Deputy Mary Mitchell O'Connor: I have been following with increasing alarm the debate about the dangers of electronic cigarettes. Today, Dr Edel Duggan, clinical director of the National Poisons Information Centre, informed my office that she, too, is very worried about the dangers posed by electronic cigarettes. She is especially concerned about the alarming spike in the number of children in particular who have suffered from nicotine poisoning in the past two years. Dr Duggan believes there could be a fatality if the problem is not addressed urgently. Nearly as many cases of nicotine poisoning were recorded in the first three months of this year as in the whole of 2013. The statistics we received today were frightening. They include 17 cases, comprising 11 children under the age of six, two teenagers and four adults. The National Poisons Information Centre believes the real number of nicotine poisoning cases is likely to be much higher. An electronic cigarette is a battery operated device designed to deliver nicotine, flavour and other chemicals which are vaporised into an aerosol and inhaled by the user. These e-cigarettes contain liquid nicotine, which can cause acute illness and vomiting in young children. Severe nicotine poisoning can lead to coma, convulsions, heart attack and respiratory arrest. A measure of 40 milligrams per millilitre has the potential to be fatal, and some of these e-cigarettes on the market have 36 milligrams of nicotine per millilitre, which is too close for comfort. The e-cigarette industry advises that the e-cigarette cartridges should be stored out of reach of children but as we know, children are well able to get something they want, especially if it is attractive. Sales of e-cigarettes in Ireland have increased by 500% in the past year and it is a business in this country worth over €7.3 million. The industry is reported to have been worth €3 billion on a global scale last year. E-cigarette packaging is attractive and they have attractive flavours, which is a deliberate attempt by the industry to target young people. The marketing is clever in that it avoids falling under any other regulatory framework that would otherwise protect the public and children in particular. I am worried, Dr. Duggan is worried and the Minister for Health should be worried.  

Minister for Health (Deputy James Reilly): I thank the Deputy for raising this very important issues. As the Deputy is aware, I have been very public regarding my aims and objectives regarding smoking and tobacco, particularly the harm they cause in Ireland. With regard to e-cigarettes, these products are not presented by the manufacturer as medicinal products for smoking cessation or as medical devices with a therapeutic purpose, so they do not fall under the medicinal products or medical devices legislation. As e-cigarettes do not contain tobacco, they are not currently regulated under Irish tobacco legislation. At the European level, the European Council has recently adopted a new EU tobacco products directive, which will come into force later this month. This new directive provides for the regulation of e-cigarettes by setting mandatory safety and quality requirements, such as those on nicotine content, ingredients and devices, as well as refill mechanisms, etc., for e-cigarettes. It also looks to ensure products are child-proof and tamper-proof, and this is clearly a relevant issue from what the Deputy has stated. The directive would also make health warnings and information leaflets obligatory, introduce notification requirements for manufacturers and importers of e-cigarettes and impose stricter rules on advertising and monitoring of market developments. The tobacco products directive also states that member states are free to regulate such matters within the remit of their own jurisdiction and are encouraged to do so. A World Health Organization study group report concluded that the safety and extent of nicotine uptake from e-cigarettes has not been established and not enough scientific evidence existed to validate the claim that the products were smoking cessation aids. The report also notes that the delivery of nicotine to the lung might be dangerous and that it was of global importance to address lung delivery in scientific studies. Further research and clinical trials were recommended by that group at that time. Of further concern, although not directly related to exposure to the potential harm from second-hand aerosol, is the impact that the use of e-cigarettes might have on the enforcement of the ban on smoking in enclosed public places. As e-cigarettes can often look like cigarettes and emit smoke-like material, it can cause considerable confusion as to whether the person using the e-cigarettes is smoking a cigarette. Additionally, there is a concern that the policy objective of denormalisation of tobacco use could be compromised by the open use of e-cigarettes in places where cigarette smoking is prohibited. This is a critical point to understand. If one asks a smoker why he or she began the habit, the response will not be because he or she liked it. Most people feel ill the first time they inhale smoke, as it is a toxin, a carcinogen and cigarettes kill one in two people who take up the smoking habit. People are drawn to the habit because they feel it makes them seem "cool". If we allow e-cigarettes to facilitate people to continue with a habit that resembles smoking, we will undermine the public health policy of denormalising smoking, particularly where children are present. Following this rationale, the use of e-cigarettes will no longer be permitted in any of the Health Service Executive's facilities or campuses. The ban commenced on 1 May as part of the HSE's tobacco-free campus policy, which, in line with Tobacco Free Ireland, our national policy, aims to denormalise smoking and protect the health of staff and patients. The executive has committed to reviewing this policy as new evidence becomes available. Other bodies have also taken the initiative, including larnród Eireann, and all organisations and agencies are free to do so on a voluntary basis. My Department is currently reviewing the available international research and literature relating to e-cigarettes, including the health effects of these devices. Based on the results of this exercise, it is my intention to introduce further regulation on e-cigarettes as necessary and appropriate. I acknowledge, understand and share the Deputy's concerns regarding the use of devices such as e-cigarettes. I understand this from a health perspective both in terms of the user and people exposed to the emissions. I am also concerned from a tobacco denormalisation perspective and taking into account any erosion of significant developments in the tobacco area in the last decade. As stated, there is a lack of research and evidence regarding the long-term effects of such devices given that they are a relatively new phenomenon. Whereas anecdotal evidence is emerging regarding the assistance of such devices in achieving smoking cessation, no hard evidence supports this conclusively. It is important to state that the majority of the manufacturers of these products do not present or licence them as smoking cessation aids. With this in mind, the steps taken by the EU Commission in the new tobacco products directive on the regulation of e-cigarettes is a positive development. As stated, my Department is reviewing this area and based on this I intend to further regulate this area as appropriate.  

Deputy Mary Mitchell O'Connor: I appreciate that the Minister has stated that e-cigarettes are not presented as medicinal products and do not fall under medical products legislation. I welcome the HSE banning the use of e-cigarettes on its facilities, and I welcome other organisations who have voluntarily banned the use of e-cigarettes, including Irish Rail, Bus Éireann, Dublin Bus, Dublin Airport and Aviva. However, I am worried by what people like Harvard professor and director of the Center for Global Tobacco Control at Harvard University, Gregory Connolly, stated recently in Dublin. He argued that, if unregulated, e-cigarettes could be the panacea for the tobacco industry's woes by discouraging quitting and encouraging children to take up smoking. He also indicated that, if regulated, e-cigarettes could offer a miracle in helping people to quit smoking. Professor Connolly urged Ireland to show leadership within the EU by passing a law to regulate e-cigarettes as medical devices. In the meantime I will listen to Dr. Duggan's concerns that e-cigarettes could cause a fatality. She is urging parents to keep them out of the sight and reach of children at home and be especially careful in disposing of them after use. E-cigarettes are unregulated but they should be regulated.  

Deputy James Reilly: I thank the Deputy for raising this very important issue, as it is a serious concern. As the Deputy pointed out, there have been 17 cases of liquid nicotine poisoning reported by the National Poisons Information Centre in Ireland and God knows how many there have been elsewhere around the world. Nicotine is a highly addictive and dangerous drug and of what benefit is it to become addicted to nicotine? There is no benefit, so why would one allow marketing of these products to people as a lifestyle choice when all that can come of it is harm? If e-cigarettes have a role in smoking cessation, let it be proven before claims are made in this regard.   The World Health Organization strongly advises against the use of e-cigarettes until they are proven safe. Studies to be published later this month indicate that some e-cigarettes produce a known carcinogen that would be inhaled by users because of fumes produced at such a high temperature. A second study prepared for the same journal has similar findings, and I am aware of a study which indicates that nicotine by itself can facilitate progression and metastases of tumours. A study published in The Lancet indicates that 94% of people who attempted to quit smoking using e-cigarettes had failed to do so after six months, which is a pretty lousy return.   E-cigarette use among teenagers in the US has doubled in a single year, which must be a grave concern for us. Almost a quarter of teenager e-cigarette users in the US do not smoke regular cigarettes. We all know the impact of smoking on our society, with one in two smokers dying of a related disease. Families suffer hardship from cancers, strokes, heart attacks and the loss of meaningful and useful life years as a consequence of the habit.   I disagree utterly with the outrageous statement made by an individual on the radio recently suggesting that the very welcome reduction in people smoking was due to these products. There is no evidence to support that for half a moment. This reduction has been the result of tremendous work done by the Health Service Executive, HSE, the Department of Education and Skills, the Department of Health, the Irish Cancer Society, the Asthma Society, the Irish Lung Foundation and many others who have worked to try to inform people of the dangers of this heinous and deadly product and to prevent our children's ever taking up this habit