Société française de tabacologie Paris 2014

Société française de tabacologie
Paris 2014
Méthode et résultats du
consensus d’experts suisse sur
la e-cigarette
Prof Jacques Cornuz, Dr Jérémie Blaser
Policlinique médicale universitaire, CHU
Lausanne, Suisse
Plan
• La situation en Suisse
• L’étude Delphi
• Les recommandations suisses
• Conclusion
• Discussion
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E-cigarette: situation en Suisse
• Actuellement, les cigarettes électroniques
sont disponibles en Suisse, mais seuls les
liquides ne contenant pas de nicotine
peuvent être vendus.
• Les e-liquides contenant de la nicotine
peuvent être achetés à l’étranger ou bien
commandés sur Internet à l’étranger, avec
une limite maximale de 150 ml /
personnes
7%
16%
BAG Bulletin
18/2014
Quelle évolution?
Switzerland: cigarettes sales (mios)
20000
Cig. « légères »
18000
16000
2e rapport
E-cig
14000
12000
10000
1er Rapport du surgeon
general
?
Filtre à cigarettes
8000
6000
4000
2000
1941
1943
1945
1947
1949
1951
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1959
1961
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1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
0
Nombre de cigarettes vendus en Suisse (mios)
5
Swiss-vap Study
Context
• Many questions from patients and the media
re. nicotine e-cig.
• Little scientific data about safety and efficacy
• Different opinions among Swiss experts
• No specific regulation in Switzerland
• Expectations from local authorities, doctors,
health care professionals, …
-> Need for an actual position of tobacco
experts in Switzerland
Objective
• To propose recommendations for health
authorities concerning:
– Regulation
– Sale
– Use
• To get the general opinion of experts about
e-cigs.
Method (1)
• Principle of the Delphi method:
– 1st Round: Questionnaire is sent to an experts’
panel
– 2nd Round: New questionnaire is sent to the
experts, with the results of the first Round,
allowing them to modify their position
depending of the results of the first round.
– This process is repeated to optimize the
consensus possibilities
Method (2)
• In this Delphi process:
– Online questionnaire
– Experts rate the recommendations, weather
they agree or disagree, on scale from 1-10, or
– Rank some propositions, from the most
appropriate to the least appropriate
Method (3)
• Recommendations with high level of
consensus are not rated again in following
questionnaires.
• Recommendations with low levels of
consensus are formulated again, with or
without modification, depending on:
– Extent of disagreement between experts
– Comments and suggestions from experts
• 4 rounds needed for the present study
Experts’ participation
September 2013
Invited experts
(N=113)
September 2013
Invitation
accepted (N=46)
October 2013
Answers to 1st
round (N=40)
November 2013
Answers to 2nd
round (N=39)
December 2013
Answers to 3rd
round (N=39)
January 2013
Answers to 4th
round (N=38)
Inclusion criteria for invited experts:
-Trainer physicians of the program “Vivre sans tabac”
(N=58)
-The physicians of the network “Hospital quit support”
(N=8)
-Heads of the different public health services of the Swiss
universities (N=5)
-Experts known for their implication in clinical or political
tobacco prevention, as well as in public health programs
(N=42)
Experts’ panel
Location of business
place
Invited experts (N=113)
Experts Round 1
(N=40)
German-speaking part
57% (N=64)
40% (N=16)
French-speaking part
37% (N=42)
55% (N=22)
Italien speaking part
6% (N=7)
5% (N=2)
Type of expertise
Invited experts (N=113)
Experts Round 1
(N=40)
Federal Commission for
Tobacco Control
17% (N=15)
12% (N=5)
Smoking cessation
68% (N=85)
80% (N=32)
Proposed by other
experts
Gender
15% (N=13)
8% (N=3)
Invited experts (N=113)
Experts Round 1
(N=40)
Male
68% (N=77)
65% (N=26)
Female
32% (N=36)
35% (N=14)
Online Questionnaire
Definition of Consensus
If mean value is:
-Between 1-3
-Between 8-10
High level of agreement
Low level of agreement
Regulation
• Nicotine e-cigs should be sold in Switzerland
with a specific regulation, not through the
2013 Swiss laws (Federal act on foodstuffs
and utility articles).
• E-cigs should be considered as either:
– A drug (medication), regulated by Swissmedic
– New category of product containing nicotine (for
example: included in the new law on tobacco
products)
• E-cigs should not be labeled as :
– A tobacco product (such as tobacco cigarettes,
Regulation
• If e-cigs with nicotine were to be
authorized in Switzerland, companies
should:
– Respect a list of authorized e-liquids
components
– Be on a list of accepted models with
specific requirement
– Respect an upper limit of nicotine
concentration
• Advertisement should not be allowed:
– In the media
Regulation
• A warning should be stated on the product,
especially concerning the addictive
potential and the lack of evidence on the
long term security of the product.
• The components of e-liquid should be
stipulated on the product.
• A specific tax should be implemented on
e-cigs.
Sale
• Whatever the status of e-cigs, sale should be
restricted to adults.
• If e-cigs were considered as a medication,
restrictions should be proposed for minors
and pregnant women.
• If nicotine e-cigs were to be authorized in
Switzerland, they should not be sold by
tobacco industry or related.
• E-cigs should be sold either in:
– Pharmacies or kiosks
Use
• The use of e-cigs should be forbidden in
public places.
• Health authorities should advise never
smokers not to use e-cigs (e.g. through a
public campaign)
• Health authorities should not encourage
smokers to shift to e-cigs to help them quit
smoking as first line therapy.
General opinion
• If e-cigs become a popular product,
nicotine addiction should be seen as a
medical issue and a public health issue.
• Research should assess:
– Long-term inocuity
– Efficacy as a quitting tool
– Psychological and social effects
– Dual consumption: e-cigs and tobacco
products
• On the appraisal of the current data, e-cigs
Recommendations without consensus
• The following professionals should now
encourage current daily smokers to shift to
e-cigs:
– Healthcare professionals, on an individual
basis (5.92)
– Education professionals, on an individual
basis (3.97)
• Swiss legislation should follow EU
regulation (7.14)
• Given the current situation, with only few
data about security, safety and efficacy of
Statements without approval
• In your opinion, if e-cigs are not regulated, they
are likely to be used for the following:
– In sports, e.g. hockey (5.34)
– For brain enhancement, e.g. for exams, students
(7.16)
– For weight control (7.13)
– For the administration of illegal drugs (7.3)
– For one or more of the above unexpected use (7.52)
• For regular tobacco cigarette smokers, a dual
consumption might decrease the willingness of
quitting tobacco smoking (6.26)
• Instead of quitting tobacco cigarettes, the
likelihood of dual consumption (tobacco cigarettes
and e-cigs) by regular tobacco cigarette smokers
is high (7.92)
Implications
1) E-cigs with nicotine should be sold in Switzerland.
2) A specific regulation should be enacted, for example
included in the new law on tobacco products.
3) Sale should be restricted to adults.
4) Quality standards, upper limit of nicotine
concentration and a list of authorized components
should be implemented.
5) A specific tax should apply, to finance research on
the product in particular.
6) Advertisement should be restricted.
7) Use in public places should be forbidden, in order to
diminish the risk of renormalization, to protect people
from passive vaping and to avoid potential confusion
with passive smoking
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Merci de votre attention
[email protected]
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