靠「電子煙」拚經濟?

魏玉亭(成大醫院醫師)、翁鼎家(成大醫院醫師)、王榮德(成大醫學院公衛所講座教授)

電子煙最近受到媒體與社會大眾的矚目。有人認為電子煙比香菸安全,還可用來戒菸,電子煙產業發展協會更宣稱「電子煙可以改善健康,振興經濟」。但本文站在維護全民健康的立場,提出不同觀點。

電子煙前身是攜帶式霧化器,主要是利用電子元件將液體狀的藥物霧化成蒸氣,治療氣喘等呼吸道疾病。電子煙的發明者則將含有尼古丁及其他添加物的液體霧化成蒸氣,藉此取代燃燒菸草,希望減少燃菸產生的致癌物。

然而,大部分的電子煙產品仍會釋出潛在的毒性物質。例如電子煙煙霧中常見的甲醛就是第一級致癌物,會造成DNA的傷害和突變,長期暴露會增加癌症並對生殖系統造成危害。還有乙醛是2B級致癌物,以及鉛、錫、鎳等重金屬,均會導致使用者的健康受損。此外,二手煙霧也會增加室內細微顆粒(包括PM2.5)及尼古丁濃度,影響大眾健康。

傳統菸品產生的致癌物在電子煙中雖有減少,但在未禁售菸品的整個大環境底下,已有相當證據顯示,電子煙會增加青少年與年輕成人嘗試抽香菸的風險,造成使用菸品的年齡層下降;同時增加後來抽菸成癮的機率與嚴重度,甚至提高校園內毒品濫用的風險。由於電子煙中的尼古丁仍會造成「成癮」和「依賴」,提倡者說是為戒菸,結果反讓更多人使用菸品,並且成癮;台灣好不容易推動菸害防制法初有成效,難道還要為電子煙重蹈覆轍?更何況醫界對於戒菸已有更安全有效之方法!

電子煙的安全性更值得關注,此與其添加物及操作方式有關,使用不當容易造成爆炸、燒傷等事故傷害。二○一四年美國即有高達三七八三件電子煙中毒通報事件,諸如誤食、眼睛或皮膚接觸導致癲癇、缺氧性腦部損傷;喝下或注射電子煙液體導致喪命等。

因此,世界衛生組織二○一四年聲明,電子煙對使用者和吸入二手煙者均具健康危害;二○一八年初「美國國家科學、工程與醫學學院」發表的電子煙總體評估仍支持此結論。企業投入研發電子霧化器的正規治療用途,雖有益全民健康與經濟發展;但如用於發展電子煙,政府需通盤考量對全民健康的衝擊,很有可能會賠上人民健康又加重健保負擔,得不償失。

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美國癌症協會 ACS

美國癌症協會(ACS)發表聲明
電子煙比一般菸品危害較少
並建議臨床醫師支持所有可戒除一般菸品的方法

對於(不想採用一般傳統方式戒菸的)抽菸人士
應鼓勵轉換到傷害最小,相對健康的產品
完全轉換到電子煙比繼續抽菸來的好

原文:
The American Cancer Society’s (ACS) board of directors issued a new position statement on e-cigarettes, stating the products are
“less harmful than smoking cigarettes”
and recommending “clinicians support all attempts to quit.”

These individuals should be encouraged to switch to the least harmful form of tobacco product possible; switching to the exclusive use of e-cigarettes is preferable to continuing to smoke combustible products.

原文連結:
1.
https://www.cancer.org/healthy/stay-away-from-tobacco/e-cigarette-positi...

2.
https://www.heartland.org/news-opinion/news/american-cancer-society-issu...

美國食藥署 FDA

美國食藥署(11.29.2017)說,要跟上時代
將會成立新的尼古丁對策委員會來重新評估
原本尼古丁口香糖貼片口含錠的管制性尼古丁替代的療法

美國食藥署想確保
對於新創的產品有正確的政策
可以幫助燃燒一般菸品的抽菸民眾戒菸;
對於現有或未來的一些尼古丁攝入器材
美國食藥署考慮認可這些產品加入尼古丁替代的療法

來源連結:
https://blogs.fda.gov/fdavoice/index.php/2017/11/advancing-medicinal-nic...

(附註來源:路透社)
https://www.reuters.com/article/us-fda-smoking-proposal/fda-moves-to-spe...

美國疾管署 CDC

2.美國疾管署 CDC

用電子煙完全取代一般菸品的情況下
對於未懷孕的成年吸菸人(的健康)可能有所助益

電子煙(對健康)的傷害比一般菸品少嗎?
是的—但是這並不代表安全無虞 ~~美國疾管署 2017年11月
(CDC, Centers for Disease Control and Prevention)

美國疾管署原文:
E-cigarettes have the potential to benefit
adult smokers who are not pregnant
if used as a complete substitute for regular cigarettes
and other smoked tobacco products.

Are e-cigarettes less harmful than regular cigarettes?
Yes—but that doesn’t mean e-cigarettes are safe

原文連結:
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm

美國心臟協會 AHA

1.美國心臟協會 AHA
當一名想用電子煙來戒菸的患者
在嘗試傳統的戒菸方式
屢屢失敗,無法接受,甚或排斥時
臨床醫師不應阻卻這名患者用電子煙來戒菸 --美國心臟協會

美國心臟協會原文
when repeated efforts with conventional treatment fails, is intolerant, or rejected
by a patient who wants to utilize e-cigarettes to help them quit,
clinicians should not discourage their use by the patient.
原文連結:
http://newsroom.heart.org/news/american-heart-association-issues-e-cigar...

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