What is the National Drugs Observatory?

The National Drugs Observatory (NDO) within NADS, is the national data collection system on drugs. It is the central location for obtaining drug information and drug statistics. The NDO serves as the principle research center for compiling and analyzing drug data in order to track trends in supply and demand activities for the generation of timely and accurate assessments of the drug situation and drug control efforts to inform local drug policy and drug related services. 
 

Moreover, the NDO is established to fulfill the country’s reporting obligations on the progress of measures taken with regard to United Nations Conventions and the Organization of American States General Assembly Resolutions adopted by The Bahamas on drug control.  The NDO provides reliable data and information to these bodies so that anti-drug strategies can be monitored and assessed locally, regionally and globally.
 

The data collection and monitoring reference framework used by the NDO follows the guidelines adopted from the Lisbon Consensus which identifies 13 areas of policy interests compliant with United Nations and the Organization of American States policies. These thirteen areas of focus include:

• Drug consumption among the general population
• Drug Consumption by young people
• High-risk drug consumption
• Service Utilization
• Drug-related morbidity
• Drug –related emergency room visits
• Psychiatric morbidity directly attributed to drug consumption
• Drug-related mortality
• Social exclusion and disadvantage
• Drug –related crime
• Economic cost of drug consumption.

NADS in keeping with its mandate to have a fully functioning NDO assigned two researchers to this section during the period under review, Ms. Indirah Belle and Ms. Greer Mc Kinney.   

Research Activities

Researchers at the NDO undertook two research studies during 2015 on th etopics of  ‘beedies’, and ‘e-cigarettess’, which have both become popular among the local youth. 

‘Beedies’ Research Study

Researchers at the National Anti-Drug Secretariat (NADS) undertook this descriptive study at to learn more about ‘beedies’, which are being smoked by many of our nation’s youth.  A beedie, also spelled bidi, bedis or biri, is a thin Indian cigarette filled with shreds of tobacco and wrapped in a tendu leaf tied with a string at one end.  Tendu leaves are broad-leafed plants native to India.  The name beedie is derived from the Marwari word beeda—a leaf wrapped in betel nuts, herbs, and condiments.  These cigarettes contain more tar and nicotine than regular cigarettes – but less actual tobacco (Yen, Hechavarria, & Bostwick, 2000).
 

These small, filters-less cigarettes come in a variety of flavors including strawberry, cherry and cinnamon.   Youths can have their choice of “exotic flavors” – as termed by the Darshan brand – like Black Liquorice, Mandarin Orange and Mango (Yen, Hechavarria, & Bostwick, 2000). Known as the ‘poor man’s cigarette’, Beedi smoking tends to be associated with a lower social standing.  These tobacco-filled leaves are inexpensive, when compared to regular cigarettes.  Those with a high social standing who do smoke beedies often do so out of the public’s eye (Yen, Hechavarria, & Bostwick, 2000)
 

Contrary to popular belief, beedies are not a safe alternative to cigarettes. Due to the natural look of the product, some people mistakenly think that they are safer to smoke than regular cigarettes.  The omission of warning labels on packages further propels the myth of beedies relative safety.  Unlike most cigarettes smoked by youth, beedies are unfiltered and may, in fact, have more deleterious health effects.
 

According to the Office of Smoking and Health at the U.S Centers for Disease Control, an unfiltered beedie releases 3-5 times more tar, carbon monoxide and nicotine than a regular cigarette, despite containing less tobacco.  As with many other types of smoking, beedies increase the risk of certain kinds of cancers, heart disease, and lung disease.  The research available on beedies show that their users run the risk of developing oral and lung cancers, just like that of cigarette smokers (Yen, Hechavarria, & Bostwick, 2000).
 

Because a beedies typically does not have a filter and the leaves used to wrap the tobacco are not porous, a smoker must inhale more often and more deeply to keep it lit.  Studies in India have shown that this leads to larger amounts of tar, nicotine, and carbon monoxide in the lungs than when a regular cigarette is smoked (Suzan, 2009).  Like other tobacco smokers, Beedie smokers would be expected to have an increased risk of coronary health disease and cancers of the mouth, pharynx and larynx, lung, esophagus, stomach, and liver.  Beedie use during pregnancy can cause prenatal mortality (Suzan, 2009).
 

Several progressive countries, including the United States, have banned many of the beedie products.  The US banned several of the products citing that they did not meet the requirements of the Tobacco Control Act.  While beedies are not illegal in The Bahamas, local distributors have stopped importing the product due to its high rate of duty.  This has created an underground market which is suspected of being organized by local Chinese merchants.
 

Among its key findings was the fact that these filter-less cigarettes were more lethal than regular cigarettes.  It was also discovered that the local beedie market has gone ‘underground’ as local importers have sought to avoid paying the new high cost of duty as outlined in the recently passed customs Excise Act.  
 

The study concludes by recommending that the Ministry of Health examine the health risks associated with the smoking of beedies and determine whether such risks are sufficient to support banning the product in The Bahamas as in other progressive jurisdictions.  Joint intelligence-lead operations involving the Customs Department and the Royal Bahamas Police Force should also be executed to disrupt and prosecute persons operating the underground beedie market.  Finally, a public awareness campaigns should be launched to educate members of the public, particularly youths, on the lethal effects of smoking beedies.  The belief that persons who begin smoking beedies are more likely to begin using illegal drugs can only be supported by scholarly research.

‘E-Cigarettes’ Research Study

E-cigarettes are prototypes of electronic nicotine delivery systems (ENDS) (World Health Organization [WHO], 2014).    These battery-operated devices are designed to deliver nicotine with flavorings and other chemicals to users in vapor instead of smoke (National Institute on Drug Abuse, [NIDA], 2014).   They can be manufactured to resemble traditional tobacco cigarettes, cigars or pipes, or even everyday items like pens or USB memory sticks (NIDA, 2014).   Commonly referred to as nicotine vapour products, they can even take the form of colorful candy straws (WHO, 2013). Because e-cigarettes simulate smoking, persons are said to be vaping not smoking (Substance Abuse and Mental Health Services (SAMHSA), 2014). Other common names for these devices include: e-hookas, hookah pens, e-cigs, vapes and vape pipes.
 

E-cigarette devices are manufactured mainly in China (Grana, Benowitz, & Glantz, 2013).  More than 90% of those produced worldwide are made in China (Gravely, Fong, Cummings, Yan, Quah, Borland, & Hummel, 2014).  China is also the largest producer of the liquid for cartridges (Carr, 2014).  E-cigarettes are manufactured in many forms and products are continually evolving in design, content and performance.  There are 466 brands of electronic cigarettes (WHO, 2014).  Most e-cigarettes however consist of three main components: a cartridge which holds a liquid solution (e-liquid); heating device (vaporizer) and a power source which is usually a battery (NIDA, 2014).  There are disposable, rechargeable as well as refillable tank systems (Grana et al., 2013).  The main constituents of the liquid (e-liquid) by volume include nicotine when present, propylene glycol, with or without glycerol and flavoring agents (WHO, 2014).  There are a variety of flavoring agents which include flavors such as coffee, mint, candy and fruit (NIDA, 2014).                                         
 

Initiation and ongoing use by high school students were attributed to the fact that students say that e-cigarettes can be “smoked quickly” are “smokeless” and are easy to conceal (Durmowicz, 2014).  A major contributing factor that resulted in e-cigarettes gaining much popularity among smokers and non-smokers is the marketing claim that they are safer than tobacco products such as cigarettes and cigars.  Grana and Ling in 2014, conducted an analysis of 233 websites that sold e-cigarettes products in the United States, United Kingdom, India and Australia. According to these researchers, “the internet has been, and remains, a main channel for marketing e-cigarette products”.  The results of the analysis showed that health benefit claims were present on 95% of sites.  Statements about the absence of tar and carcinogens in e-cigarettes were regularly reported.  Claims that e-cigarettes emit “only water vapor” that are harmless to others were found on 76% of websites and almost all 98% sites compared the risks and benefits of e-cigarettes to tobacco cigarettes.

E-cigarettes online sales in the US were estimated at $ 700 million during 2013 (Carr, 2014).  E- Cigarettes have particularly been appealing to an increasing number of young previous non-smokers because they are regarded as being safe, fashionable and good tasting (Brody, 2014). However, ongoing scientific research has indicated that hookah smoking may not be as safe as some declare.  Researchers have found that smoking from a hookah has harmful effects on the health of a human being much like smoking a cigarette and in some ways it is even more dangerous than cigarette smoking. 

Evidence obtained through a review of medical research conducted on a variety of brands and samples of e-cigarettes as stated in Grana et al., 2013 however revealed that e-cigarettes aerosol is not merely “water vapor” as is often claimed in the marketing of these products. Tests of these products revealed the presence of varying levels of nicotine content from label amounts, the presence of volatile organic compounds, tobacoo- related carcinogens, metals and chemicals.  Some of the chemicals, particularly some flavoring agents in e-cigarettes aerosol are cytotoxic to human cells particularly in human embryonic cells.  Further, chemicals found in the aerosol and e- liquid were found on California’s official list of known human carcinogens or reproductive toxicants and included nicotine, acetaldehyde, formaldehyde, nickel, lead and toluene (Grana et al., 2013). 

In light of the potential health risks, there is an urgent call for better regulation and improvements as it relates to quality standards and product design in The Bahamas.  The Bahamas should also join in the consensus among healthcare professionals in countries around the world including the United States of America, Canada and United Kingdom, calling for continued research to examine the impact of these products more closely.   The study concludes by recommending that the Ministry of Health examine the health risks associated with the use of e-cigarettes with a view to support better regulatory and quality standards.  Finally, a public awareness campaign will be launched to educate members of the public, particularly youths, on the harmful effects of using e-cigarettes.