From Action on Smoking and Health <[email protected]>
Subject ASH Daily News for 30 September 2021
Date September 30, 2021 11:46 AM
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** 30 September 2021
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** UK
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** Comment: Tackling health inequalities must be a fundamental priority for the NHS (#1)
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** Study: Tobacco and alcohol may increase likelihood of using illegal drugs (#2)
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** Councils ‘staring down the barrel’ on workforce capacity, Sunak told (#3)
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** International
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** US: Philip Morris IQOS imports barred (#4)
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** Australia: Importing nicotine e-cigarettes banned following youth use concerns (#5)
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** Parliamentary Activity
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** Parliamentary questions (#6)
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** UK
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Saffron Cordery, Deputy Chief Executive of NHS Providers, writes in the Health Service Journal (HSJ) on the need for inequalities to be a key focus for the NHS and the role the newly formed Office for Health Improvement and Disparities (OHID) will play in making this happen.

Cordery notes that NHS Providers' new report 'Health inequalities: a core concern’ "chart this noticeable shift towards making health inequalities a key priority for the NHS and set out how a supportive policy framework will help it address a longstanding injustice." She says the launch of OHID "comes at a critical time for the NHS as it continues to grapple with huge backlogs brought about by the COVID-19 pandemic" and that "A strong partnership between the health and care system and the organisations responsible for wider determinants of health will be critical."

Cordery says "there is now a real opportunity to make tackling health inequalities a fundamental priority for the NHS" but that challenges and barriers remain. She says Trusts all over the country are still grappling with actually identifying disparities and their causes and that it is "only when a trust is able to identify whether structural factors are influencing inequality among their patients can it take steps to address them."

Cordery concludes saying that the "launch of OHID signals a chance to refresh the government’s approach to inequalities, and trust leaders are keen to sustain the momentum gained on this issue as a result of the pandemic. This is now underpinned by a national policy framework which will be central to enabling trusts, and systems, to prioritise health inequalities both in terms of the immediate task ahead and in the years to come. OHID is an important new organisation, which will help the government make good on its commitments to tackle health inequalities and to improve people’s lives."

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** Source: HSJ, 30 September 2021
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** The use of legal drugs (tobacco and alcohol) may lead to the use of cannabis, a new study led by the University of Bristol and published in the journal Addiction has found. The study also found evidence that cannabis use may lead to smoking initiation, and opioid dependence could lead to increased alcohol consumption. Additionally, there might be shared risk factors that influence the use of multiple substances.

Dr. Zoe Reed, Senior Research Associate in the Tobacco and Alcohol Research Group (TARG) in Bristol's School of Psychological Science and co-author of the paper, said "Legal consumption of alcohol and tobacco may directly increase the level of illicit drug use. However, the relationships are complex. Consuming one drug does appear to increase the consumption of another, but it may also be the case that people have underlying risk factors which increase their chances of consuming both alcohol and tobacco and illicit drugs."

The study found evidence for a possible gateway effect between tobacco use and subsequent alcohol and cannabis use, cannabis use and subsequent tobacco use, and opioid dependence and subsequent alcohol consumption. Some of these may be bidirectional relationships, where cause and effect goes both ways. However, given that tobacco and alcohol use usually begin before other drug use, shared risk factors may also underlay these relationships. Ultimately, Further examination of these specific relationships is required to determine the exact mechanisms behind these possible gateway effects.

Hazel Cheeseman, Deputy Chief Executive of Action on Smoking and Health commenting on the studies implications said "Tobacco and alcohol cause tremendous harm to society and these findings indicate that they may also increase the use of other drugs. Governments tend to take separate approaches to reducing the harm from legal and illegal drugs, but the long-promised Addictions Strategy provides an opportunity to look at the overlap between addictions and be more integrated."

Source: Medical Xpress, 30 September 2021
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** See also: Addiction - Using Mendelian randomization to explore the gateway hypothesis: possible causal effects of smoking initiation and alcohol consumption on substance use outcomes ([link removed])
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** Urgent action to address local government’s workforce capacity and skills crisis has been placed at the heart of council chiefs’ demands to Rishi Sunak. Investment in training and the creation of a national workforce strategy for local government are centre points of the Society of Local Authority Chief Executives & Senior Managers' submission to the chancellor’s spending review, due to take place in under a month. It comes as Solace disclosed the results of a survey it undertook in August, with 64 responses, which shows a third of senior managers currently lack staff with appropriate skills and qualifications to run services properly and 89% are concerned about the pipeline of staff for senior roles over the next three to five years.

Solace also urges significant investment on social infrastructure, with a focus on preventative and early intervention measures, and a multi-year funding settlement. Solace President, Joanne Roney, said that since she joined local government as an apprentice at the age of 16, its “outlook has never been as bleak as it is now”. “Councils were struggling to recruit and retain before Coronavirus, but the pandemic has pushed our heroic workforce to breaking point. Councils are staring down the barrel at a staffing capacity and capability crisis,” Roney continued.

Solace also demands a three-year financial settlement for councils as a minimum, but says it will ideally last five years to match that received by the NHS. It calls for the 2021-22 local government settlement to be rolled over with an uplift of at least 1% in real terms each year. The submission also expresses the concern that the recently announced extra funding for social care will not kick in until 2023 and do little to alleviate the sector's immediate crisis.

Source: LGC, 29 September 2021
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** International
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** Philip Morris International (PMI) and partner Altria Group will be barred from importing the IQOS heated-tobacco sticks into the US after they lost a legal battle with British American Tobacco (BAT) before a US trade agency. Philip Morris pledged to challenge what it called a “puzzling” decision.

PMI and Altria infringe two patents owned by BAT’s subsidiary Reynolds American, the US International Trade Commission said in a notice posted on the agency’s website. The import ban and an order to stop selling any products already imported will take effect in 60 days.

Reynolds claimed that Philip Morris infringed three patents. Two for an electrically-powered device with a heater to generate an aerosol and one for a control body. A trade judge in May found infringement of the two device patents and the commission reviewed issues regarding his findings on all three patents and affirmed the judge, with modifications.

Reynolds first sued in April 2020, claiming PMI and Altria copied patented technology that it had developed for its Vuse products. The companies have since lodged additional patent-infringement claims against each other in US courts, and have asked the US Patent and Trademark Office to cancel the other company’s patents. Decisions in some of the cases are expected early next year. Philip Morris said European patents related to the two in this case “have been repeatedly and universally rejected in European courts and the European Patent Office.” The next step in the legal fight will be the US Court of Appeals for the Federal Circuit, which specialises in patent law. Appeals before the court take longer than a year.

Source: Bloomberg, 29 September 2021
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** The importation of nicotine e-cigarettes is being banned because of a "significant increase" in their use by young people, the head of Australia's pharmaceutical regulator says. The possession of one without a prescription is also illegal, except for in South Australia. The sale of nicotine e-cigarettes, or nicotine vapes, is illegal in Australia without a prescription.

However, importing nicotine vapes from overseas websites, without a prescription, remained legal until now. From October 1st 2021, the Australian Border Force will have the power to intercept packages of nicotine vapes, nicotine pods or liquid nicotine. The Therapeutic Goods Administration (TGA) said it hoped the move would also drive current vapers to GPs to continue to access the product if they don't have a prescription.

However, Director of the Australian Tobacco Harm Reduction Association (ATHRA) Alex Wodak said "The people who will be most affected will be the people who are currently smoking and who decide they want to switch to vaping, after October 1st, they're going to find it very difficult. [...] Some people who are currently vaping will undoubtedly go back to combustible cigarettes. [...] smokers are going to find it very hard to jump through all the hoops that are going to be set up."

Source: ABC News, 29 September 2021
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** Parliamentary Activity
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** PQ1: WHO FCTC

Asked by Mark Pawsey MP, Rugby
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** To ask the Secretary of State for Health and Social Care, whether officials in his Department have consulted consumers of (a) vaping and (b) other reduced-risk products ahead of the Ninth session of the Conference of the Parties to the Framework Convention on Tobacco Control.

Answered by Maggie Throup, The Parliamentary Under-Secretary for Health and Social Care
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** The Department has not consulted consumers on vaping or other reduced-risk products ahead of the Ninth session of the Conference of the Parties to the Framework Convention on Tobacco Control. However, the Department meets with the Independent British Vape Trade Association to discuss a range of policy and regulatory issues.
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** Source: Hansard, 29 September 2021 ([link removed])
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** PQ2: E-cigarettes
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**
Asked by Mark Pawsey MP, Rugby

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** To ask the Secretary of State for Health and Social Care, what plans he has to tackle misinformation on the harms of vaping relative to other nicotine delivery and tobacco products.
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** Answered by Maggie Throup, The Parliamentary Under-Secretary for Health and Social Care

In 2022, the Office for Health Improvement and Disparities (OHID) will publish an independent review of the up-to-date evidence on the safety of vaping products. The review will include information about the relative harm of smoking and vaping.

New guidance from the National Institute for Health and Care Excellence (NICE), to be published in November 2021, will make recommendations about using electronic cigarettes to help people stop smoking.

The OHID will use the upcoming NICE guidance publication as an opportunity to communicate with the public and healthcare professionals about the relative harms of using nicotine containing products and smoking to support an informed choice.

Source: Hansard, 29 September 2021 ([link removed])
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** PQ3: Oral tobacco
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** Asked by David Jones MP, Clwyd West
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** To ask the Secretary of State for Health and Social Care, if he will make an assessment of the potential merits of (a) creating a separate regulatory category for non-combustible nicotine products and (b) including snus in that category.
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** Answered by Maggie Throup, The Parliamentary Under-Secretary for Health and Social Care

There are no current plans to make such an assessment. However, the Department is due to publish its post implementation review on the Tobacco and Related Products Regulations 2016 by the end of the year. Following this review, the Department will consider the need for any regulatory changes, including on non-combustible nicotine products and oral tobacco.
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**
Source: Hansard, 29 September 2021 ([link removed])
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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.

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