USM PENANG, 8 April 2024 – The National Poison Centre (NPC) at Universiti Sains Malaysia (USM) plays a vital role in addressing poisoning incidents across the nation, closely monitoring emerging trends associated with new products in the market or regulatory alterations.

According to NPC drug and poison information services chief pharmacist, Sulastri Samsudin, NPC has been monitoring poisoning exposure cases related to electronic cigarettes (e-cigarettes) and their liquids since 2015, when they were first made commercially available.

“Over the span of nine years from 2015 to the present, the NPC has meticulously observed 111 cases linked to e-cigarettes and their accompanying liquids, with notable surges occurring during two distinct periods, first between 2020 and 2021, and then between 2022 and 2023,” she cited.

Sulastri said the first phase of increase by twice was in 2020 at 13.5 per cent and 2021 at 19.8 per cent compared with 6.3 per cent in 2019, which was during the Movement Control Order (MCO) due to the COVID-19 pandemic.

"The majority of cases then involved children aged below five. This situation can be attributed to the accessibility of these products to children due to inadequate storage practices.

"This is further compounded by the form of product packaging, especially liquid e-cigarettes without safety features and the existence of interesting flavourings such as appealing food and sweets/candies.

"The second phase of increase was after the MCO, which was in 2022 and 2023. Although there was a slight decrease to 18 per cent in 2022; in 2023, the NPC recorded the highest number of e-cigarette exposure calls of 30.6 per cent, a five-time increase compared with 2019,” she said in a statement released recently.

Sulastri also mentioned that in the same year, nicotine was removed from the Poisons Act 1952.  

“The second phase also showed a change in the trend in the age category, where more teenagers aged 15 to 19 years experienced poisoning due to the deliberate use of e-cigarettes.

“Furthermore, more than 95 per cent of reported cases were symptomatic,” she said.

“The majority of symptoms exhibited by patients were consistent with nicotine poisoning symptoms such as severe vomiting, drowsiness, diarrhoea, abdominal pain, fainting, and seizures/convulsions.”

She, however, said there were also patients who showed more severe symptoms such as psychosis, hallucinations, aggressive behaviour changes and were suspected of involving drug abuse into e-cigarette liquid.

"Since 2021, the NPC had started receiving cases of exposure to e-cigarettes linked to the drug, Magic Mushroom, or its active ingredient psilocybin, and recorded a total of 23 cases to date.

"Without any control over e-cigarettes, the NPC cannot confirm the content of the substance," she added.

As such, Sulastri urged the government to speed up the implementation of the Control of Smoking Products for Public Health Act 2023 which was approved last year, to ensure greater control of electronic cigarette products, mitigate e-cigarette-related harm, and safeguard public well-being.

Among the control measures that can be taken are:

• Use safety caps for e-cigarette refill containers;
• Prohibit the use of food flavourings in e-cigarette liquids;
• Limit the concentration of nicotine and the amount of liquid in e-cigarette liquids and refill containers;
• Ensure that products, especially chemicals, are tested and registered for monitoring purposes;
• Set a strict standard operating procedure for product manufacturing processes of e-cigarette products;
• Strengthen the monitoring system for cases of exposure to e-cigarette poisoning;
• Ensure that e-cigarettes are off limit to minors/underaged individuals.

"NPC once again calls for the speedy implementation of control over smoking products, especially e-cigarettes, to prevent more Malaysians, especially the younger generation, from falling victim to nicotine addiction and poisoning," Sulastri said.

Translation: Tan Ewe Hoe