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11 October 2021
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What is IQOS

 

IQOS: What you need to know
IQOS is the latest tobacco product to come on the market. But is IQOS safer than electronic nicotine delivery devices like JUUL? And is it safer than regular cigarettes? Our expert, Maher Karam-Hage, M.D., answers some questions about this new product.

 

Sales of a new heat-not-burn alternative to cigarettes are now allowed in the United States. The Food and Drug Administration will permit the product IQOS (pronounced EYE-kose) to be sold as a “modified risk” tobacco product to people over the age of 18.

The FDA has launched a crackdown on the use of e-cigarettes among young people and says marketing of this new product will be heavily restricted to adult smokers only.

This is because so many kids started using e-cigarettes like JUUL.

The FDA says IQOS sales to adults will be allowed because “the products produce fewer or lower levels of some toxins than combustible cigarettes.” However, the FDA is very specific that they do not endorse the product as “safe” or "FDA approved."

According to the FDA statement: "All tobacco products are potentially harmful and addictive and those who do not use tobacco products should continue not to do so."

 

We do not know if IQOS is less harmful or if it will cause less disease than smoking in the long run.

Maher Karam-Hage

Physician

 

We talked to Maher Karam-Hage, M.D., professor of Behavioral Science and medical director of the Tobacco Treatment Program at MD Anderson, about this new product. He says IQOS may be just as harmful as regular cigarettes and so-called ‘light’ cigarettes. Here's what he had to say.

What is IQOS?

IQOS is a tobacco heating system that uses tobacco that is wrapped in a special paper to deliver nicotine to users.

These so-called "heatsticks" are heated up inside the IQOS and nicotine is released with other tobacco components and flavors for users to inhale.

This is different from regular cigarettes, which burn tobacco. The key thing, though, is that the aerosol released by the heated tobacco in IQOS contains cancer-causing chemicals.

Is IQOS safer than smoking cigarettes?

Because it is tobacco, the chemicals released in the aerosol from an IQOS device are the same cancer-causing substances found in cigarettes and e-cigarettes. Some were found in IQOS at even higher levels, while others were lower.

Heating the tobacco instead of burning may produce fewer cancer-causing substances. And the ones that are released are in lower amounts. But that doesn't mean IQOS is safe, says Karam-Hage.

"We do not know if IQOS is less harmful or if it will cause less disease than smoking in the long run," he says.

The bottom line: "Quitting smoking is the best way to reduce your disease risk from tobacco. And the best way to do that is to use medications, nicotine patches, lozenges and gum."

How does IQOS differ from JUUL and other e-cigarettes?

E-cigarettes currently on the market are nicotine delivery devices that have a battery, a heating element and a container for liquid. When the liquid is heated, users inhale the aerosol as a vapor.

IQOS devices do not use heated liquids, like e-cigarettes, to deliver nicotine into the body. IQOS devices heat real tobacco leaves that contain many naturally occurring toxins and cancer-producing substances.

Another way e-cigarettes and IQOS devices vary: E-cigarette liquids come in a variety of flavors. IQOS only come in regular tobacco flavor or menthol.

"The only way IQOS and e-cigarettes are similar is that they both have a battery and they are not burning the tobacco," says Karam-Hage.

What should smokers know about IQOS?

The FDA has not endorsed IQOS as a safe product. It also has not said it is an effective tool to help users quit smoking regular cigarettes.

Karam-Hage compared this new product to the "supposedly healthier" low-tar cigarettes introduced decades ago. Low-tar and "light" cigarettes did not prove to be safer in the long run and in some cases cause new forms of disease.

If you don't smoke, don't start. If you do smoke, the best thing you can do for your health is quit all tobacco products.

Karam-Hage says the best way to quit is with a program that includes a combination of medications or medicinal nicotine replacement that uses purified nicotine, along with psychological support.

Heat-Not-Burn Tobacco Products
A device that heats tobacco without burning claims to be safer than cigarettes. Don't be fooled into thinking it's harmless! There is no safe type of tobacco use.

These heat-not-burn tobacco products became legal in the United States in 2019. They are different from vape pens, pod-b ased devices like JUUL, and e-cigarettes.

What is I QOS?

IQOS is a brand of heated tobacco products that is being marketed as "a better alternative to smoking." Because the tobacco is heated, the company claims that it has less chemicals than burned tobacco. These claims are based solely on research conducted by the tobacco industry. Independent studies are needed to help understand the health effects of using heat-not-burn devices.

The IQOS heat-not­-burn device uses a disposable tobacco unit called called a "HEET" or "HeatStick" filled with compressed ground tobacco, which is inserted into an electronic holder. Each "HeatStick" contains about the same amount of nicotine as one cigarette. An electronic heat element warms the stick and releases an aerosol that the user inhales.

Facts about heat-not-burn tobacco devices:

They produce an aerosol that contains nicotine, chemicals, additives, and flavorings by heating tobacco.

They contain about the same amount of nicotine as traditional cigarettes.

They are available in convenience stores and specialty shops.

They are NOT the same as e-cigarettes: these products use tobacco to deliver nicotine, whereas e-cigarettes use a liquid to deliver nicotine.

They give off secondhand aerosol that is unsafe to breathe (like a cigarette).

 

Heated tobacco products are NOT safe!

Heated tobacco products contain tobacco. There is no safe type or level of tobacco use, and there is no evidence that heated tobacco products are safer than traditional cigarettes.

They also contain many chemicals and components that have been designated as harmful by the FDA, including:

Carbon Monoxide

Nicotine

Heavy metals like arsenic, lead, and mercury

Acetone (found in nail polish remover)

Ammonia (found in fertilizers and household cleaners)

Benzene (found in gasoline)

 

This device can lead teens to become lifelong smokers.

Companies that make products like e-cigarettes and vape pens claim they can help smokers quit. But evidence is showing they lead to traditional cigarette use and are a way for the tobacco industry to attract new customers.

Beware of their sale to youth. Heated tobacco products are sleek, high-tech devices that are being designed and marketed in ways that are known to attract youth. While the legal age to buy tobacco products, including IQOS, is 21, online stores don't always ask for proof of age.

Heated tobacco products are highly addictive: IQOS and other heated tobacco products contain nicotine. Teens and young adults are easily addicted to nicotine. The US Surgeon General has declared that youth use of nicotine in any form is unsafe.

Menthol flavors are used to lure teens: For decades, the tobacco industry has used menthol and other flavors to attract young smokers. Menthol masks the harshness of cigarette smoke, making them easier to smoke and harder to quit. Menthol cigarette use is more common among young smokers than other age groups.

 

6 IMPORTANT THINGS TO KNOW ABOUT IQOS, THE NEW HEATED CIGARETTE PRODUCT

The new tobacco product IQOS was recently granted permission to be sold in the U.S., sparking concerns of yet another nicotine delivery device being introduced to the U.S. market amid a youth e-cigarette epidemic.

The Food and Drug Administration determined in April that Philip Morris International can now begin marketing and selling the heat-not-burn device IQOS, the first product of its kind to be sold in the U.S. Heat-not-burn tobacco products, also called heated tobacco products, are electronic devices that heat tobacco leaves to produce an inhalable aerosol, instead of burning tobacco like traditional cigarettes.

While IQOS is an electronic device, the FDA has classified it as a cigarette, which means the product is subject to all the same existing restrictions for traditional cigarettes. Philip Morris claims these products are safer than cigarettes, but much remains unknown about the devices and the impact they will have.

 

Here are six important things to know about IQOS.

1. IQOS uses different technology than e-cigarettes.

What is the difference between IQOS and e-cigarettes?

Heat-not-burn products are different from e-cigarettes because they use actual tobacco, not the flavored e-liquid typically found in e-cigarettes. The concept behind heat-not-burn is that it allows users to experience what looks and feels like smoking a regular cigarette without inhaling combusted tobacco.

2. The devices have not been “FDA approved.”

Is IQOS approved by the FDA?

As the FDA stated, while its decision “permits the tobacco products to be sold in the United States, it does not mean these products are safe or 'FDA approved.'”

The company submitted applications to the FDA for two different regulatory approvals: one to market the product as a new tobacco product (called a Pre-Market approval), and the other to market the product as less harmful than other tobacco products (called a Modified Risk Tobacco Product approval). The FDA decision applies to the Pre-Market approval application. The agency has not decided on whether the device can be marketed as less harmful than other tobacco products.

3. Heated tobacco products are not proven to be safer than cigarettes.

Is IQOS safer than smoking cigarettes?

Tobacco companies claim that heat-not-burn products are less harmful than cigarettes because when tobacco burns, or combusts, it produces more than 7,000 chemicals that are found in cigarette smoke.

Philip Morris claims that IQOS is less toxic than cigarettes, but multiple papers in an issue of the journal Tobacco Control concluded that the company’s own data does not fully support those claims. Research shows that although IQOS may have lower levels of some toxicants than cigarettes, it can still expose users to higher levels of other toxicants. Likewise, IQOS could expose users to lower risks of some diseases, but higher risks of others.

Philip Morris’ research underscores the fact that fewer toxic chemicals does not mean lower levels of harm when people use the product, and that reduced exposure claims are misunderstood as reduced harm claims.

4. IQOS may appeal to youth.

Are teens using IQOS?

Truth Initiative® researchers found that IQOS may appeal to youth and young adults because of marketing that depicts the product as “sophisticated, high-tech and aspirational” and “sleek, exclusive items akin to iPhones.”

The marketing of the product is particularly concerning because of the current youth e-cigarette epidemic, driven by JUUL. E-cigarette use has surged, especially among young people — many of whom never smoked cigarettes. In fact, e-cigarette use grew 78% among high schoolers and 48% among middle schoolers in just one year from 2017 to 2018, and JUUL now accounts for three-quarters of the U.S. e-cigarette market.

Another study published in Tobacco Control underscores these concerns: “Just as e-cigarettes, particularly the JUUL-style, promoted with a modern, high-tech image and harm reduction and ‘smokeless’ messages, appeal to adolescents, it is likely that IQOS, marketed in a similar manner, will also appeal to adolescents.”

To prevent youth access to IQOS and exposure to its advertising and promotion, the FDA is placing restrictions on how the products are marketed — especially through websites and social media — and requiring that advertising is targeted to adults.

5. The tobacco cartridges will be available in menthol and could strengthen the Marlboro brand.

Does IQOS come in flavors?

Philip Morris plans to offer rolls of tobacco resembling small cigarettes, called HeatSticks, with menthol, a flavor that has been shown to attract young users and make cigarettes easier to smoke and harder to quit. The company did not provide information in its applications to the FDA about how the menthol variant will affect the appeal, toxicology or other health effects of the product.

Additionally, Philip Morris is planning to market HeatSticks under the Marlboro name. Marketing the new device using the Marlboro brand may increase the overall appeal of all Marlboro products, including cigarettes. Research shows that Marlboro tops the list of preferred cigarette brands among teenagers.

6. These products are part of the industry’s efforts to deal with increasing regulation.

Is IQOS regulated?

Tobacco companies are attempting to undermine government regulation by using harm reduction claims as a strategy for reframing the industry as part of the solution instead of part of the problem, according to commentary in Tobacco Control.

“[Heated tobacco products] are the latest effort by tobacco companies to adapt to a changing regulatory landscape to maintain and expand their customer base amid declining social acceptability of tobacco use and declining cigarette consumption,” the commentary stated. “Where regulations are absent or loopholes exempt [heated tobacco products] from existing regulations, companies market [heated tobacco products] to increase social acceptability for all their tobacco products.”

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