Researching safer alternatives to cigarette smoking

Last updated 12 Jan 2013

R & D plan 2003-2016: the quest for safer product choices for smokers

Conclusions so far

The electronic cigarette is far safer than cigarettes and is for some smokers a lifesaving alternative, which should be treated as an important aid in achieving New Zealand’s smokefree nation goal by 2025 and so should be made available for regulated sale within NZ.

Cigarette smoke kills thousands annually in New Zealand. No deaths due to nicotine have been reported.

In 2003 Health New Zealand found factory-made (FM) cigarettes burnt completely but hand-rolled cigarettes self-extinguished. The paper of FM cigarettes was laced with accelerant. A standard for slower burning has now been written but still not implemented by tobacco companies.

In 2006 after research on the Marlboro UltraSmooth cigarette, Laugesen and Fowles concluded that even with the best filters devised, smoking combustible cigarettes is irredeemably dangerous. Reducing cigarette harm is therefore a matter for advocacy to reduce cigarette sales. (see www.endsmoking.org.nz) and to provide safer alternative products (www.healthnz.co.nz )

In 2006 Health New Zealand Ltd began to test safer (non-combustible) smoking substitute products, but nasal and oral snuffs attracted little support from smokers or funders.

In 2006, Dr Laugesen began studying nicotine products, first oral products (spray, pouch, lozenge, gum) and how these could be used more effectively (before quitting, by providing more alternatives, by using them alongside denicotinised cigarettes). These studies have encouraged improvements in the use of nicotine as medications, but nicotine medications are not to every smoker’s liking.

In 2007-9 Dr Laugesen studied vapourised nicotine – being the first to test the e-cigarette outside of China during 2008, and then with Jed E Rose of Duke University in 2009, became the first to test the nicotine pyruvate cigarette. Duke’s rights to the nicotine pyruvate cigarette patent have been sold to Philip Morris. The (recreational) nicotine electronic cigarette is preferred by most smokers to the current nicotine medicinal inhaler, and its sale in NZ remains illegal in April 2012.

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Health New Zealand Ltd’s 2003-2013 R& D plan to promote safer alternatives to cigarette smoking

Name of product

Barrier to increased sale

Manufacturer

Remarks

Next steps

Health New Zealand Ltd role

Tobacco Products – combustible

 

 

 

HNZ 1 Firesafe cigarettes

Manufacturers fail to supply market with fire safe cigs.

All cigarette manufacturers

No fire-safe cigarettes on sale: No NZ regulations

NZ Standards in 2009 adopt fire- safe standard

In 2003 in Tobacco Control showed RYOs are firesafe. HNZ in 2009 helps set Standard via Standards Committee.

HNZ2 Marlboro UltraSmooth

Since our research, this MUS brand withdrawn from sale.

Philip Morris USA

No safer than a Holiday regular brand

Project complete.

Published research on this cigarette in 2006 in Tobacco Control. Cigarettes can’t be made safe to an acceptable degree.

Tobacco products – Denicotinized

HNZ 3 Very low nicotine denicotinised cigarettes

RNCs not sold commercially in NZ at present

Vector Tobacco Company

Funded by HRC

Do very low nicotine cigarettes

Help smokers to quit?

Yes.

Quitting increased by using VLN cigarettes.

Dr Laugesen a co-investigator in this 3 year study, the RELIQ study.

Published 2012

HNZ 13 2012

No explanation of policy

No external funding

Will Denics reduce addiction?

Yes they will says prior research.

Published 2012

HNZ 14 2013

 

Lack of pilot testing in smokers not wanting to quit

22nd Century

Funded by Turanga fund

If sold with own brand, what mix do smokers use?

NIHI Univ of Auckland to complete this study in early 2013

To be published

HNZ as co-investigator

HNZ 15 2013

2nd pilot

?

Fine tuning

finish 2014

Co-investigator

 

Tobacco Products – non-combustible – oral and nasal

HNZ4 Swedish Snus

(moist tobacco snuff)

Requires law change to allow sale. Regulations needed to exclude snuffs not in line with Swedish standards.

Swedish Match

 

Can’t be sold in NZ. Can be imported for personal use; cost prohibitive due to tax.

RCT for stop smoking study still needed. Lack of non-tobacco donor.

Co-applicant with Professor Crane, Wellington School of Medicine, to HRC for funds for RCT for stop smoking; Not successful in 2006, 2007, 2008.

HNZ5

Nasal tobacco snuff

Legal to sell, illegal to advertise. No public information on (low) relative harm of snuffs.

Swedish Match

Few repeat sales in 2007-8. Sales cannot succeed while advertising banned.

No further research worthwhile as sales low.

Health NZ research on nasal snuff now complete and displayed Website publication www.endsmokng.org.nz

Nicotine-only products – not inhaled

 

 

 

HNZ 6 Nicotine gum, patch, lozenge

Subsidised by government through vouchers.

Pfizer, Novartis

Aims to elucidate benefits of greater choice for quitters.

CTRU RCT is finished recruiting.

Co-investigator wth CTRU team. (the SONIQ study) For Published.

HNZ 7 Nicotine pouch, spray, lozenge.

Sale in NZ requires registration as a medicine. Market small. NN has not yet applied to sell it in NZ.

Niconovum AB. (NN) Helsingborg, Sweden

On sale in Sweden in 2009. Mouth spray also, and gum.

CTRU with HNZ completed PK study** in 2007. NN later sells out to Reynolds Tobacco Coy.

Co-investigator with CTRU. (The NEWS study). Published. McRobbie, 2009, 2010.

.

Nicotine-only products – inhaled

Electronic cigarette A). HNZ8 PK testing and effect on cravings

B) HNZ 9

C) Electronic cigarette Benchtop safety tests

Sale in NZ requires approval as a medicine. Sale is permitted in USA and UK as a cigarette alternative.

Ruyan (Holdings) Ltd, Hong Kong and Beijing, China. Funded by manufacturer

(Ruyan)

In 2008, Health NZ Ltd is main tester for Ruyan outside of China. Back-ground paper 2008 for WHO’s Tobacco Regulation Committee.

PK testing finished, 2009.

Co-investigator. (the WIRED study) Contract manager for the funder. Published 2010.

Safety testing completed, 2009.

Coordinator and principal investigator

Published 2012

HNZ 10 Nicotine pyruvate inhaler/ cigarette

Not in production. Not registered for sale.

Prototype only

Inventor Dr Jed Rose.

Funded by Duke Univ. North Carolina USA

A novel product tested in 2009.

Managed testing in Christchurch. Co- investigator. Published 2010.

HNZ 11

E-cigarette RCT

Study of efficacy in Smoking cessation

Hydro e-cigarette with and without nicotine.

Funded. Health Research Council of NZ

RCT E-cig v.Patch and v. placebo.

2011-2013

Co investigator, CTRU

First such trial of an e-cigarette to be funded. Published Sept 2013.

HNZ 12

2012

How e-cigs fit into tax and price policy

Collaborating with U of Canterbury (UC), Victoria U. Wellington (VUW) and CTCR U of Auckland

Funded by Canterbury Community Trust

Poster at SRNT Boston Mar 2013

 

Co-investigator, Cost of smoking study Wave 1. Completed. Dec 2012

HNZ 12

2013 cont’d

Validation of intentions at new price.

Papers to be published in 2013

Cost of smoking study -2013 Wave 2 Followup of Wave 1 people Jan-Mar 2013

HNZ 12 cont’d

 

Validation of intentions as price increases

UC and all

TBA

 

Cost of smoking study 2013-14 Published Tob Control 2014; also NTR 2014.

HNZ 16

Testing e-cigarette brands

Health NZ and e-cigarette manufacturers

Health NZ

 

Published 2015 NZ Med J 

*RCT = Randomised Controlled Trial. CTRU = Clinical Trials Research Unit, Univ. of Auckland.

# NHF = National Heart Foundation. NIHI National Institute Health Innovation (formerly CTRU).

**PK study = pharmacokinetic study to show whether blood nicotine increased.

Health New Zealand Ltd 2013