No, Singapore’s vape ban didn’t cause the etomidate crisis: Commentary

Singapore is confronting what has been dubbed an “etomidate crisis”.

In recent months, enforcement agencies have seized thousands of illicit vapes adulterated with etomidate. Laboratory tests found that roughly one in three confiscated vapes contained the drug, prompting the authorities to classify it as a controlled substance and impose severe penalties on traffickers.

Against this backdrop, a troubling narrative has taken shape on some social media platforms: that Singapore’s strict anti-vape laws somehow triggered the etomidate crisis by pushing consumers into illicit markets for unregulated, drug-laced vapes. 

This is not only misleading, but also dangerous. Such claims recycle half-truths and outdated science, while ignoring global evidence that vaping carries serious risks. They deserve a clear rebuttal.

Indisputable harms

Pro-vape advocates often cite a decade-old claim from Public Health England that vaping is “95 per cent less harmful” than smoking, and therefore a gateway to quitting. But no credible health authority stands by this figure today.

Harm has two sides: short-term acute harms that appear quickly, and long-term chronic harms that accumulate silently. 

On the acute side, the 2019 to 2020 vaping lung illness outbreak in the United States showed what can happen when solvents and oils, including carcinogens like formaldehyde, are inhaled deep into the lungs.

Long-term harms of vaping are only beginning to emerge, but already show links to chronic lung diseases such as asthma and chronic obstructive pulmonary disease – a progressive lung condition where breathing becomes increasingly more difficult. 

It took decades to prove the dangers of smoking. Vaping has not had that time yet the early findings are already worrying.

The gateway effect

Evidence also shows that vaping draws young people into nicotine addiction. In Britain, youth vaping surged during the boom of disposable vapes, tripling among 16- to 19-year-olds between 2020 and 2023. Adolescents who vaped were found to be three times more likely to start smoking than their peers.

If Singapore were to legalise vapes, even a conservative assumption of a 2 per cent annual initiation rate among those aged 10 to 19 – far below Britain’s experience – would mean about 8,000 new adolescent vapers every year.

This is not “reduced harm”. It is a new epidemic of nicotine addiction.

Vaping does not help smokers quit

Another argument is that e-cigarettes help smokers quit. But extensive randomised controlled trials and extensive systematic reviews do not support this at the population level.

The World Health Organisation’s (WHO) technical note on e-cigarettes is explicit: “Currently, the evidence does not support a generalised conclusion that commercialisation of e-cigarettes as consumer products will improve population health by supporting tobacco use cessation.”

Yes, some individuals report quitting cigarettes via vaping. But large-scale studies show otherwise. A four-country study published in 2023 found that smokers who took up daily vaping were no more likely to quit than those who did not, highlighting that motivation to quit mattered more than access to vapes.

Instead, vaping often sustains nicotine dependence and encourages dual use of both vapes and cigarettes. Singapore’s own Smokers Survey echoes this pattern: vapes are being used as substitutes, not off-ramps.

Lessons from abroad

Pro-vape voices argue that Singapore could have avoided the etomidate crisis by regulating vapes instead of banning them. But the experiences of Australia, the UK and even tightly controlled markets like China show the opposite.

Australia initially distinguished “therapeutic” (nicotine) vapes, which required a licence, from non-nicotine consumer products. But shops quickly exploited loopholes, selling nicotine vapes under the guise of “non-nicotine” ones, often to minors. 

Policing this proved a mammoth task. By 2024, the government was forced to enact sweeping reforms, banning imports of disposable vapes altogether and restricting access to pharmacies via prescription only.

Britain went further in liberalising vapes, encouraged by Public Health England’s now-defunct guidance. Vape shops proliferated, youth vaping soared and some devices were even found to deliver “spice”, a synthetic cannabinoid. 

This year, the UK banned single-use disposable vapes and introduced a new Tobacco and Vapes Bill to tighten regulation.

Even in mainland China and Hong Kong, where licensing and national standards are in place, the authorities have intercepted etomidate-laced cartridges. Regulation did not stop them.

These examples show that regulation cannot sanitise a market that is global, profitable and easily exploited by illicit suppliers. The claim that regulation would have kept Singapore safe from etomidate-laced vapes is simply wrong.

Singapore was right to ban

Critics argue that prohibition drives products underground, creating black markets and complicating enforcement. This is a legitimate concern. But Singapore’s experience shows that an outright ban has contained the problem. In contrast, countries that legalised vapes saw demand explode and youth uptake surge while illicit actors thrive anyway.

In other words, regulation in lieu of a ban does not prevent illicit trade – it amplifies it by creating a vast consumer base to serve.

If e-cigarettes were truly a proven harm-reduction tool, why has the WHO issued a global call to action against them? And why are countries like Vietnam and Papua New Guinea drafting laws to ban them outright?

Meanwhile, jurisdictions that once embraced regulation of vapes – Australia, New Zealand, the UK – are reversing course. The authorities in all three have tightened their approaches in response to rising youth addiction, illicit trade and evidence of health risks. The global tide is shifting against vaping, not in its favour.

Singapore’s outright ban since 2018 is often criticised as draconian. But international evidence now suggests it prevented a far greater crisis.

It is time to clear the air and reject vape disinformation.

Teo Yik Ying is vice-president for global health and dean of the Saw Swee Hock School of Public Health at the National University of Singapore.

Source: The Straits Times © SPH Media Limited. Permission required for reproduction.

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