Category: Addiction

New Online Recovery School a First for South Africa

South Africa is a traumatised nation

Photo by Steinar Engeland on Unsplash

Dr Siya Mjwara, founder of the AskDrSiya Psychotherapy and Wellness Coaching Practice, has just launched the first online recovery school in South Africa. The Recovery School will support individuals in identifying and confronting their challenges and businesses in developing and implementing wellness solutions in order to reduce absenteeism and improve productivity, as well as overall workplace culture. Dr Mjwara will provide a supportive and transformative environment where healing and growth are possible for all.

She says, “We create a virtual sanctuary where individuals can find healing, empowerment and community support. We strive to cultivate a space where you can reclaim your life and thrive, no matter what you’ve been through.

“After 17 years of working with individuals, couples and families, I can say, without a doubt, that we South Africans are a traumatised nation. Unfortunately, many of us are completely unaware of how our traumas are negatively impacting our lives, as well as the decisions we take on a daily basis. Recently, I’ve been hearing people say, “avoid dating anyone who has never been to therapy”. This is an indication that more of us are recognising how unresolved trauma can negatively impact our relationships.

“Besides our personal experiences, such as childhood trauma, relationship, family and workplace traumas, many of us are still dealing with the effects of intergenerational trauma.

This is part of the background that informs the vision for The Recovery School. My wish is for individuals to not only cope with trauma, but also to be able to thrive and become the best version of themselves. It takes courage to face your fears and begin living authentically, and you don’t need to walk the journey alone.

The school’s programmes are primarily designed to enable individuals to

  1. Rediscover themselves
  2. Break free from limiting beliefs
  3. Cultivate resilience
  4. Forge meaningful connections
  5. Live fully in the present
  6. Achieve their goals

Dr Mjwara BSW Hons (UWC), MA FCS (UWC), Dphil (UNIZULU) can be contacted on Ask@DrSiya.co.za or 079 772 1950.

Removing Largest Serving Sizes of Wine Decreases Alcohol Consumption, Study Finds

When pubs, bars and restaurants in England removed their largest size of wine sold by the glass, consumers drank less alcohol

Photo from Pixabay CC0

Alcohol consumption is the fifth largest contributor to premature death and disease globally. Many cues in physical and economic environments influence alcohol consumption across populations. One proposed intervention to excessive alcohol consumption is reducing the size of servings of alcoholic drinks sold by the glass, but there has been no real-world evidence for the effectiveness of this.

In the new study, researchers asked 21 licensed premises in England to remove from their menus their largest serving of wine by the glass – usually 250mL – for four weeks. The researchers then tracked the total volume of wine, beer and cider sold by each establishment.

Over the course of the four weeks, the total volume of wine sold by the licensed premises decreased by 7.6%, and there was no overall increase in beer and cider sales. There was an increase in the sales of smaller servings of wine by the glass – generally 125mL and 175mL – but no impact on sales of wine by the bottle or beer or cider sales.

“This suggests that this is a promising intervention for decreasing alcohol consumption across populations, which merits consideration as part of alcohol licensing regulations,” the authors say.

Marteau adds, “Removing the largest serving size of wine by the glass in 21 licensed premises reduced the volume of wine sold, in keeping with the wealth of research showing smaller serving sizes reduce how much we eat. This could become a novel intervention to improve population health by reducing how much we drink.”

One of Cape Town’s Few Free Rehab Centres has Closed its Doors to Adults

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By Matthew Hirsch for GroundUp

The Kensington Treatment Centre, one of few in-patient rehabilitation centres in Cape Town, has stopped accepting adults because of financial constraints.

The Western Cape Department of Social Development (DSD) confirmed that the Kensington Treatment Centre no longer takes adults “due to the need to accommodate more children in secure care without any additional funds”.

In the past financial year, the facility had treated 120 people.

The department says it is necessary to focus on youth at risk.

Its budget for substance abuse programmes has been cut by R600 000 for the 2023/24 financial year.

New applications will be directed to other substance treatment centres funded by the department, which currently has six in-patient facilities: Metro South, North, East, Cape Winelands, Overberg and West Coast. Enquiries and admissions can be made through self-referral or external referrals.

There are also six outpatient treatment centres run by the City of Cape Town.

Bianca Rabbaney, who works for U-Turn Homeless Ministries, has personal experience of how difficult it is to access rehab facilities in times of need. She lived on the streets for more than 20 years, because her family couldn’t cope with her. For most of that time she had a substance use problem.

“My life just spiralled down to almost completely nothing, and in that time I did search for help,” she says.

“There are so many of us who want to come out of drug addiction but we can’t do that when we’re out on the street. From my personal experience when I walked my journey, there were so many places I went to that rejected me.”

“They used to send us away because we didn’t have money to come into the facility or we didn’t have a place to stay. It made it difficult for someone like me to access that kind of assistance,” she says.

Rabbaney eventually got help at the Matrix Rehabilitation Programme Parkwood. She has been abstinent for eight years now.

“I never forgot the struggle that I had to go through to get to a shelter, get myself into a rehabilitation program and to get my life back together. We don’t have many of those facilities at the moment.

“I would like to send a message out there that there is hope after addiction. There is hope after being homeless. We just need more facilities.”

Budget cuts

The provincial DSD is concerned about possible further cuts to its budget.

“We will only know the impact on this programme next year after the final budget allocation,” said Monique Mortlock-Malgas, spokesperson to MEC Sharna Fernandez.

The department is also looking to regulate illegal rehabilitation centres.

“This process may assist with the demand for services to the extent that DSD can help more centres provide proper quality services to the public. Centres that are unable to comply will, however, need to be closed,” said Mortlock-Malgas.

Lise van den Dool, chief programme officer at U-Turn, says there are also state-funded beds in registered facilities but there is a long waiting period for these and this is a problem because people may lose motivation. “When a person is ready to walk that journey you’ve got a short window period,” she said.

Van den Dool said the biggest issue is what happens after the rehabilitation process. She said work programmes are fundamental to recovery – not just preparing people to be ready for work, but helping them keep their jobs.

According to data from the 2022 census, after loss of income, substance abuse is the main cause of homelessness in the country. Some studies, including one by U-Turn, suggest that there are at least 14 000 homeless people in Cape Town.

Republished from GroundUp under a Creative Commons licence.

Source: GroundUp

One in Six Patients with Opioid Use Disorder Leave the Hospital too Early

The number of patients admitted with opioid use disorder (OUD) and injection-related infections who left the hospital before completing treatment increased significantly between 2016 and 2020 (from 9.3% to 17%) according to analysis from researchers at the Perelman School of Medicine at the University of Pennsylvania. One in six of these patients now leave the hospital before medically advised (BMA).

The findings, published in JAMAalso reveal that the rate at which patients with any opioid-related issues (patients presenting with other issues but exhibiting opioid dependence) left the hospital BMA increased more than 50% (from 7.5 to 11.3%). In both of these groups, nearly half of BMA discharges occurred before the third day, when withdrawal symptoms are most severe. Now that fentanyl has become the dominant opioid causing overdoses, the findings illustrate the need for patient-centred care that adequately manages pain and withdrawal symptoms so that patients can complete treatment.

Approximately 500 000 patients are discharged against medical advice, or in the United States annually, and those circumstances are associated with increased likelihood of death and hospital readmission. Previous research shows that patients with addiction cite withdrawal and pain as their reason for BMA discharge.

“The rapid increase in early discharges is alarming; in 2016, less than one in ten patients admitted for OUD and injection-related infections left the hospital before their care team considered it safe. By 2020, one in six were leaving early,” said lead author Ashish Thakrar, MD. “What’s more, since the study period ended, the COVID-19 pandemic caused the opioid crisis to escalate, underscoring just how urgent it is to understand how we might be able to reverse this trend and get patients the treatment they need.”

Using nationally representative data from the National Readmissions Database, researchers compared the rate of discharge BMA in patients admitted for OUD to the BMA discharge rate for non-opioid admissions. They also evaluated changes in the proportion of BMA discharges before the third admission day, when opioid withdrawal is most severe, and changes in the proportion of discharges BMA in patients with stimulant use disorder.

They identified opioid-related admissions as those with opioid use, dependence, abuse, or overdose. To account for patients who were more likely to have severe OUD and fentanyl use, they also included patients with OUD and an injection related infections, such as bacteraemia, endocarditis, or osteomyelitis.

Between 2016 and 2020, they found that the number of patients admitted with OUD and injection-related infections who left the hospital BMA increased 82%, from 9.3% to 17%. They also found that the discharge BMA rate for all opioid-related admissions increased 50% during this period, from 7.5% to 11.3%. The proportion of BMA discharges occurring before the third day also increased for individuals with OUD and an injection-related infection, from 42.6%, to 48%.

In contrast, the BMA rate increased only marginally for non-opioid mental health or substance use admissions, and all non-opioid admissions (from 3.1 to 3.5%, and 1.1 to 1.5%, respectively).

“These data didn’t allow us to discern which type of opioid that individuals were using when admitted for OUD, but we know that fentanyl, an opioid 25 to 50 times more potent than heroin, has spread in unregulated drug supplies and is now involved in 88 percent of opioid overdoses in the US. Withdrawal symptoms from fentanyl are more difficult to manage than from other opioids like heroin and oxycodone,” said Thakrar. “This study illustrates why we need more research on how to manage individuals withdrawing from fentanyl and other substances in the unregulated drug supply.”

“The drugs that individuals are using have changed over the past decade, and how we treat them should change, too,” said senior author M. Kit Delgado, MD, MS. “Health systems can expand the use of interventions that are already proven to treat withdrawal and reduce but not widely used, such as medications like buprenorphine and methadone.”

Thakrar and Delgado also suggest that hospitals could be incentivised to reduce discharges BMA and to support specialty services such as addiction consult services that have been proven to reduce BMA discharges and that can reduce the risks of future readmission or death.

Source: Penn University Medicine

Dependence on Pain Medication is on the Rise

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Dependence on pain medication is on the rise due to lack of vigilance by medical professionals, according to a new study from the University of Surrey. In the paper published in the journal Pain and Therapy, patients dependent on pain medication describe feelings of ‘living in a haze’ and being ignored and misunderstood by the medical profession.

In the first study of its kind in the UK, Louise Norton and Dr Bridget Dibb from the University of Surrey investigated the experiences of patients dependent on medication for chronic pain. Pharmacological treatment for chronic pain usually involves potentially addictive substances such as non-steroidal anti-inflammatory drugs, gabapentinoids, and opioids. Increased prescription levels of such pain relief medications have been associated with heightened levels of overdose and misuse.

Dr Bridget Dibb, Senior Lecturer in Health Psychology at the University of Surrey, said: “An increasing number of people are experiencing chronic pain, which can interfere with their daily life and lead to depression and anxiety. Medication can help alleviate pain and return a sense of normalcy to a person’s life; however, there is a risk of dependence, which can potentially cause damage to vital organs, including the liver and kidneys.

“The first step to tackle this problem is to learn more about a person’s experience, how they perceive their dependence and how they interact with others, including the medical profession.”

To learn more, interviews were carried out with nine participants who had become dependent on pain medication. Participants spoke about how their dependence on pain medication resulted in them feeling not fully present and removed from their lives due to the side effects of the treatment. Many also expressed frustration about the lack of alternative treatment options available on the NHS to manage their pain, with medications being too readily prescribed.

The majority of participants also spoke about their negative interactions with medical professionals, with some attributing the cause of their dependence on them. Many believed a lack of continuity between doctors led to missed opportunities in spotting their dependence, enabling it to continue.

Louise Norton added: “Relationships with medical professionals substantially affect the experiences of those with painkiller dependence. Doctors can often be seen as authority figures due to their expertise and so patients may be apprehensive to question their treatment options. However, through providing patients with thorough information, doctors can enable more shared-decision making in which patients feel better supported and equipped to manage their chronic pain.”

Researchers noted participants felt stigmatised when speaking with others about their dependence due to a lack of understanding about their reliance to prescribed pain medications. Such interactions left participants feeling ashamed and critical of themselves.

Dr Dibb added: “Those with a dependence on prescription painkillers not only have to navigate their reliance on the medication but the shame and guilt associated with such a need. Combining this with feelings of being misunderstood and ignored by medical professionals, they have a lot of emotional needs to be managed alongside their physical pain. To prevent this from happening medical professionals need to be more vigilant when prescribing medication and ensure that their patients are fully aware of the risk of dependence before they begin treatment.”

Source: University of Surrey

Fathers’ Parental Leave may Protect against Hospitalisation for Alcohol Consumption

Source: CC0

Fathers who have been on parental leave have a significantly reduced risk of being hospitalised due to alcohol consumption. This is shown by a study published in Addiction from researchers at the Department of Public Health Sciences, Stockholm University.

The aim of the study was to assess whether fathers’ parental leave influences alcohol-related morbidity and mortality. In order to try to find out if that is the case, the researchers have investigated the effects of parental leave policy that was implemented in Sweden in 1995. The policy encouraged fathers to use parental leave by reserving 30 days of leave for their use alone and resulted in the proportion of fathers using parental leave increasing from 43% to 75%.

“Our findings were pretty remarkable considering the severity of the studied outcome. Although alcohol-related hospitalizations were rather uncommon, we found that after the policy was implemented there was a 34% decrease in these hospitalizations among fathers in the two years after birth, as well as smaller decreases up to 8 and 18 years after birth,” says Helena Honkaniemi, researcher at the Department of Public Health Sciences, Stockholm University.

“Most changes were found among hospitalisations for alcohol intoxication and alcohol-related mental and behavioural disorders. Additional analyses evaluating actual changes in parental leave use from before to after the policy suggest that these health consequences could be explained by the increase in fathers’ parental leave use, rather than other underlying trends,” says Helena Honkaniemi.

However, no changes were found for alcohol-related mortality.

Co-author Associate Professor Sol Juárez believes that the results of the study could be useful for policymakers.

“Policymakers should consider that fathers’ parental leave not only promotes more gender-equal participation in childcare, but can also reduce alcohol-related harms,” Juárez says.

The study “Alcohol-related morbidity and mortality by fathers’ parental leave: A quasi-experimental study in Sweden” draws on Swedish register data of all fathers of singleton children born from January 1992 to December 1997, three years before and after the policy was implemented.

Source: Stockholm University

Young Males Most at Risk of Developing Schizophrenia from Cannabis Use

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A registry-based study on cannabis users in Denmark spanning 39 years found that young males were more than twice as likely to develop schizophrenia as young females. The researchers, who published their findings in Psychological Medicine, estimated that about 15% of schizophrenia in this population group is due to cannabis use.

Previous research suggests an increase in schizophrenia population attributable risk fraction (PARF) for cannabis use disorder (CUD). However, sex and age variations in CUD and schizophrenia suggest the importance of examining differences in PARFs in sex and age subgroups.

Moreover, cannabis potency measured by the percentage of delta-9-tetrahydrocannabinol (THC) (main psychoactive component of cannabis) has increased dramatically, eg from 13% in 2006 to 30% in 2016 in Denmark. CUD has also increased markedly – past-year CUD rose significantly from 4.9% in 2014 to 5.9% in 2018 among US 18–25-year-olds.

A growing body of evidence suggests that the relationship between CUD and schizophrenia may differ by sex. Male sex and early heavy or frequent cannabis use are associated with earlier onset of psychosis.

The researchers conducted a nationwide Danish register-based cohort study including all individuals aged 16–49 at some point during 1972–2021, identifying CUD and schizophrenia status.

The researchers examined 6 907 859 individuals, with 45 327 cases of incident schizophrenia during follow-up. Males had slightly higher risk for schizophrenia with CUD (142%) than females (102%). But among 16–20-year-olds, the risk for males (284%) was more than twice that for females (81%). They also found that during the 39-year study period, the annual average increase in PARF for CUD in schizophrenia incidence was 4.8% among males and 3.2% among females. In 2021, among males, this risk fraction was 15%; among females, it was around 4%.

Conclusions

The researchers concluded that “Young males might be particularly susceptible to the effects of cannabis on schizophrenia. At a population level, assuming causality, one-fifth of cases of schizophrenia among young males might be prevented by averting CUD. Results highlight the importance of early detection and treatment of CUD and policy decisions regarding cannabis use and access, particularly for 16–25-year-olds.”

ADHD Stimulant Drugs have Potential for Abuse at Schools that Carry Them

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Researchers have identified a strong association between prevalence of prescription stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) and rates of prescription stimulant misuse by students in US middle and high schools. Published in JAMA Network Open, the study highlights the need for assessments and education in schools and communities to prevent medication-sharing among teens. This is especially important considering non-medical use of prescription stimulants among teens remains more prevalent [PDF] than misuse of any other prescription drug, including opioids and benzodiazepines.  

The study used data collected between 2005 and 2020 by the Monitoring the Future (MTF) study. MTF is a large, multicohort survey of legal and illicit drug use among American adolescents in eighth, 10th, and 12th grade.

“The drug supply has rapidly changed, and what looks like medications – bought online or shared among friends or family members – can contain fentanyl or other potent illicit substances that can result in overdoses. It’s important to raise awareness of these new risks for teens,” said NIDA Director Nora Volkow, MD. “It’s also essential to provide the necessary resources and education to prevent misuse and support teens during this critical period in their lives when they encounter unique experiences and new stressors.”

Stimulant therapy is an evidence-based treatment for ADHD, but it can also be harmful if used without prescription or guidance from clinicians. Prolonged stimulant misuse can lead to several detrimental health effects including cardiovascular conditions, depressed mood, overdoses, psychosis, anxiety, seizures, and stimulant use disorder.

Previous studies have shown that more than half of adolescents who misuse prescription stimulants get the medication for free from friends or relatives. While diagnoses of ADHD and prescribing of stimulant therapy for ADHD have increased significantly in the United States over the past 20 years, few studies have looked at the relationship between stimulant therapy and prescription stimulant misuse in schools. This is the first large, national study to examine prevalence of prescription stimulant misuse and factors correlating with prevalence among students in eighth, 10th, and 12th grade across the U.S.

Researchers at the University of Michigan examined both school- and individual-level characteristics associated with prescription stimulant misuse. Across 231 141 student participants surveyed at 3,284 secondary schools, the school-level prevalence of nonmedical use varied from 0% to over 25% of students. Schools with a greater number of students (12% or higher) reporting prescription stimulant therapy for ADHD tended to have the highest percentages of their student body reporting prescription stimulant misuse (8% of total student body). By comparison, schools with fewer students (0 to 6% of student body) reporting stimulant therapy for ADHD were associated with lower rates of prescription stimulant misuse (4 to 5% of student body).

Other features of schools that were associated with increased rates of misuse included having a higher proportion of parents with higher levels of education, being located in non-Northeastern regions of the US and in suburban areas, having a higher proportion of non-Hispanic white students, and showing “medium-level” (10-19% of total student body) binge drinking. However, the association between school prevalence of stimulant therapy for ADHD and prescription stimulant misuse remained strong when accounting for prevalence of other types of substance use and numerous other individual- and school-level sociodemographics.

Recent research from this team expands on the associations found in this study, including a study that suggested teens with a history of taking both stimulant or non-stimulant medications for ADHD are at high risk for prescription stimulant misuse, as well as cocaine and methamphetamine use. The researchers note that it is important to interpret these results as associations, not causations, and that the primary goal of these kinds of studies is to inform effective preventative and support [PDF] strategies for teens.

“The key takeaway here is not that we need to lessen prescribing of stimulants for students who need them, but that we need better ways to store, monitor, and screen for stimulant access and use among youth to prevent misuse,” said study author Sean Esteban McCabe, PhD. “There’s variation in stimulant misuse across different schools, so it’s important to assess schools and implement personalised interventions that work best for each school. It’s also critical to treat and educate teens on prescription stimulants as the medications they are intended to be and limit their availability as drugs of misuse.”

Source: National Institutes of Health

Hair Analysis Reveals Double the Number of Adolescent Substance Users

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Far more children and adolescents could be using drugs than admitted to in surveys, according to a new US survey using hair analysis to test for actual drug intake. Published in the peer-reviewed journal American Journal of Drug and Alcohol Abuse, the study of nearly 1300 children aged 9–13 found that, in addition to the 10% self-reporting drug use, an additional 9% had used drugs as determined by hair analysis.

The paper suggests hair analysis far outweighs the accuracy of assessing drug use compared to survey alone, and experts recommend that future research should combine both methods.

“It’s vital that we understand the factors that lead to drug use in teenagers, so that we can design targeted health initiatives to prevent children from being exposed to drugs at a young age,” says study leader Natasha Wade, an assistant professor of psychology at the University of California, San Diego.

Adolescent substance use is a serious public health issue, with 5% of US 8th graders (ages 13–14) reporting cannabis use in the last year. The numbers are even higher for alcohol and nicotine use, with 26% of 8th graders admitting to drinking and 23% to smoking nicotine in the past year. These numbers are worrying, as substance use in adolescence is linked to negative life outcomes, but they may be even higher.

To find out a multidisciplinary team of experts, led by Dr Wade, asked 1390 children whether they had taken drugs in the last year. Hair samples were then also taken so that independent tests could confirm whether recent drug-taking had taken place.

Of the children who were asked if they had taken drugs, 10% agreed that they had. Hair analyses also showed that 10% of adolescents overall tested positive for at least one drug, with 6.1% testing positive for cannabinoids, 1.9% alcohol, 1.9% amphetamines, and 1.7% cocaine.

However, the children that self-reported drug-taking were not the same as those who tested positive through hair samples. In fact, of the 136 cases that self-reported any substance use and 145 whose hair samples were positive for any drug, matches were found for only 23 cases.

Most importantly, hair drug analysis revealed an additional 9% of substance use cases over and above self-report alone, nearly doubling the number of identified substance users to 19%.

“A long-standing issue in substance use research, particularly that relating to children and adolescents, is a reliance on self-reporting despite the known limitations to the methodology. When asked, children may mis-report (unintentionally or intentionally) and say they take drugs when they don’t, or conversely deny taking drugs when they actually do,” Dr Wade adds.

“But rather than scrapping self-reporting of drug use altogether, a more accurate picture of teenage substance use can be gained by measuring both.

“Self-reporting has its own strengths, for instance young people may be more willing to disclose substance use at a low level, but are less likely to when frequent drug-taking patterns emerge.

“Conversely, hair assays are not sensitive enough to detect only one standard drink of alcohol or smoking one cannabis joint. Instead, the method is better at detecting frequent and moderate to heavy drug use.

“Combining both methodologies is therefore vital to accurately determine the levels of substance use in the teenage population.”

Commenting on the findings of their paper, the authors also add however, that it is important to note that there is a chance that some, perhaps even many, of these youth are unaware that they even used a substance, as it could have been given to them by a parent or peer or they may have simply forgotten they had used it.

Source: Taylor & Francis Group

Doctors Lean on Science When it Comes to Smoking Cessation Best Practice

Vaping with an e-cigarette
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Scientific evidence that supports vaping as an additional approach to tackle smoking-related morbidity and mortality is fast growing. The time is ripe for decisionmakers to embrace tobacco harm reduction and to steer away from precautionary principle-based tobacco control policies. This is according to Dr Riccardo Polosa, Founder of the Centre of Excellence for the Acceleration of Harm Reduction (CoEHAR) and Professor of Internal Medicine of the University of Catania, Italy.

Towards the end of 2022, the South African Tobacco Products and Electronic Delivery Systems Control Bill was officially introduced into parliament by the Minister of Health. Now, in the coming months, it will be discussed and possibly amended by a portfolio committee.

With this Bill lumping Electronic Nicotine Delivery Systems (ENDS, i.e. e-cigarettes and vapes) in the same category as smoking, Kurt Yeo, co-founder of consumer advocacy group Vaping Saved My Life (VSML), explains that it is essential for those involved in this process to consider the mounting scientific evidence demonstrating that vaping is far less harmful than tobacco smoking and is an effective way to support smokers seeking less risky alternatives and/or wanting to quit.

Dr Colin Mendelsohn is an Australian academic, researcher and clinician, who has helped smokers quit for over 30 years, says that vaping nicotine is a more effective quitting aid than nicotine replacement products such as patches and gums and is the most popular aid for quitting or reducing smoking globally. “It has the potential to save the lives of hundreds of thousands of South African smokers and prevent untold disease and suffering.”

He adds that vaping has been estimated to cause no more than 5% of the harm from smoking. “While the long-term effects have not yet been established, e-cigarettes are certain to be far less harmful than smoking. Vaping carries only a small fraction of the risk of tobacco smoking and is an effective quitting aid or long-term safer substitute for smoking. Vaping should be easily accessible to help adult smokers to quit deadly cigarettes.”

Dr Polosa highlights that decisionmakers and the public should also beware of many flawed articles scientific and fake news that are propagating ‘findings’ of potential harms, thus feeding the counter-narrative that e-cigarettes are ‘not as safe as promoted’. “Proliferation of poor-quality science and fake news need to be actively contrasted by good quality science and by correct information/education.”

The proof is in the numbers

“Countries which have supported vaping such as the United Kingdom and New Zealand have had accelerated declines in smoking rates,” explains Dr Mendelsohn. “For example, in New Zealand the national adult smoking rate fell by an unprecedented 33% in the two years between 2020 and 2022 after vaping was legalised.”

Illustrating this point further, Dr Polosa says that according to the same national surveys used for reporting smoking prevalence to the World Health Organization (WHO), these countries show faster declines in smoking prevalence compared with neighbouring countries with lower uptake of these alternatives. “In Sweden and Norway, eradication of smoking is now almost a reality with a daily smoking prevalence among Norwegian and Swedish youth close to zero (1% and 3%, respectively). Widespread diffusion of e-cigarettes in New Zealand and the United States is also contributing to the historical acceleration in the downward trend in daily prevalence of smoking among young people (1.3% and 1.9%, respectively).”

Regulation is essential, but the proposed Bill is deeply flawed

When it comes to regulation, Dr Polosa asserts that vaping and smoking are completely different animals. “Smoking kills. Vaping does not.”

Therefore, to regulate vaping in the same way as smoking does not make any sense, says Dr Polosa. “Doing so denies smokers access to much lower risk products. Rather, the South African government should table a risk-proportionate approach where the main regulatory levers are applied differentially.”

“This means that the most stringent and restrictive regulation would be applied to the most harmful products: tobacco cigarettes. Regulation of the smoke-free alternatives would focus on consumer protection (i.e., benefits to the consumer) and control of uptake by adolescents in a way that does not cause significant harm to adult smokers. This would meet the demands of people who cannot or do not wish to quit completely, but with much less cancer, cardiovascular and respiratory disease as a result,” Dr Polosa explains.

Dr Mendelsohn agrees and says that the preferred regulatory model is for nicotine liquids for vaping to be sold as adult consumer products from licensed premises, with strict age verification, like cigarettes and alcohol. “Regulation of e-cigarettes should be proportionate to risk and a light touch approach is more appropriate. A balanced regulatory model is needed which allows adult smokers easy access to regulated vaping products while restricting access to underage users. The current proposals will restrict adult smokers’ access to an effective quitting aid which can save lives and prevent smoking-related illness.”

“A precautionary approach to prevent the use of much less harmful smoke-free products is unjustified in the face of the massive burden of smoked tobacco products, which are widely available. This principle requires policymakers to compare the risks of introducing a product with the risks of delaying its introduction. In the case of vaping, the relatively small risks of harm will be outweighed by the far more substantial harms from delaying access to current smokers,” Dr Mendelsohn explains.

He points out that harsh restrictions on the sale and marketing of electronic cigarettes will have negative unintended consequences and will lead to black market sales of unregulated products to both adults and children. “The public health goal should be to encourage smokers who are unable to quit to switch to vaping, a far safer alternative.”

Yeo concludes by saying: “With the Bill aiming to reduce the incidence of tobacco-related illness, disability and death, regulations should be drawn up based on all available research and case studies to ensure South Africa’s smokers are truly helped.”