National Poison Centre calls for control measures after recording five-fold hike in e-cigarette poisoning

GEORGE TOWN, March 27 — The National Poison Centre (NPC) of Universiti Sains Malaysia has recorded a five-fold increase in poisoning cases due to electronic cigarettes (e-cigarettes) exposure last year.

The NPC drug and poison information services chief pharmacist Sulastri Samsudin said there was an increase of 30.6 per cent last year compared to 2019.

She said there was also a change in trend where more teenagers between the ages of 15 and 19 years old experienced poisoning due to intentional use of e-cigarettes.

She said 2023 was also the year that nicotine was removed from the Poisons Act 1952.

“More than 95 per cent of reported cases were symptomatic,” she said in a statement today.

She said a majority of symptoms exhibited by patients were consistent with nicotine poisoning symptoms such as severe vomiting, drowsiness, diarrhoea, abdominal pain, fainting, and seizures.

“However, there were also patients who exhibited more severe symptoms such as psychosis, hallucinations, aggressive behavioural changes, and suspected involvement of drug abuse in e-cigarette liquids,” she said.

The NPC has been actively monitoring poisoning cases due to e-cigarettes and their liquids since these were first reported in 2015.

“A total of 111 cases have been referred to the NPC call centre in the last nine years,” she said.

However, she said there were two periods of significant increases in reported cases, in 2021 and in 2023.

“The first phase of increase was during the Movement Control Order (MCO) period due to the Covid-19 pandemic, which is a two-fold increase in 2020 (13.5 per cent) and 2021 (19.8per cent) compared to 6.3 per cent in 2019,” she said.

She said a majority of the cases involved children under the age of five.

“This situation can be attributed to the accessibility of these products to children due to unsafe storage,” she said.

Sulastri said the products lack safety features and contained flavouring agents such as food and candy that are attractive to small children.

She said there was a slight decrease in cases, at 18 per cent, in 2022 but this hiked to 30.6 per cent last year.

“Since 2021, NPC has started receiving cases associated with Magic Mushroom or its active ingredient psilocybin and a total 23 cases were recorded to date,” she said.

“However, without any control on e-cigarettes, NPC cannot confirm the content of these substances,” she added.

She called on the government to speed up the implementation of the 2023 Control of Smoking Products for Public Health which was approved last year.

She said there needs to be a control over e-cigarettes such as the use of safety caps for e-cigarette refill containers.

“Food flavourings in e-cigarette liquids should be prohibited,” she said.

She said nicotine concentration and the amount of liquid in e-cigarette liquids and refill containers should be limited.

“E-cigarette products, especially chemicals, should be tested and registered for monitoring purposes,” she said.

She said there needs to be strict standard operating procedures for product manufacturing processes of e-cigarette products.

“Access to e-cigarettes need to be regulated to stop easy access by underage individuals and the monitoring system of e-cigarette poisoning cases should be strengthened,” she said.

Sulastri said control measures for smoking products, especially e-cigarettes, must be expedited to prevent more people, including young children, from becoming victims of nicotine addiction and poisoning.