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Hi, it’s Audrey in Singapore, which has some of the world’s strictest drug laws — and where vapes are coming under closer scrutiny. But first…  

Today’s must-reads

  • AstraZeneca plans to invest $50 billion in the US before 2030, upping spending ahead of potential tariffs on imported medicines.  
  • Drug giant Roche paused shipments of its controversial gene therapy Elevidys. 
  • Carlsmed, which uses AI to personalize spine surgery, raised $100 million in its US IPO.

Up in smoke

Vapes are already banned in Singapore. But you can still walk around sometimes and see locals casually flouting the rules, puffing on their devices — also known as e-cigarettes — at restaurants or outside on their lunch hours in the central business district. 

A third of vapes seized in the country are laced with the anesthetic substance etomidate, Health Minister Ong Ye Kung has estimated, based on a sample. Doctors typically inject etomidate to induce sedation, but misusing it can cause hallucinations and permanent organ failure.

Increasing detection of etomidate on illicit drug markets is becoming a global concern, according to the United Nations Office on Drugs and Crime, with e-liquids containing it being found in East and Southeast Asia and Oceania. 

Singapore is working to reclassify etomidate as an illegal drug under the Misuse of Drugs Act. Under the new classification, users of etomidate-laced vapes will face equally tough punishment in Singapore as consumers of hard drugs like cocaine. They’ll be put through mandatory rehabilitation or, for repeat offenders, sentenced to at least a year in jail. 

It’ll take a few weeks to come into effect, Ong told reporters in the city-state this past weekend. 

“I think there is strong suspicion that it is already causing deaths in Singapore, so it is a serious problem,” he added. 

The vaping industry is worth an estimated $22 billion globally — but as my colleagues have reported, it can be legally blurry. Countries from the US to Australia have moved to crack down on the devices as they become increasingly popular with young people, and as health risks become ever more apparent. Containing harmful chemicals, vapes can lead to nausea and vomiting, mouth and airway irritation, chest pain and palpitations — though longer-term impacts are still being studied. 

The proliferation of etomidate-laced vapes is a fresh challenge for squeaky-clean Singapore — with its latest move part of a wider enforcement effort that saw S$41 million ($32 million) worth of vapes and their components seized between January 2024 and this March. Local media has published cautionary tales of drug-laced vapes destroying families and driving users to the brink of taking their own lives.

Singapore already has some of the world’s toughest drug laws, and trafficking significant quantities of drugs carries the death penalty. Even citizens or residents found to have consumed drugs overseas can face the same imprisonments or fines as those who do so within Singapore.  

Social media scenes of locals openly flouting the existing ban have been contributing to Singapore’s scrutiny of vapes. Health authorities have targeted the removal of over 600 groups on the platform Telegram selling vapes since last year — some of them allowing students to directly purchase the devices. —Audrey Wan

What we’re reading

The first pill to treat postpartum depression showed varied results in the real world, the New York Times reports

The world keeps millions of vaccines on ice. Is it worth it? asks NPR. 

Meet the Indiana Amish community considered one of the developed world’s least-allergic populations, via the Washington Post.

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