shaped like a pen, while a vape is a handheld device referred to as vaporisers. E-cigs are usually equipped with nicotine, while vapes may or may not consist of nicotine in its e-juice. In this article, I will use both terms interchangeably.

There are an estimated 7,000 e-liquid flavours. Among the metals that may be present include lead and nickel, possibly from the coils used to heat the liquid. Among the known health effects of vaping so far include dry mouth, dizziness, cough, vomiting, nausea, headache, blurred vision and abdominal pain.

The concentration of nicotine in the fluid differs by demand of consumers or the sellers. Absorption in the body also differs between individuals and mechanisms of inhalation. Unfortunately, in most local studies, the knowledge of nicotine concentration used in their devices are unknown to consumers.

Nicotine has been used as an insecticide since the 17th century till 2014, and can present many effects to our health. There is an increased risk of cardiovascular, respiratory, gastrointestinal disorders, disruption to reproductive health, decreased body immune response, increase blood viscosity, tumour proliferation, and is carcinogenic in some studies.

A traditional cigarette contains nicotine in the concentration of 8mg-20mg per stick. In e-cigarettes, there have been reports of other forms of illicit drugs such as heroin and marijuana found mixed along in the e-juice.

All nicotine products fall under the purview of the Poisons Act 1952, but so far, no license has been issued by the Health Ministry for vaping products in Malaysia.

In August this year, Japan Tobacco International (JTI) Malaysia stated the illegal vape market in Malaysia roughly amounted to RM2 billion and has doubled in the past one year. 

In July this year, MOH said it will prepare a new Act, the Tobacco Control Act, to oversee the use and regulations of tobacco, vape, e-cig, and shisha, likely to be out by year end.

In 2014, a report by the World Health Organization Framework Convention of Tobacco Control (WHO FCTC), mentioned that e-cigarettes pose serious threats to adolescents and foetuses.

In many cases, teenagers use vape/e-cigarettes unwittingly, sharing it among friends, and without parental knowledge. Parents who smoke or use vape have shown to significantly influence their children to either smoke cigarettes, use vape or worse, use both cigarette and vape, also known as dual users.

US federal agency Centers for Disease Control and Prevention last month was investigating a slew of multistate outbreaks of lung injury associated with vaping.

There were 805 lung injury cases reported from 46 states and one US territory, with 12 deaths confirmed in 10 states. Almost 69 per cent of patients were male, and all patients had a history of vaping, tainted with cannabis from marijuana flowers, Tetrahydrocannabinol or THC.

More than 20 countries in South America, Middle East and Southeast Asia such as India, Thailand, Singapore, have banned the sales of e-cig products.

In America, vape is considered a risk following the outbreak of vape-related deaths, and the Trump administration has plans to ban vaping. Many developed countries have strictly forbidden its import into their country.

In Malaysia, in 2016, police confiscated 11 vape bottles that contained THC.  In August 2019 , the Health Ministry confiscated 66,998 bottles of e-juice worth RM1.4 million, from 78 premises, selling nicotine tainted e-juice to schoolgoing children.

Malaysia needs to take a stand, to not only monitor but regulate vape use; especially on unauthorised products and online marketing which are prevalent now.

Children must never be exposed to vaping at all, devices must be child proof and there must be harsh penalties for those selling to children. Proper labelling must be enforced to buyers, allowing adults only to purchase.

The ingredients of e-juice has to be monitored. Surveillance of vape-related health symptoms, need to be developed and imparted to healthcare providers. This is to ensure they are able to wisely advice vapers, to curtail its use, and possibly refer cases with non-infectious lung damages to relevant pulmonologists.

School educators, colleges and universities need to implement more aggressive health promotion activities to disseminate better knowledge, awareness and deter kids from trying out vape.

Why has Malaysia transgressed into allowing something possibly so sinister to be endemic in Malaysia is unknown. Otherwise, we can expect the effects to occur in Malaysia too, it is just a matter of time before we see a similar sinister trend in our country as well.

The writer is a deputy dean (liaison and wealth creation) and senior professor in Community Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia

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