From next year, access to e-cigarettes and related products containing liquid nicotine will require a doctor’s prescription. This is to ensure liquid nicotine is handled like the poisonous, addictive substance it is and not promoted to young people. It’s good news for public health and bad news for the tobacco and e-cigarette industries.
It’s not a ban on importing e-cigarettes. But it will close loopholes between established prohibitions on the supply and sale of nicotine at the federal level, and state and territory laws restricting access to nicotine.
Here’s the evidence to show why closing the loophole between health regulations, customs regulations and state and territory laws is good news for the nation’s health.
The so-called benefits of e-cigs don’t stand up
There have only been a small number of quality reviews on the harms and benefits of
e-cigarettes for the whole population (rather than for individual people). They draw the same conclusions.
CSIRO and the US National Academies of Science, Engineering and Medicine reviews found the evidence for e-cigarettes helping people quit smoking is inconclusive. The reviews also found e-cigarettes are harmful in their own right and associated with increased smoking and nicotine use in young people.
A 2017 review from Australia’s National Health and Medical Research Council drew similar conclusions.
Australian regulator, the Therapeutic Goods Administration or TGA, found no evidence to support the sale of e-cigarettes as a “therapeutic good”; the evidence of therapeutic benefit was inconclusive. Nor has the TGA found evidence to relax existing poison safety controls that require liquid nicotine access to be authorised by a doctor.
Protecting young people
Tobacco companies and retailers claim e-cigarettes are an effective quit aid and are targeted at adult smokers who need them.
However, the tobacco industry and retail sector promote e-cigarettes through youth-friendly events, such as music festivals, and through social media by using influencers and celebrities, including singer Lily Allen.
And the promotion of flavoured e-cigarette products — strawberry, doughnut or banana, for instance — could create a generation of nicotine addicts.
Flavoured e-cigarettes can be appealing to children.
So, Australia’s latest move will protect young people and avoid the fate of countries like the US, where e-cigarette use in secondary school children has increased 78% in just 12 months.
Parents and teachers are now seeing more e-cigarette use in Australian schools. It is telling that the largest growing segment in e-cigarette use in Australia is in 18 to 24-year-old non-smokers and use has also risen among 12 to 17-year-olds.
What about quitters?
There are individuals who feel e-cigarettes help reduce the harms of smoked tobacco, and doctors who agree with them.
Given the toxicity and addictiveness of liquid nicotine, it is entirely appropriate to close loopholes that until now have enabled it to be acquired with no medical authority.
This is no different from controls around other harmful substances, such as methadone for treating heroin addiction.
There are two key differences with e-cigarettes. One, the case has not been made within an evidence-based framework that the products are safe and effective for widespread distribution; and two, they are being pushed through retailers operating outside the health system.
Is this the end of the line for e-cigarettes in Australia?
The government’s proposal is not closing the door to evidence or to options that may work for some individuals with a legitimate need to access these products. It is closing a door that exploits a disconnect between the poison and import laws to protect young Australians.
The restrictions will also prevent profiteers from addicting young Australians to harmful, novel products. Evidence on the benefits of e-cigarettes remains inconclusive but the risks to young Australians are increasingly clear.