Smuggled cigarettes and the lack of regulations for smoking devices make health and tobacco dependence worse in Ecuador, according to a doctor who signed a global letter

Cigarette smuggling, which even questions their origin (and, therefore, the materials with which they are made), is one of the factors that worries a group of doctors due to the additional damage that it would cause in smokers and for encouraging more and more consumption to the child and adolescent population.

The same occurs with so-called reduced-risk devices (such as electric cigarettes, vapers and others), whose entry into the country is not regulated and that prevents knowing, for example, if they have nicotine or not, the amount they have and more details, says the Ecuadorian doctor Enrique Terán, Ph.D. in Pharmacology and one of the 100 experts in the world who sent, last month, an open letter to the 182 parties or countries of the Framework Agreement for Tobacco Control, for a position to be adopted more open in the fight against smoking and the damage it causes to health.

Terán, who is also a university professor in Ecuador and a member of the Latin American Network for the Reduction of Damages Associated with Smoking, participated, at the end of last October, in the fourth scientific congress on reduction of damages by smoking that was held in Colombia, country that seeks to pass a law that regulates the use of so-called reduced risk devices.

Terán, the only Ecuadorian signatory to the letter to the 182 countries, urges national authorities and representatives, such as the Ministry of Public Health (MSP) and the Health Commission of the National Assembly, to also discuss this issue in Ecuador.

Are there fewer and fewer tobacco users or have all these campaigns that have taken place worldwide not been so effective, have they not yielded good results?

The evidence presented by international organizations such as the World Health Organization (WHO), the Pan American Health Organization (PAHO) and even the Ministries of Health show that smoking is decreasing in different countries, however, we The question is always left to us: what is the origin of this information?

In the case of Ecuador, for example, unfortunately the primary source is tax collection through the payment of taxes to the SRI (Internal Revenue Service) and, of course, it is extrapolated and it is said that as less taxes are being collected, the cigarette consumption is going down.

Cigarette leaves 19 deaths a day in Ecuador, according to research

But it is enough to stand in the streets, on the street corners and see how informal vendors, the traders, who sell smuggled cigarettes have proliferated, cigarettes that do not have a sanitary registration, that do not have any control and that much less pay taxes. This is unfortunately generating a bad perception of the success of these campaigns… An official pack or pack of cigarettes (of 20 units) costs around $ 5 or $ 6, (but) these (some) Chinese cigarettes that they sell cost a pack of 20 units only $ 1 or $ 1.20, which means that the possibility of increasing cigarette consumption is much higher.

So with these under-registrations, there are now more risks that there are more patients developing the diseases derived from smoking?

We now have a problem that is getting out of control, because we not only have to take into account tobacco damage, but also the damage of those tobacco products of doubtful origin. It is for this reason that consumption in the child population is increasing considerably.

The Ministry of Health (MSP) itself in its report published in the Ensanut 2012 (survey) realized that an average 50% of the Ecuadorian adult population, between 18 and 70 years old, has smoked or actively smokes, and we are concerned to a great extent that they report that 30% of the population between the ages of 14 and 17 has also smoked.

Life expectancy increases in those who quit smoking

And even more, the population between 10 and 13 years of age, so they report that approximately 9% or 10% of this population has had direct exposure to cigarettes through smoking. It means that the control measures are not giving the expected results and that the problem is increasing in Ecuador.

On the subject of diseases, smoking is always linked to lung cancer. In these conferences, have you been able to show or record other types of diseases linked to tobacco use?

The best-known icon is lung cancer, but let us remember that tobacco is the leading cause of chronic obstructive pulmonary disease, which is a disabling disease and is increasingly making its debut in younger people, precisely because of indiscriminate cigarette smoking.

Unfortunately, we in the country (Ecuador) do not have an official data regarding this pathology. To put in context, in Colombia (where the medical congress took place, in recent days) chronic obstructive pulmonary disease is the third cause of death despite the fact that Colombia in the region has the lowest rate of cigarette consumption, 13 million of Colombians at least suffer from this pathology.

In Ecuador, the figures should not be very different, even more so when, according to figures published a couple of years ago (and the existing ones) in some studies, they show that around 30% to 35% of the Ecuadorian population is a smoker active.

What diseases can nicotine cause besides addiction?

Nicotine per se Its only fundamental problem is this addictive phenomenon, a phenomenon that is closely related to the stimulation of the central nervous system. Nicotine suppresses sleep, suppresses appetite, improves alertness, improves mental responsiveness, and all of that seems positive.

Unfortunately, nicotine has a pharmacological phenomenon called tolerance or desensitization, which means that I consume nicotine and have beneficial effects, but that effect disappears quickly and for it to reappear I have to consume more, more and more … So that’s where the process of tobacco dependence comes from, which makes the individual have to consume more and more to obtain the same results.

With these reduced-risk devices, the advantage is that that individual can receive and control the amount of nicotine that is administered in order to gradually decrease it and achieve, therefore, better results.

Whoever has used traditional tobacco and then switches to these low-risk products, is he going to become dependent on these products or is he able to overcome smoking, to quit?

Without any kind of advice, it is possible to think that you will go from one addition to the other. However, the real spirit of these devices is that with the right support it allows you to gradually reduce the consumption of nicotine until in some cases it is simply a vape. What many people use is simply an essence that does not contain nicotine in order to have that satisfaction of being able to breathe something out.

So these low-risk products have nicotine, and what other ingredients?

Inevitably they have a flavoring that is usually what makes them attractive and what gives them greater plasticity than cigarettes. For everyone who has been exposed to cigarettes, the smell of cigarettes is distinctive and not pleasant. These products are flavored and, of course, there is a wide spectrum of essences and flavors, which obviously must be analyzed and regulated, and may or may not contain nicotine. That is where the regulatory agency must come in, to regulate the nicotine content that is included in these products.

And do you know about how many of these low-risk products are in the Ecuadorian market? More than 10, more than 20?

In concept, the products of reduced risk include the electronic cigarette, vapers, the use of smoking incineration devices that do not produce combustion, but produce incineration and therefore are of reduced risk. Within each of these groups there is a multiplicity of offer, depending on the manufacturer.

He is the only Ecuadorian doctor of the 100 who sent a letter to the WHO to discuss these other alternatives for patients who consume tobacco … Have they been able to notice a decrease in the effects and damages in patients? have as scientific evidence?

There is enough data. For people who smoke there are two fundamental problems: on the one hand, physical dependence, a product of the nicotine content of cigarettes. And on the other hand, there is the psychological dependence, the satisfaction, the tranquility, the pleasure that (they say) smoking gives them. There are several drug alternatives to try to help the patient to quit smoking, however, the vast majority of them focus primarily on physical addiction, they do very little about psychological addiction and that is why it is documented that the rates of failure, smoking relapse rates are extremely high.

Trade in foreign cigarettes that do not comply with labeling proliferates and affects local industry

For this reason, these so-called reduced risk products are intended to be an additional support for the process. We do not want to be misunderstood that these products are healthy, risk-free, the term is explicit, they have a lower risk than the original product, which is the combustion cigarette. That is why we respect and support the criterion that it should be insisted on trying to minimize the adoption of new smokers to any of the strategies, but the burden that patients who currently smoke represent on the State must be taken into account.

And what would these alternatives be for those who cannot quit tobacco addiction? Is it giving them these reduced risk products?

The alternative in the first place is to generate a regulation regarding these devices. At the moment, in the country, as in many others in the region, access to these products is not regulated. There is no registration or review by the health authority, therefore, these products are sold without a health registration, no one controls the origin, no one controls the components, much less the quantity (and) what to say about the price. It is a question of supply and demand at the moment.

The first thing to do is create a regulation so that these products have a legal connotation. Existing that, health professionals, doctors, will be able to suggest these to their patients as a medical alternative so that they can overcome their addiction to cigarettes and can reach the goal of quitting tobacco use. Number three, the illicit market is going to end and what lies behind it, which unfortunately ends up being dangerous and can become harmful. (I)