The Australian Therapeutic Goods Administration’s (TGA) recent interim decision to effectively ban nicotine-containing e-cigarettes is a harsh blow to smokers. Australian smokers will be denied access to life-saving technology estimated to have helped millions of smokers to quit overseas.
Those most affected will be from lower socio-economic and disadvantaged groups, which have the highest smoking rates and are hardest hit by the cost of smoking.
Currently, nicotine-containing e-cigarettes are effectively prohibited in Australia. If the TGA’s interim decision is made final next month, e-cigarette users (or vapers) will still not be able to buy or import nicotine for vaping without a prescription. Their only legal option would be to ask their doctor for a prescription, which doctors are generally reluctant to provide.
If the ban remains, vapers will still be forced to source nicotine solutions from an unregulated and illegal black market, placing them at even greater risk. Without regulation, the contents of nicotine refill bottles are a mystery, labels are inaccurate, childproof bottles are not mandated and there is no quality control.
Other users will buy large quantities of highly concentrated nicotine online and mix their e-liquid at home, with the risk of exposure to children and dosage errors.
Meanwhile, vapers who try to quit smoking are branded criminals. The fine for possessing nicotine for vaping in Queensland is up to $9108 and the government encourages the public to report any offenders. This fear will lead some vapers to return to smoking.
The TGA’s decision also leaves Australia out of step with other similar countries. E-cigarettes with nicotine are legal and available, or are in the process of being legalised, in the United Kingdom, European Union, United States, Canada and New Zealand. Their approach to smoking cessation products is in sharp contrast to policy in Australia, which has missed the opportunity to welcome e-cigarettes as a harm reduction tool, and a safer alternative. Meanwhile, the most lethal nicotine products, cigarettes, are freely available in Australia and do not need TGA approval.
The TGA assessment appears clouded by a long-standing commitment to prohibition. Many tobacco activists and policy makers have followed a total abstinence approach for decades. In their view, anything that looks like a cigarette, is used like a cigarette or delivers nicotine cannot be a good thing.
Harm minimisation supporters understand some people cannot quit nicotine.
E-cigarettes are a safer alternative, providing smokers with the nicotine to which they are addicted and the “smoking ritual”, without the smoke, tar, carbon monoxide and other toxic chemicals that cause almost all the harm. E-cigarettes are not completely safe. Nothing is. However, even the most ardent opponents admit e-cigarettes are substantially safer than smoking.
While there are still unknowns, the available evidence and risk-benefit balance support a role for e-cigarettes with nicotine to help smokers quit. The ideal compromise is balanced, proportionate regulation of nicotine-containing e-cigarettes under the existing Australian Consumer Law with careful monitoring. According to the UK Royal College of Physicians: “It is important to promote the use of e-cigarettes … as widely as possible as a substitute for smoking.” Australia cannot afford to wait any longer.
Colin Mendelsohn is an associate professor at UNSW. This article was originally published on The Conversation.