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On 28th August 2018 the Ministry of Health and Family Welfare has released an advisory on Electronic Nicotine Delivery Systems (ENDS) including e-Cigarettes, Heat-Not-Burn devices, Vape, e-Sheesha, e-Nicotine Flavoured Hookah and the like products on their official website. It spoke in lengths about Electronic Nicotine Delivery Systems (ENDS) and its ill-effects. While ENDS and the products that come under this umbrella like e-Cigarettes, Heat-Not-Burn devices, Vape, e-Sheesha came to existence to reduce the dependence of tobacco and curb smoking, turns out that these products have their own perils.
What is ENDS?
Electronic Nicotine Delivery Systems (ENDS) are devices that heat a solution to create an aerosol, which frequently also contains flavours, usually dissolved into propylene glycolor/and glycerin. Electronic cigarettes, the most common prototype, are devices that do not burn or use tobacco leaves but instead vaporise a solution, which the user then inhales. The main constituents of the solution, in addition to nicotine when nicotine is present are propylene glycol, with or without glycerol and flavouring agents. ENDS solutions and emissions contain other chemicals, some of them considered to be toxicants.
Why they can be dangerous?
Also, aerosol contains nicotine, the addictive component of tobacco products. In addition to creating dependence, nicotine can have adverse effects on the development of the foetus during pregnancy. It may contribute to cardiovascular disease to the people who use ENDS. Also, nicotine may function as a "tumour promoter" and seems to be involyed in the biology of malignant diseases. Foetal and adolescent nicotine exposure may have long-term consequences for brain development, potentially leading to learning and anxiety disorders. A number of metals - including lead, chromium, and nickel, and chemicals like formaldehyde have been found in aerosols of some ENDS, with concentrations equal to or greater than traditional cigarettes, under normal experimental conditions of use. As such, the evidence is sufficient to warn children and adolescents, pregnant women, and women of reproductive age, points out the ministry.
We spoke to Dr Anand Jaiswal, Director, Respiratory and Sleep Medicine, Medanta to know the ill-effects of e-cigarettes, here is what he has to say, "E-cigarettes were first introduced in China and has thereafter spread across the globe. It was initially believed that e-cigarettes are safer compared to the normal ones as it contains nicotine and not harmful carcinogen which exposes people to the risk of cancer. However, over time, studies found that the liquid chemical in e-cigarettes when inhaled for an extended period maybe detrimental for the lungs. This gives rise to concern over the safety of e-cigarettes as there is also a belief that they might contain a certain level of carcinogens which can harm the lungs, if consumed over a prolonged period. The FDA has not issued any safety notification on the use of e-cigarettes yet."
The ministry has so directed the states and union territories to monitor the sales of these products and check if they comply with the guidelines of Drugs and Cosmetics Act, 1940 which require them to be manufactured under a valid drug manufacturing license and also a valid sales license for products containing more than 2mg of nicotine. The Drugs and Cosmetics Act, 1940 & Rules, 1945 permit the use of Nicotine up to 2 mg and 4 mg in gums, Iozenges and strips, which may be used as aids for Nicotine Replacement Therapy (NRT).
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