Electronic Cigarettes to Fight against Tobacco Smoking

Dr Lam Pin Min asked the Minister for Health if the Ministry will consider introducing electronic cigarettes as an adjunct strategy to fight against tobacco smoking.

Mr Gan Kim Yong: Electronic cigarettes (e-cigarettes) have been marketed as safer, healthier alternatives to tobacco smoking, and as smoking cessation devices. However, their effectiveness in helping smokers quit tobacco use has yet to be demonstrated, similar to the requirements for other Nicotine Replacement Therapies (NRTs).

Concerns have also been raised about the safety of e-cigarettes as they contain nicotine. International studies have shown that they can expose users to toxic and cancer-causing substances. A local study conducted by HSA found poor consistency between actual nicotine content in e-cigarettes and the amount labelled. In addition, e-cigarettes could potentially be a "gateway" for the young to become addicted to nicotine and lead to the use of conventional cigarettes and the development of a smoking habit.

The World Health Organization (WHO) has concluded that until e-cigarettes are deemed safe, effective, and of acceptable quality by a competent national regulatory authority, consumers should be strongly advised not to use them 13 . The UK's Medicines and Healthcare Products Regulatory Agency announced plans in June 2013 to regulate e-cigarettes as medicines with effect from 2016, but also notably stated that the quality of e-cigarettes currently in the UK market was such that they cannot be recommended for use 14 .

We share the WHO and UK's concerns over the lack of efficacy and safety of e-cigarettes, and their effects on long-term health. Until there is strong, conclusive evidence supporting the safety and efficacy of e-cigarettes, MOH will continue to adopt a prudent approach and prohibit the import, distribution, and sale of e-cigarettes in Singapore.

Smokers who wish to quit smoking should use methods that have been proven safe and effective. These methods include using cold turkey withdrawal, undergoing smoking cessation counselling, and receiving approved pharmacotherapy interventions such as nicotine replacement therapy and other non-nicotine medications that are available.

We will continue to closely monitor the developments and studies regarding emerging tobacco products, such as e-cigarettes, and seek new ways to strengthen the effectiveness of our tobacco control measures in line with international guidelines and practices.

Note(s) to Question No(s) 26:

13 World Health Organization. Tobacco Free Initiative. "Questions and answers on electronic cigarettes or electronic nicotine delivery systems (ENDS)." Available online: http://www.who.int/tobacco/communications/statements/eletronic_cigarettes/en/index.html (accessed 5 November 2011).

14 UK MHRA. "Nicotine containing products." Available online: http://www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Product-specificinformationandadvice%E2%80%93M%E2%80%93T/NicotineContainingProducts/index.htm (accessed 5 November 2011).