Issue 18 / 16 May 2016

AUSTRALIA needs a change of tack when it comes to reducing smoking rates, which includes allowing some e-cigarettes to be sold legally, says a leading expert.

Professor Wayne Hall, inaugural director of the Centre for Youth Substance Abuse Research at the University of Queensland, told MJA InSight that “we’ve gone as far as we can with tax increases – I think we’ve reached the end of the road”.

“By making low risk e-cigarette products available for purchase, it would be easier to justify more restrictions on tobacco cigarettes. If you can have a less harmful product there in the shops, why would you keep cigarettes available?”

Professor Hall was commenting on research published today in the MJA which explored how and why tobacco smokers and recent quitters in NSW use e-cigarettes.

The research was based on the Cancer Institute Tobacco Tracking Survey, which included phone interviews with 2966 tobacco smokers and people who quit smoking in the past 12 months.

The authors found that 9% of the sample reported currently using e-cigarettes, and this rate was highest among 18–29 year olds at 16%. For people aged over 30 years, the most common reasons for using e-cigarettes was to help them either quit smoking or cut down on their smoking. There is a larger number of younger people (25%) than older people (16%) who reported the reason for e-cigarette use as the perception that it was not as bad for their health as smoking cigarettes, though this finding did not reach statistical significance.

The authors said their results showed that while e-cigarette use remained low, some people are using these products to try to reduce smoking-related harm.

They recommended that physicians and public health authorities should be aware of tobacco smokers’ interest in e-cigarettes, and inform smokers that e-cigarettes are currently unregulated and untested as smoking cessation aids.

In a statement to MJA InSight, a spokesperson from NSW Health backed up this message, saying that there was insufficient evidence on the benefits and harms of using e-cigarettes to quit smoking.

“Electronic cigarettes have not been approved by Australian health authorities as a smoking cessation aid or nicotine replacement therapy. There are concerns among health experts about safety because of unregulated doses of nicotine, other chemicals used in e-liquids, exposure to particulate matter and the safety of the e-cigarettes themselves.”

An accompanying MJA editorial said that e-cigarettes had at least two distinct roles.

On the one hand they are a product that may assist in smoking cessation, with possible but as yet unproven benefits. On the other, e-cigarettes are a means for the tobacco industry to circumvent restrictions on promoting their image and their tobacco products.

“This dual role implies the need for parallel regulatory tracks,” the authors wrote. The first involves the application of existing provisions for the authorisation, marketing and sales of therapeutic goods. The second involves applying existing controls on all promotions that may encourage smoking, including exposure of young people to advertising and promotion of smoking or tobacco-related imagery.

“This twin-track approach offers a means for evaluating and maximising any potential benefits while minimising risks of harm.”

Professor Hall said it was important to remember that not all e-cigarette products were created equal, adding that “there is a variety of these products on the market, of varying quality”.

However, it was very difficult to acquire any meaningful data about the effects of these different products in Australia when they are prohibited. For this reason, it would be worthwhile to allow less harmful e-cigarette products to be legally sold in Australia under restrictions, he said.

“We have to find ways of trialling the devices with lower toxic risk.”

Professor Hall said that research from the UK would be a good starting point for determining which products to trial in Australia.

“The British experience has been that ‘tanks’ are more effective than cigalikes.”

Tank e-cigarettes are designed to be refilled with nicotine-containing liquids, whereas cigalikes have disposable or replaceable cartridges.

Professor Hall also expressed concerns that tobacco industries would use e-cigarettes as a means to bypass the advertising restrictions. 

To this end, Australia should avoid following a precedent set in the US, where new guidelines could allow tobacco industries to monopolise the e-cigarette market. 

Regulations from the Food and Drug Administration require manufacturers of vapour or e-liquid devices to submit a costly pre-market tobacco application for each product.

“Only big tobacco industries will be able to afford this. Smaller start-ups won’t be able to,” Professor Hall said.

3 thoughts on “Put e-cigs to the test

  1. Steven Raith says:

    There’s definitely a good case to follow the UK model, which up till now has been fairly free-rolling.

    The very latest stats – hot off the press from ASH UK, using very solid polling methods – confirms that in the last four years, over 1.3m users of e-cigs gave up smoking. There are 1.4m who ‘dual use’ but that number is dropping as fast as the number of quitters is rising, and the pattern suggest that next year, there will be more exclusive vapers than there will be dual users.
    Full figures here: http://www.ash.org.uk/files/documents/ASH_891.pdf

    As there is absolutely no doubt regarding the comparative harm of e-cigarettes (that is, that they are 95% safer (Royal College of Physicians, Nicotine Without Smoke – https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-toba…) then to allow e-cigarettes with useful amounts of nicotine (a max of 54mg/ml should be more than most need with modern devices) would allow Australia to join in with the massive success we’ve had in the UK with these devices.

    But it’s important to remember why they work here. We have a fairly free market on these devices, that doesn’t restrict tank sizes, nor nicotine strength (up to sensible levels – 54mg is quite a throat hit!) and allows for a good level of innovation to flourish (As well as small businesses to reap the benefits).

    In short, we didn’t get there by regulating the devices to death.

    It’s vital that the Australian Public Health world realise this, and ignore the ‘flat earth’ elements who claim the UK is ‘out of step’.

    I’m happy to be out of step and 1.3m smokers down over four years ago, thanks.

    Steven R

  2. Joe Kosterich says:

    Work from the UK shows e-cigaretts to be 95% less harmful than regular cigarettes. Yet it is easier to buy the latter. The opposition to them is not about health or science. It is aboout the blind ideology of certain elemnst in the tobacco control lobby. Maybe they fear e-cigs will do them out of cushy government funded positions.

  3. Judith Olney says:

    It must be remembered that while smoking tobacco may put smokers at risk of disease, smoking is a habit, not a disease in itself. Vaping, (using a personal vapouriser), is not smoking, and it is not using a “therapeutic” device, and is not using a smoking “cessation” device. Vaping is an orders of magnitude safer alternative to smoking tobacco. One of the side effects of switching to this safer alternatives, is that many vapers,  (one that uses a personal vapouriser), stop smoking tobacco cigarettes. 

    In Australia we have the bizarre situation, (well not so bizarre when you look at the amount of tax governments rake in from tobacco taxes), where the vastly safer alternative to smoking tobacco, is either banned from sale, or restricted in the same many as smoking. Where it is illegal to buy the vastly safer alternative, in my state of Western Australia, it is legal for any adult to purchase tobacco from almost every supermarket, deli, etc. 

    There is much very credible evidence from the UK, and Europe, as well as the US, that shows vaping to be at least 95% safer than tobacco smoking, and that without draconian and counter productive regulations and restrictions, many smokers are making the switch, millions of smokers in fact.

    P.S. I made the switch to vaping myself, almost 3 years ago, and have not had a single tobacco cigarette since. I was smoking 20 RYO per day, and had done for more than 20 years. With vaping, I was able to stop smoking in one day, literally overnight. Although this has been of huge benefit to me personally, as well as my family, it means that to continue to use this vastly safer alternative, I have to purchase any equipment from overseas, and have to engage in civil disobedience. 

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