My colleagues and I examined trends in daily smoking and vaping in Australia and New Zealand from 2016 to 2023. We found that smoking declined up to three times more rapidly in disadvantaged and Indigenous communities in New Zealand compared to Australia, reflecting New Zealand’s higher vaping rate.

In New Zealand, people who smoke have easy access to a wide range of regulated vaping products and flavors, which are sold as adult consumer products through licensed retailers—just like cigarettes and alcohol. This is similar to the approach taken in countries such as the United States and Canada, except that New Zealand government messaging fully embraces vaping as a harm reduction strategy. 

Australia, on the other hand, has adopted a highly restrictive, medicalized approach, designed primarily to deter youth vaping. Legal vapes are available only through pharmacies, often requiring a doctor’s prescription. Most flavors are banned, though enforcement efforts have largely failed to curb a booming illicit market.

Smoking in New Zealand’s Māori population declined nearly three times faster than in Australia’s Indigenous population between 2019 and 2023.

The recent decline in smoking in New Zealand’s disadvantaged communities has been remarkable. In the seven years in question, smoking prevalence in the lowest socioeconomic quintile fell three times faster per year than in Australia (12 percent per year versus 4 percent), mirroring a dramatic difference in vaping rates (15.8 percent versus 2.8 percent in 2023).

Historically, people on low incomes quit smoking at a significantly lower rate than others. However, in New Zealand, the recent decline in smoking within these communities outpaced that of the general population.

Similarly, smoking in New Zealand’s Māori population declined nearly three times faster than in Australia’s Indigenous population between 2019 and 2023 (16 percent per year versus 6 percent per year). This trend aligns with the higher daily vaping rate among Māori (23.5 percent) compared to Indigenous Australians (6.5 percent).

The accelerated decline in Māori smoking is in stark contrast to poor outcomes for marginalized communities from traditional cessation treatments and public health campaigns. In Australia, intensive efforts under Close the Gap and other initiatives have had disappointing results: Smoking rates in the most disadvantaged quintile are three times higher than in the most advantaged quintile—and the gap is widening. 

Smoking, which is increasingly concentrated in disadvantaged groups, is a leading driver of health inequalities in the form of disproportionate impacts from smoking-related disease and death. Smoking is responsible for half the difference in life expectancy between societies’ most and least advantaged groups.

Our study highlights vaping’s potential to reduce these disparities by providing an effective, far less harmful alternative to smoking for high-risk populations. 

Smoking also imposes severe financial burdens on disadvantaged communities. Australia and New Zealand have the highest-priced cigarettes in the world. In Australia, vaping costs on average about 20 percent of the cost of smoking retail cigarettes. The average person who makes the switch to vaping illicit products will save over $9,000 AUD ($5,600 USD) per year—money that can then be redirected towards needs like food, clothing, improved housing and an otherwise healthier lifestyle. 

The impacts of the two countries’ policies on their general populations are also markedly different. New Zealand’s overall smoking rate plummeted by an astonishing 10 percent per year—dropping from 14.5 percent to 6.8 percent over the seven-year study period. In contrast, Australia’s smoking rate declined by only 5 percent per year, from 12.2 percent to 8.3 percent. 

These declines closely reflected the vaping rates in each country: In 2023, 9.7 percent of New Zealand adults vaped daily—nearly three times Australia’s rate of 3.5 percent. In both countries, the age group with the highest vaping rate, young adults, also had the fastest decline in smoking.

We can infer that the decline in smoking in New Zealand is almost certainly linked to the high vaping rate and government support for tobacco harm reduction. Of course, “cross-sectional” studies like this cannot definitively prove that vaping was the cause. Numerous other inter-country differences could have an influence on changes in the smoking rate. However, alternative explanations are unlikely for a number of reasons.

A more consumer-friendly regulatory model with government support could dramatically reduce smoking rates in Australia and other nations with harsh restrictions.

One is that Australia and New Zealand have broadly similar tobacco control policies and demographics. What’s more, our research examined a wide range of other potential contributing factors during the study period—and found no good evidence that any played a significant role. These included changes in tobacco taxation and cigarette affordability; standardized plain packaging for cigarettes; the COVID-19 pandemic and associated economic downturn; and the availability of heated tobacco products (in New Zealand only).

If vaping is the key driver of New Zealand’s success, as appears overwhelmingly likely, then our conclusion must be that a more consumer-friendly regulatory model with government support could dramatically reduce smoking rates in Australia and other nations with harsh restrictions. There is clear potential for other countries to use vaping as a means to reduce both the health gap and financial stress for low-income and Indigenous communities.  

The solution isn’t to ban vaping or to push it underground. It’s to regulate it sensibly—encouraging people to switch from smoking while implementing reasonable safeguards to protect youth. New Zealand has shown what works. It’s time for other countries to pay attention.

Top photograph by Elsa Olofsson via Flickr/Creative Commons 2.0. All graphics based on study data by Colin Mendelsohn.

Mendelsohn CP, Beaglehole R, Borland R, Hall W, Wodak A, Youdan B, Chan GCK. Do the differing vaping and smoking trends in Australia and New Zealand reflect different regulatory policies? Addiction 2025. DOI: 10.1111/add.70006

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The subjects of this experiment are the respective populations of Australia and New Zealand. The two countries have broadly comparable tobacco policies, demographics, quality of life and population health—similarities that increase the likelihood of differing outcomes on tobacco use and related harms being caused primarily by vaping policies.

If this were a clinical trial, the negative outcomes for the people of Australia are so severe that it would be unethical for researchers to allow it to continue.

On June 24, the Australian government announced that it would water down its stringent restrictions on vapes. But the move, while welcome, is too little, too late.

Regulatory Approaches

In 2020, New Zealand adopted a progressive and supportive approach by legalizing and regulating vapes. The Ministry of Health encourages vaping as a smoking cessation aid through various government initiatives—including an educational website called “Vaping Facts,” the “Vape to Quit Strong” campaign, mass media education, and clear advice for health professionals.

Vapes are sold as adult consumer products in New Zealand through licensed retail outlets, with strict age verification. A wide range of flavors is available, although nicotine levels are capped at 28.5mg/ml. Both disposable vapes and advertising of vaping products are banned.

Australian public education campaigns predominantly focus on the harms of vaping, with minimal encouragement for adults who smoke to switch.

In contrast, Australia has implemented a highly restrictive, purely medicalized approach to vaping. Nicotine liquid is classified as a medicine, requiring a prescription from a doctor or nurse practitioner. Nicotine and vaping products can only be legally purchased from pharmacies, with flavors limited to tobacco, menthol, and mint. Recreational vaping and personal importation are banned. Vapes have become so difficult to obtain legally that these policies effectively amount to prohibition.

Australian public education campaigns meanwhile predominantly focus on the harms of vaping, especially to young people, with minimal encouragement for adults who smoke to switch to vaping as a harm reduction measure. The health minister has said he aims to “drive the vaping industry out of the country.”

That health minister has just been forced to strike a political deal with the Australian Greens, however. As a result, people will be able to purchase vapes from pharmacies without a prescription, starting in October. But only three flavors will be available, with a poor choice of hardware and at high cost. Furthermore, the powerful Pharmacy Guild has strongly opposed any involvement with the proposal, and it remains to be seen if this model will get off the ground without its support.

Still, it can be read as a belated, tacit admission that the status quo hasn’t been working.

Public Health Outcomes

New Zealand has historically had higher smoking rates than Australia. However, this trend has recently reversed.

Since the regulation of vaping in 2020, New Zealand has experienced an unprecedented decline in its daily adult smoking rate: from 11.9 percent in 2020 to 6.8 percent in 2023—a total drop of 43 percent, or about 14 percent per year.

Significant reductions were observed across various demographic groups, including Māori and Pasifika communities and those with lower socio-economic status. As smoking has fallen, vaping has risen, with 9.7 percent of the adult population now vaping daily. And the smoking decline has been most pronounced among young adults with the highest vaping rates, those aged 18-34, supporting the notion that vaping has contributed to this reduction.

By 2023, Australia’s daily smoking prevalence was significantly higher than New Zealand’s.

Thanks to this rapid decline in smoking, New Zealand is now on track to achieve its target of becoming smoke-free by 2025.

In contrast, Australia has seen a much slower decline in its smoking rate, with a 6 percent annual reduction from 2020 to 2023. By 2023, the daily smoking prevalence was significantly higher than New Zealand’s at 8.3 percent, with 3.5 percent of the adult population vaping daily. 

Youth smoking has continued to decline in both countries, with only 1.2 percent of New Zealand youth and 0.3 percent of Australian youth smoking daily. But youth vaping rates have raised concerns, particularly in New Zealand. In 2023, 10 percent of 14-15-year-olds in New Zealand were vaping daily.

Most of New Zealand’s increase in youth vaping occurred before regulation commenced, however. Since regulation took effect, the youth vaping rate has begun to level out. This rate is expected to decline as the novelty of vaping wears off, as we have seen in the United States.

In Australia, daily youth vaping was at 3 percent in 2023, and anecdotal reports suggest that youth vaping is continuing to rise rapidly. The unpopular prescription-only model means that illicit vapes dominate the market, and these are readily accessible to young people.

Illicit Markets and Economic Impact

Most of Australia’s 1.7 million vapers have rejected the medical pathway. Fewer than one in 10 have a nicotine prescription. The difficulty in finding doctors who will write nicotine prescriptions and the limited range of products stocked by pharmacies have driven 90 percent of Australian vapers to the illicit market.

An estimated 120 million disposable vapes are illegally imported annually and sold from retail outlets, on social media and the internet. These unregulated products pose potential health risks and are sold freely to youth. Nicotine vapes are now the second largest illicit drug market in the country, after cannabis.

This illicit market is largely controlled by organized trafficking networks and outlaw biker gangs. The result has been a violent turf war to control market share. Over the past 18 months, there have been over 80 firebombings of tobacco and vape shops, three public killings and regular extortion. Vulnerable children are being used to light fires and commit other crimes on the gangs’ behalf.

In response, the government has set up a special crime force, Operation Lunar, and increased Border Control and policing efforts. However past experiences with drug wars suggest that these measures will have little long-term effect on supply and use.

Under New Zealand’s consumer model, costly doctor visits are unnecessary, and the country avoids the expense of trying to police a substantial illicit market.

In contrast, New Zealand’s legal and regulated vape market means that the country has seen very little evidence of an organized illicit market. The legal market offers substantial economic benefits, including tax revenue from vaping products, stimulation of the retail and manufacturing sectors, and government savings from reduced health care costs. Under New Zealand’s consumer model, costly doctor visits for nicotine prescriptions are unnecessary, and the country avoids the expense of trying to police a substantial illicit market.

The demise of Australia’s retail vape industry is another harmful effect of its harsh medical model, depriving people who smoke of the valuable support and advice previously available from vape shops.

Even under Australia’s new plan, given the continuing relative difficulty of obtaining a restricted number of unappealing vaping products from pharmacies only, the illicit market will continue to thrive.

A Clear Winner

This analysis supports New Zealand’s harm reduction-oriented, consumer-based approach to vaping. The most striking benefit has been the accelerated decline in smoking rates, with predictable improvements to public health to follow.

While New Zealand is now on track to achieve its smoke-free target in 2025, modeling suggests that Australia will miss its own smoke-free goal by a wide margin.

While New Zealand’s approach is not perfect, it offers a far more effective strategy for reducing total harm.

Besides obstructing progress on smoking cessation, Australia’s restrictive model has handed control of the vaping industry to illicit operators—doing away with consumer protections and age restrictions, and creating further dangers from the resulting turf war.

While New Zealand’s approach is not perfect, particularly with higher youth vaping rates, it offers a far more effective strategy for reducing total harm. Enhanced compliance measures could further stabilize youth vaping, although the net harms from youth vaping are debatable and certainly not comparable to smoking.

Australia has just recognized, to a limited degree, the urgent need to reverse course, and abandon an approach that incurs high costs, creates violent chaos and demonstrably impedes public health goals. The country has much further to go to ensure low-barrier access to vapes for everyone who smokes.

Top image by US Geological Survey via Picryl/Public Domain. Inset graphics by Colin Mendelsohn, based on public data.

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The intricate web of negative consequences underscores the urgent need for a paradigm shift towards regulation and harm reduction. On February 12, some colleagues and I released a briefing paper to launch a campaign to raise awareness of these self-inflicted problems.

Australia is the only country in the Western world to require a nicotine prescription to vape legally. The restrictions are so harsh that they amount to de facto prohibition. This has led over 90 percent of Australia’s 1.7 million adult vapers to give up on legal pathways and purchase their vaping products from the illicit market.

Measures ostensibly intended to safeguard public health are putting people at risk in a number of ways beyond the sabotage of smoking cessation.

This market is not a fringe phenomenon but a mainstream crisis, with an estimated 120 million disposable, unregulated vapes imported illegally from China each year. Products are brazenly sold in retail outlets and across social media platforms, without consumer protections, to both adults and minors.

The irony is stark: Measures ostensibly intended to safeguard public health are putting people at risk in a number of ways beyond the sabotage of smoking cessation.

Illegal vapes are a highly profitable commodity. A disposable vape can be purchased from China for as little as AU$3 and sold in Australia for AU$35. Given those huge margins and the impossibility of enforcing such a widespread market, the incentives to participate are strong.

By nurturing this lucrative domain for illegal enterprises, Australia has created a battleground for organized trafficking networks. Firebombing, public executions and daylight robberies signify an intensifying turf war among various factions, from groups with roots in the Middle East to outlaw motorcycle gangs. These acts of violence can involve the exploitation of young, marginalized recruits who carry out attacks, and their subsequent criminalization.

Isolated law enforcement busts are often celebrated in the media, but represent a drop in the ocean. Research has shown that illicit markets, in Australia and overseas, have rarely been significantly disrupted by enforcement or crackdowns. This has been the case with alcohol, with other drugs, with sex work and more. Further research has found that drug-law enforcement, by creating power vacuums and instability in illicit markets, can increase associated violence.

Australia has a vast coastline, and the Australian Border Force has nowhere near the resources to constantly patrol it all.

Even the head of the Australian Border Force (ABF) has warned that banning vapes at the border, a policy being implemented right now, won’t eradicate the illicit market. Already, he estimated, the ABF was only managing to detect a quarter of illicit drugs making their way into Australia. That’s likely an overestimate.

The ABF’s limited success in intercepting illegal vapes illustrates the futility of trying to impose this type of border control here. Australia has a vast coastline, and the ABF has nowhere near the resources to constantly patrol it all. The force scans just 1.4 percent of the 6.3 million containers that arrive in Australia by sea every year. The rarity of prosecutions highlights the low risk of trafficking and the failure of enforcement to make any significant dent.

The parallels with past prohibitions are striking. Heroin was banned in Australia in 1953 but is widely available. Illicit tobacco, avoiding heavy taxes, is now estimated by industry sources to comprise 23.5 percent of the total tobacco market. In 2022, a ban on tobacco in Bhutan was repealed after it led to a thriving illicit market, associated violence and corruption, and increased tobacco use.

Banning drugs doesn’t stop people using them. Instead, it drives them underground, exposing them to additional risks from unregulated products and markets. Sellers always rise to meet the demand and find creative solutions, regardless of legal barriers. Australia’s failure to learn from historical precedents suggests a disconcerting disregard for evidence-based policy-making.

Easy access to unregulated sales channels for minors undermines the key rationale of Australia’s prohibitionist approach.

According to the Iron Law of Prohibition, banned substances not only become more potent and dangerous but also more accessible to vulnerable populations, such as youth. A tragic example of this is the outbreak of the severe and sometimes fatal lung injury misnamed as “EVALI” (E-cigarette, or Vaping, product use-Associated Lung Injury) in North America in 2019-20. It resulted from illicit THC vapes, adulterated in the unregulated supply chain with vitamin E acetate.

Easy access to unregulated sales channels for minors undermines the key rationale of Australia’s prohibitionist approach. Youth vaping rates in Australia remain similar to New Zealand and other Western countries with a more liberal approach. And making vapes difficult to access, if it were achieved, would risk perpetuating youth smoking, which is far more dangerous.

The economic implications of vaping prohibition are also substantial. A huge illicit market represents a significant loss in potential tax revenue for the government, funds that could support public health initiatives.

The disconnect between public opinion and policy is another critical aspect of the vaping debate. A recent survey found that 88 percent of Australians support regulating vapes as an adult consumer product, like tobacco and alcohol. This growing public sentiment could serve as a catalyst for policy change, urging lawmakers to reconsider the current prohibitionist stance.

The only way to significantly reduce an illicit market is to replace it with a legal, regulated one.

The contrast between Australia’s vaping landscape and that of countries like New Zealand, where a regulated market has effectively deterred a significant illicit market, is stark. Illicit vape markets are well documented in the United States and United Kingdom, but they’re much smaller in proportion because vapes are legally available at retail outlets.

The solution to Australia’s vaping dilemma lies in following New Zealand’s vapes blueprint by embracing regulation over prohibition. The only way to significantly reduce an illicit market, as the government would presumably wish to do, is to replace it with a legal, regulated one—with products sold by licensed legal outlets, with quality control and age verification. This approach would ensure product safety, curtail violence, reduce youth access and align Australia with global best practice in harm reduction.

The narrative of vaping in Australia is a further cautionary tale about the perils of prohibition. As well as being a harsh lesson for Australian regulators, it should also serve as a warning to other countries considering their own vape policies.

Photograph (cropped) of ABF boat off Western Australia by Calistemon via Wikimedia Commons/Creative Commons 4.0

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Where vaping is seen by other Western democracies as a huge opportunity for public health, successive Australian governments have framed it as a threat. The ensuing prohibitive regulations have neutralized the potential benefits and led to troubling and escalating unintended consequences.

More Smoking and a Rampant Illicit market

Australia’s unique prescription-only model for vaping has not resonated with adult vapers. Less than 10 percent hold a nicotine prescription, which is hard for many to obtain. Many have returned to smoking. Of the rest, the vast majority turn to the illicit market.

This illegal trade, estimated at 100 million vapes annually, is controlled by organized trafficking networks that import and sell unregulated products, with no consumer protections or age verification. Increasingly, the illicit nicotine and tobacco trade is associated with violence, with reports of extortion, fire-bombings and public executions from turf wars over market share.

Health Minister Mark Butler’s response to this clear failure is further harsh prohibition.

Most importantly, adult smoking rates declined by only 5 percent over the four years from 2018-2022. In comparison, the prevalence of smoking has fallen sharply over the same period in similar countries where legal vapes are readily accessible: by 39 percent in New Zealand, 33 percent in Great Britain and 18 percent in the United States. 

Why such disparity? The answer lies largely in Australia’s precautionary approach to vaping.

Worryingly, while other Western countries report a decline in youth smoking associated with the rise of vaping, smoking among Australians aged 14-17 has increased substantially: from a rate of 2.1 percent in 2018 to 6.7 percent in 2022. When youth are given the message that vaping is unsafe, they tend to conclude that they might just as well smoke cigarettes instead.

Health Minister Mark Butler’s response to this clear failure is further harsh prohibition. Changes for 2024 included a doubling down on the prescription and pharmacy model; a complete ban on disposables and on the personal importation of vapes; and harsh restrictions on flavors, nicotine strength and pharmaceutical-like packaging. All of this will make legal vaping even less appealing, less accessible and less affordable.

A Masterclass in Science Denial

Vaping is opposed in Australia by a tight network of all state and federal health departments, health charities, and medical and public health associations. These groups dismiss and undermine the established science of vaping through scaremongering, disinformation and cherry-picking.

Even our most prestigious health organizations distort and deny the evidence. In 2022, I led a review of the Position Paper on vaping by Australia’s leading health and research body, the National Health and Medical Research Council (NHMRC).

Our findings, authored by 11 leading Australian and international experts and published in the journal Addiction, found that the NHMRC’s assessment contained serious scientific flaws, misinformation and grounds for concerns about bias. We concluded that it “fails to meet the standard expected of a leading national scientific body.” Yet our review received little media attention and was dismissed by the NHMRC.

A further government-commissioned review, led by Professor Emily Banks at the Australian National University in 2022, was equally flawed. But our peer-reviewed critique in Drug and Alcohol Review was similarly ignored, and the ANU report is regularly referenced today as the gold-standard guide for Australian policy.

Submissions by leading Australian experts to the health minister—here and here—and Chief Medical Officer, as well as our recent Evidence Review to all members of parliament, have been rejected.

Tellingly, repeated invitations to anti-vaping advocates to debate the evidence have also been refused.

The official narrative is further amplified uncritically by the mainstream media, which focuses on alarmist and negative messaging around vapes.

Underlying Reasons for Opposition

Tobacco control in Australia is driven by a small network of influential insiders who desperately attempt to maintain their control. Tobacco harm reduction is a threat to their traditional approach and to their legacy. Their entrenched abstinence-only ideology and irrational fear of nicotine has led to moral outrage over the continued use of this “addictive” drug. Nicotine is framed as the problem, rather than the deadly harms from smoking.

Vaping threatens the very existence of the tobacco control industry. They have prior positions to defend and organizations to run. Vaping threatens the ongoing funding for their research, conferences, wages and their largely ineffective abstinence-based programs.

Governments are driven by minimizing political risk. Kudos can easily be gained by appearing to be “tough on the tobacco companies” or “protecting our children.”

Once tobacco companies entered the vaping market, the focus of tobacco control shifted to attack vaping in order to punish the tobacco industry, understandably its historical enemy. It prioritized this to the detriment of the primary goal of preventing smoking-related deaths from cancer, lung and heart disease.

Rather than openly admitting these unacceptable motivations, opposition is often framed as publicly acceptable arguments, with superficial appeal but little supportive evidence. 

Governments are driven by minimizing political risk, and it takes great courage for political leaders to oppose these powerful and united forces. In contrast, kudos can easily be gained by appearing to be “tough on the tobacco companies” or “protecting our children.”

A case study is how Health Minister Butler frames his proposed harsher crackdown on vaping as youth protection. Despite the evidence to the contrary, he repeatedly claims that “vaping is a gateway to smoking.” He states that, “Vaping is creating a whole new generation of nicotine dependency in our community,” when Australian studies show that among youth who don’t smoke, less than 2 percent vape nicotine weekly or more.

And he describes youth vaping as a deliberate strategy of the tobacco industry—”what the tobacco industry has done here is tried to find a product that will recruit a whole new generation of nicotine addicts”—when none of the vaping products widely used by youth in Australia are made by tobacco companies.

Personal Experiences: The Cost of Advocacy

My evidence-based advocacy and the efforts of others are undermined with smears, insults and harassment.

I have repeatedly faced false accusations of being funded by Big Tobacco, including in national print media and on national radio.

Attempts have been made to block my teaching, media articles and presentations. For example, an invitation to speak on vaping at a leading Sydney Hospital was withdrawn after a false claim by a respiratory specialist that I “was funded by a tobacco company,” despite this being comprehensively denied.

These and other cowardly incidents have caused me intense aggravation and frustration. My support for tobacco harm reduction is undiminished. But I have had enough.

Anti-vaping advocates have twice made complaints about my advocacy to the health regulatory body (Health Care Complaints Commission), both of which were dismissed.

Opponents attempted to have my peer-reviewed paper on vaping retracted from a leading medical journal on the basis of a purported conflict of interest. The journal supported the retraction even after the alleged conflict was explained as false. It was only after I engaged a lawyer and spent thousands on a legal challenge that the matter was resolved and the article retained.

A recent television program on vaping claimed that I was “a friend of Big Tobacco” and implied that I was acting for them. I also had to engage a lawyer to challenge this attack on my integrity.

These and other cowardly incidents, and the persistent denial of the science, have caused me intense aggravation and frustration. My support for tobacco harm reduction is undiminished. But I have had enough.

As I retire, my hope, still, is for a balanced, evidence-based approach to vaping in Australia. It won’t come soon. The latest regulatory crackdown will need to run its course and fail again before much-needed reforms are possible.

Then we will need to move beyond the echo chamber of Australia’s tobacco control groupthink, if we’re to recognize vaping not as a “public health menace,” but as a powerful ally in the fight against tobacco-related harm.

The future of public health in Australia depends on it.

Photograph via NARA & DVIDS Public Domain Archive

Inset graphic by Colin Mendelsohn

The post The Slow-Moving Train Wreck of Australian Vaping Policy appeared first on Filter.

In fact, vaping may be beneficial overall to young people.

That statement will undoubtedly spark angry reactions. I hasten to add that in an ideal world, it is generally best for young people’s health not to vape (nor, of course, smoke). But the real world is different, and youth will always experiment with pleasurable activities, especially if we tell them not to.

Vaping opponents have weaponized fears about youth use to demonize vaping. “Think of the children” is a compelling emotive tactic—reminiscent of the 1930s Reefer Madness debacle, and long used as justification for the global drug war. This argument is often used as a screen, when the real concerns are underlying ideological, moral or political objections to harm reduction that are less socially acceptable to express.

Public health policy should be based on evidence rather than emotion, moral panic and misinformation. So, what is the evidence about youth vaping? How harmful is it really, and how can it be beneficial? Importantly, what is the net impact of vaping on youth health and wellbeing?

The Harms of Youth Vaping

The young people who are most at-risk of harm from vaping are those who have never smoked, as vaping can expose them to new and unnecessary health risks. However, most vaping by never-smokers is experimental and short-term. Exposure to toxicants and the risk of harm are low with this pattern of vaping.

For example, in England in 2021, only 1 percent of 11-15-year-olds who had never smoked cigarettes vaped once or more weekly. 

Vaping frequency by never-smoking youth in England

In the United States, where a “youth vaping epidemic” has frequently been claimed, only 2.1 percent of 14–18-year-olds, in 2019, had vaped on 20 or more days in the past month.

Vaping can cause nicotine dependence in some young people who are not already smoking. However, this is a minority of cases—not, as the media and policymakers often claim, a “whole new generation addicted to nicotine.” And when it occurs, we must ask what harm it actually poses beyond the expense of regular purchases.

Nicotine itself is relatively benign in the doses used in vaping. It does not cause cancer or lung disease. However, it does have minor cardiovascular effects. And if you use it frequently and then stop, you may experience unpleasant withdrawal symptoms and cravings.

Monitoring and long-term studies are essential to detect any emerging problems. However, serious harm is likely to be very uncommon even after decades of vaping.

Vaping involves inhalation of trace amounts of other chemicals besides nicotine. It has effects on the lungs in cell and laboratory tests, but studies have so far identified no clinically-important respiratory symptoms from vaping in young people.

There is also no evidence that nicotine harms the human adolescent brain, although high doses can cause harm to adolescent rodents. Studies have not found differences in IQ, educational achievement or cognitive abilities in adults who smoked in the past compared to those who never smoked, so vaping is very unlikely to have these effects.

And there is certainly no evidence that vaping nicotine causes the misnamed serious lung disease “E-cigarette or Vaping Associated Lung Injury” (EVALI), when a completely different culprit has been identified. Neither does it cause seizures or spontaneous pneumothorax, as is often claimed. There is a rare risk of burns and injuries from lithium-battery explosions.

Long-term vaping may cause cardiovascular and respiratory effects, and ongoing monitoring and long-term studies are essential to detect any emerging problems.

However, as vaping is far less harmful than smoking, serious harm is likely to be very uncommon even after decades of vaping. People who smoke cigarettes but quit by the age of 35 have a full recovery and a normal life expectancy. 

The Benefits

Most frequent youth vaping is by those who have previously smoked, or currently do. Vaping by young people who already smoke is beneficial if it diverts them completely or partly away from cigarette smoking, and many vape for this purpose.

It cannot be overemphasized that vaping, overall, is diverting young people away from deadly smoking.

Some young people who would have smoked have never started because nicotine vapes were available as an alternative. Other research has found that restrictions on vaping are associated with increased youth smoking.

It cannot be overemphasized that vaping, overall, is diverting young people away from deadly smoking. Increases in youth vaping have been accompanied by accelerated declines in smoking in the United States, the United Kingdom and New Zealand. 

Accelerated decline in youth smoking in the US as vaping increased

Young people who try vaping are more likely to try smoking. But this simply tells us that people who are more likely to try nicotine products are also more likely to try other nicotine products. There is no evidence that vaping causes people to smoke if they would not otherwise have done so (the “gateway theory”).

Young people who vape exhibit the same genetic, psychological and social factors (such as peer-group pressure, or parental smoking) that are also shown to predispose people to smoking—i.e., they have a “common liability” to both vaping and smoking.

If there is a small “gateway effect” for some youth, it is certainly outweighed by a much larger number moving from smoking to vaping.

There is also growing evidence that those who vape first (before smoking) are less likely to smoke later, compared to those who smoke first.

Many people also experience positive effects from vaping nicotine on mental health. Nicotine has been shown to create pleasure, reduce anxiety and relieve depression. And just like adults, young people often vape for these benefits.

The 2021 Canadian Student Tobacco Alcohol and Drugs Survey, for example, reported that the most common reason for vaping was to relax and relieve tension. Vaping is more common in teens with depression, and is likely being used by some to self-medicate.

Young people benefit immeasurably when their parents quit smoking.

Nicotine also improves attention, working memory and cognitive function and is beneficial for young people with attention deficit hyperactivity disorder and schizophrenia. Vaping nicotine can assist with weight control and is used by some for this purpose. Other benefits are social acceptance and enjoyment.

Another critical factor is vaping’s role as an effective quitting aid for adults who smoke. Young people benefit immeasurably when their parents quit smoking.

Adults who quit with vaping have improved health and live longer, removing the trauma and grief of losing a parent to a smoking-related disease. As vaping is less costly than smoking, there is more money for the family budget and reduced financial stress. Kids grow up without secondhand smoke. And parents who switch to vaping are also no longer smoking role models, meaning their children are less likely to start smoking. 

Youth Have Bigger Problems

Even if you deny some of these benefits, the panic about youth vaping is grossly out of proportion to the harm it causes.

A recent assessment of youth drug harms in New Zealand ranked vaping as just about the least harmful form of drug use among young people.

No young person or adult has ever died from vaping nicotine.

There are far, far bigger issues that should concern us regarding young people’s health. In the US high school population in 2021-22, 41 percent reported poor mental health, and 22 percent had considered attempting suicide. Many others used drugs with more concerning risk profiles than nicotine, or engaged in unprotected sex.

The biggest danger of the youth vaping panic is that it discourages adults who smoke from switching.

Again, young people who do not smoke should generally be advised not to start vaping, due to its small potential health risks. But at a population level, the benefits of youth vaping, particularly in reducing smoking rates, outweigh the harms.

The biggest danger of the youth vaping panic, however, is that it drives counterproductive policies and discourages adults who smoke from switching to a far safer alternative.

These adults are dying prematurely at a rate of over 8 million a year—a real, devastating harm that should be at the top of the public health agenda. For many, vaping nicotine is the only way to save their lives.  

Photograph via Pxfuel

The author recently published, with Wayne Hall, the commentary “What are the harms of vaping in young people who have never smoked?” in the International Journal of Drug Policy.

The post It’s Time to Change the Way We Look at Youth Vaping appeared first on Filter.

To legally possess nicotine e-liquid to quit smoking, vapers must get a doctor’s prescription and purchase supplies from pharmacies or international online vendors. The sale of nicotine from vape shops and other retail outlets is banned.

Predictably, this prohibitionist model has created a thriving illicit market.

The regulations were intended to prevent youth vaping and to allow access for adults as a smoking cessation aid. After 12 months, it is clear that they have achieved neither of those goals. In fact, they have had the opposite effect, as my new report indicates.

Illicit Market, Raids and Increased Youth Vaping

Predictably, this prohibitionist model has created a thriving illicit market for unregulated vaping products that do not comply with Australian standards. Massive numbers of poor-quality devices are being imported from China and are widely sold by tobacconists, convenience stores, online and on social media. Criminal organizations are becoming increasingly involved.

Enforcement of the illicit market is minimal, but some businesses are raided. When that happens, many just resume selling illegal products within weeks. The vast majority of illegal imports are not detected.

The widespread availability of disposable nicotine vapes on the illicit market has left consumers less protected and devastated the legal retail vape industry—which continues to sell hardware and nicotine-free liquids, but is not allowed to sell nicotine. Many shops have reported a substantial decline in sales and some have closed as a result. As many vapers are now buying illegal nicotine disposables, these retail products are now being used far less. (Previously vapers bought their nicotine-free liquid locally and added nicotine from overseas, or just bought hardware locally and premixed nicotine juice from overseas. Now many do neither.)

Schools are responding by installing vape detectors and confiscating vapes.

Vaping by adolescents has reportedly increased in Australia since the new regulations began. There are almost daily media reports of widespread youth vaping. High-nicotine (5 to 6 percent) disposable vapes are freely sold on the illicit market. With no age controls in an unregulated market, they are easily accessible by teens from tobacconists, convenience stores, gas stations and even in Ubers. Devices are easily purchased on social media, often with a home delivery service.

There are also increasing reports from schools of teens vaping in bathrooms and the classroom. Some schools are responding by installing vape detectors in the toilets, removing toilet doors, locking toilets during class hours, installing security cameras, suspending students for vaping at school and confiscating vapes.

Reduced Access for Adults

The prescription model has made it harder for adults who smoke to legally access nicotine vapes to quit smoking. Legal access is complex, onerous and costly. Perversely, it is far easier to buy deadly cigarettes.

According to two recent surveys, between 88 to 97 percent of vapers do not have a prescription and only 2 percent of purchases are made from a pharmacy, the government’s preferred model. However, it is a criminal offense to possess nicotine without a prescription, punishable by fines up to $45,000 and potential jail terms.

Only 200 out of 31,000 general practitioners were publicly listed as nicotine prescribers.

Doctors have not supported the regulations. In June 2022, only 200 out of 31,000 general practitioners (GPs) were publicly listed as nicotine prescribers. GPs cannot advertise their availability for nicotine prescribing, so it very difficult for vapers to find a prescriber.

GPs are skeptical about vaping and are reluctant to prescribe nicotine. They are constantly exposed to negative messaging by the Therapeutic Goods Administration (Australia’s medicines regulator), government agencies, medical associations and colleges, health charities and the mainstream media. GPs also fear medico-legal repercussions for prescribing unapproved products, and no vaping products are approved by the medicines regulator. GPs know very little about vaping, and most do not know how to write a nicotine prescription.

Only a handful of community and online pharmacies dispense nicotine liquid. Those that do stock nicotine products have a very small range to choose from.

Admit the Mistake

The only way forward is to replace the prescription-only model and the illicit market it fosters with a legal and regulated retail market. Nicotine liquid should be an adult consumer product, sold from licensed retail outlets such as vape shops, convenience stores, tobacconists and general stores as it is in other countries. There should be strict age verification and penalties up to loss of license for underage sales.

It would be worthwhile having a dual pathway, however with both consumer and medically approved products which doctors can prescribe. This would legitimize vaping for doctors and reassure them and the public about safety concerns.

Australia’s misguided experiment has failed. We need to admit the mistake and adopt a more realistic regulatory model to support Australians who smoke and vape.

Photograph via ColinMendelsohn.com.au

The post Australia’s Experiment With Prescription-Only Vapes Has Failed appeared first on Filter.

Australia is already the only Western democracy to require a nicotine prescription to vape. Vaping is framed as a threat to public health, rather than an opportunity to improve it.

Public consultation is currently being conducted on the draft Strategy, until March 24.

The previous National Tobacco Strategy 2012-2018 was an embarrassing failure. A target of 10 percent adult daily smoking was set for 2018, but only 13.8 percent was achieved. The draft 2022-2030 Strategy has now set the same target of 10 percent for 2025. However, without ready access to vaping, this goal is certain to be missed once again.

In Australia, it will remain much easier to buy deadly cigarettes than the far safer alternative.

In sharp contrast, neighboring New Zealand recently set a 2025 daily adult smoking target of less than 5 percent, for all population groups, in its Smokefree Aotearoa 2025 Action Plan. Vaping is a key element of this plan: “Those who are not ready to quit, or are unable to, now have an alternative at much less cost and risk to health,” it states.

Concerns over the criminalization of Māori people make New Zealand’s increasingly prohibitionist approach to smoking highly controversial. At the same time, its plan would make vaping products more accessible than cigarettes. In Australia, meanwhile, it will remain much easier to buy deadly cigarettes than the far safer alternative.

Even without the planned anti-smoking measures, the benefit of vaping has been clearly demonstrated in New Zealand. Over the last 12 months, since new vaping legislation was introduced, there has been an unprecedented 20 percent decline in the adult (daily and non-daily) smoking rate (from 13.7 percent to 10.9 percent). This decline is likely to be almost entirely due to vaping, as there have been no other significant tobacco policy changes during this time. In contrast, the adult smoking rate in Australia fell by 10 percent in six years from 2013-2019 (16.4 percent to 14.7 percent).

Smoking rates have also fallen much faster recently in other countries with high rates of vaping, such as England and the United States.

Australia’s harsh restrictions on vaping, together with high cigarette prices, cause the greatest harm to the most vulnerable members of society, who have the highest smoking rates. These include people on low incomes, people struggling with mental health conditions or substance use disorders, and people experiencing homelessness. Forty per cent of Indigenous adults still smoked in 2019.

There is growing evidence that internationally, the uptake of vaping may be higher in disadvantaged groups, making it a key tool to reduce health and financial inequalities. 

Policy Guided by Fear and Misinformation

According to the draft Strategy, Australia’s precautionary approach “is underpinned by the current state of evidence regarding: the direct harms e-cigarettes pose to human health, their impacts on smoking initiation and cessation, uptake among youth and dual use with conventional tobacco products.”

However, these concerns are misguided. Vaping is not risk-free but there is overwhelming scientific agreement that it is far less harmful than smoking and a more effective quitting aid than nicotine replacement therapy. Uptake of regular vaping is rare in non-smokers.

Rather than being a gateway into smoking, the overall evidence suggests that vaping is diverting more young people away from smoking than encouraging them to smoke. Dual use is a transitional stage leading to switching completely away from cigarettes and most dual users have significantly reduced cigarette consumption.

Another justification for harsh restrictions by Australian authorities is a misinterpretation of the WHO Framework Convention on Tobacco Control (FCTC) guidelines. According to the draft Strategy, “Australia’s policy settings for novel and emerging tobacco products will continue to be guided by the WHO FCTC.”

However, as a signatory to the FCTC, Australia is obligated to support tobacco harm reduction. The FCTC requires Australia to not only allow reduced-risk products but actively promote them. In the introduction, article 1(d) of the FCTC defines tobacco control as: 

“a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke” [My emphasis.]

The involvement of the evil tobacco industry is also invoked to justify restrictions on vaping. Although we can’t trust the tobacco industry, based on past behavior, to prioritize anything but profits, our overriding priority should be to reduce the death and disease caused by combustible tobacco as quickly as possible. Safer alternatives to smoking will save lives, regardless of who makes them. It is unscientific and immoral to oppose all safer products just because some are associated with tobacco companies. International tobacco companies are slowly switching away from combustibles to lower-risk products and this transition should be encouraged and accelerated.

Smokers are being thrown under the bus.

The “primary focus and goal” of Australia’s proposed vaping regulations is to protect children and young people without any consideration of the lifesaving benefits of vaping for adult smokers. Vaping is the most effective quitting aid available and has helped millions of smokers who have been unable to quit with other methods.

Fifteen past presidents of the SRNT, the peak international organization for research into nicotine and tobacco, wrote recently “We believe the potential lifesaving benefits of e-cigarettes for adult smokers deserve attention equal to the risks to youths.” They continued “The public health objective should be to develop policies and interventions that both reduce youth vaping and increase adult smoking cessation.”

Balanced regulations can support the needs of both groups, minimizing access for young people while facilitating access for adult smokers.

Continuing the traditional “quit or die” approach will result in a continuing sluggish decline in Australian smoking rates and another failure to reach the smoking target. Smokers are being thrown under the bus. Lives are being lost unnecessarily. We need to do better.

Top image by marselelia via Pixabay. Inset graphics by Colin Mendelsohn.

The post Australia Tightens the Screws Further on Vaping Nicotine appeared first on Filter.

For decades, tobacco control and public health organizations have sought to stigmatize tobacco, nicotine, smoking and smokers. The invention of vaping, a far safer nicotine alternative which looks like smoking, is a threat to their strongly-held views and the traditional approach.

Attitudes to vaping nicotine are shaped less by the scientific evidence and more by this longstanding prohibitionist approach. Other factors such as moral judgements, values and priorities, politics, vested interests and financial factors also play a role. These considerations help to explain why different organizations have diametrically opposed views, despite using the same evidence.

Australian federal and state governments, Heart Foundation Australia, Cancer Council Australia and the Australian Medical Association oppose vaping nicotine. Their position is in stark contrast to the United Kingdom government, the British Heart Foundation, Cancer Research UK and the British Medical Association, which support vaping nicotine as an opportunity to save lives.

1. ‘”Abstinence-Only” Ideology

Australia has been successful in reducing smoking rates by promoting complete abstinence from tobacco and nicotine. Tobacco harm reduction has not been part of the traditional approach and is seen by some as a threat to it.

This contrasts with the UK’s longstanding support for tobacco harm reduction. The UK Royal College of Physicians published its first report supporting harm reduction for nicotine products in 2007. This was followed by support from the National Institute for Health and Care Excellence in 2013 and subsequent reports from the Royal College of Physicians in 2014, 2016 and 2021. The 2021 report stated:

“On the basis of available evidence, the RCP believes that e-cigarettes could lead to significant falls in the prevalence of smoking in the UK, prevent many deaths and episodes of serious illness, and help to reduce the social inequalities in health that tobacco smoking currently exacerbates.”

Australia’s zero tolerance of nicotine is not consistent with our approach to other forms of harm reduction. We accept the use of methadone for people who use heroin but not clean forms of nicotine to reduce the harm from smoking, Australia’s biggest preventable killer.

It is also not consistent with Australia’s National Tobacco Strategy and National Drug Strategy, both of which include a legitimate and integral role for harm reduction.

The goal of tobacco control should be to end the death and suffering from smoking, not to eliminate nicotine from society. Nicotine is part of the problem, but it can also be part of the solution as a harm reduction tool. The “war on nicotine,” just like the War on Drugs and other forms of prohibition, is doomed to failure.

2. Moral Outrage

Opposition to harm reduction policy has a “strong underlying tone of moralism” according to distinguished Professor of Public Health Ken Warner from the University of Michigan.*

Some opponents of vaping believe that any use of an “addictive” substance is wrong. Anything that looks like a cigarette or works like one and delivers nicotine is seen as sinful or immoral and must be eliminated, and this takes priority even when there are substantial health benefits.

Warner notes “a distinctly puritanical streak within the public health community” that will only accept “Just say no” when it comes to nicotine. It is especially unacceptable if people get pleasure from vaping nicotine, choose to do it recreationally or if the tobacco industry is involved in some way. The game plan of Big Public Health has been to punish, coerce and stigmatize smokers (and now vapers) until they change their wicked ways.

Moral and emotional arguments are common on issues such as illicit drugs, alcohol, the sex industry and sex outside marriage. For example, a preacher opposed to sex before marriage would be horrified at the prospect of distributing condoms to young people, even though this would prevent pregnancy and sexually transmitted disease. In the same way, the moral objection to vaping nicotine will result in more deaths from smoking.

Moral judgements have a strong influence over public policy on harm reduction. This helps to explain why compelling evidence alone is not be enough to bring about sensible regulations on vaping. 

3. Competing Values and Priorities

Our values, priorities and goals influence how we interpret the evidence. For example, if you believe that even the smallest risk to young people from vaping is not justified at any cost, you will oppose it even if there are substantial and immediate benefits for established adult smokers.

The Thoracic Society of Australia and New Zealand is a vocal opponent of vaping and understandably opposes anything which may harm the lungs. Vaping is not as pure as mountain air and long-term use may cause some harm to the lungs. However, their opposition to vaping nicotine is counterproductive. The harm from smoking is much greater and vaping has the potential to dramatically reduce lung disease in smokers who switch.

Policy decisions involve trade-offs and compromises. Policy on vaping should be based on its overall impact on public health, not on areas of narrow interest. For example, the small potential risk of vaping to young people is dwarfed by the substantial and immediate benefits of quitting by adult smokers. Furthermore, the risk to young people can be minimized with sensible regulation and enforcement.

4. Distrust of the Tobacco Industry

Tobacco control warriors have long fought a noble crusade to destroy the tobacco companies, whose deadly products kill up to two in three long-term smokers. This industry has repeatedly misled the public, blocked reforms with legal action and put profits before public health. The campaign against Big Tobacco has been driven by science, passion and the high moral ground.

Since tobacco companies entered the vaping market, the focus of tobacco control shifted to attack vaping to punish the tobacco industry. There is a view that “If the tobacco companies are involved in vaping, it must be a bad thing and must be opposed.” As tobacco harm reduction expert Clive Bates explains:

“The war on smoking morphed into a war on nicotine. The machine built for fighting smoking swiveled its gun turrets and started blasting away at the new products and their supporters… The leaders grew up as veterans of the ‘tobacco wars’ and continued their fight on the new fronts.’”  

However, this is counterproductive, as nicotine vaporizers are life-saving products which compete directly with cigarettes. Furthermore, the tobacco companies only control a small share of the vaping market. The war against the tobacco industry appears to have taken precedence over the primary goal of public health, which is to reduce the death and disease from smoking.

The tragic irony is that those who oppose vaping are supporting the very thing they are trying to eradicate: combustible cigarette sales. Vaping is a disruptive threat to the very existence of the tobacco industry, just like renewable energy is to fossil fuels. Attacks on vaping to punish the cigarette companies perversely lead to more people smoking and bigger tobacco company profits.

5. Protection of Self-Interest

Some public health organizations and individuals are threatened by solutions that may reduce their relevance and try to defend the status quo.

Tobacco control organizations have constructed a machine for fighting the tobacco industry and smoking and now they are saying their machine is still needed to fight the new evil, vaping nicotine. Opposing vaping provides a justification for their continuing role.

They have prior positions to defend, organizations to run, funders’ interests to respect, and rely on government, pharmaceutical and philanthropic funding to support their ongoing research, conferences, wages and campaigns.

However, instead of improving public health, this strategy has the opposite effect and will undoubtedly undermine their reputations and public confidence in them.

Some tobacco control professionals see vaping nicotine as a threat to their legacy and prestige. Vaping was developed outside the tobacco control movement and pharmaceutical industry and triggers the NIH Syndrome (“not invented here”). It is opposed because it was not their idea, and especially because it has the temerity to be so effective. Vaping threatens the abstinence-only narrative they have spent their professional lives promoting.

According to behavioral scientist Rory Sutherland, in his book Alchemy: The Surprising Power of Ideas that Don’t Make Sense, the last thing they want to hear is that “the problem to which you have dedicated your life and from which your social status derives is no longer a problem anymore.”  

Mark Tyndall, professor in the School of Population and Public Health at the University of British Columbia in Canada goes one step further. He says:

“Instead of viewing vaping as a disruptive technology that could actually replace cigarettes, ‘tobacco control’ advocates see vaping as a technology that could actually replace them and their abstinence-based programs that are largely ineffective.”  

Vaping is a paradigm shift and does not sit well with the traditional strategy of the tobacco control movement.

6. Political Risk

Governments are driven by minimizing political risk. It is politically safer to take no action on vaping.

Joshua Newman, professor of social sciences at Monash University, Melbourne, wrote about e-cigarette regulation in Australia**:

“Australian governments have not been following an evidence-based approach and, further … these governments are instead content to minimize political risk by either taking no action or by adapting existing legislation.” 

Since vaping products are used by a relatively small number of voters and public perceptions about vaping are negative, there are few political rewards for proactive regulation. More kudos can be gained by appearing to be “tough on the tobacco companies” or “protecting our children.”

Public health policy should always be based on the best available scientific evidence. However, in reality this only seems to occur when the evidence aligns with political objectives.

According to Professor Steve Allsop, former director at the National Drug Research Institute at Curtin University, “research is about evidence, fidelity and logical argument while politics is about the next election, perceptions, bargains and timing.” 

7. Groupthink

Groupthink (or “tribalism”) is “a phenomenon that occurs when a group of well-intentioned people makes irrational or non-optimal decisions spurred by the urge to conform or the belief that dissent is impossible.” 

Groupthink operates within public health organizations and is a powerful and disruptive force. “Smart people are vulnerable to putting the tribe before truth,” explains Yale psychology Professor Dan Kahan. Even smart people with good scientific literacy interpret the evidence selectively to reach a view that is consistent with the views and identity of their tribe. At the same time, they dismiss evidence that undermines the group beliefs.

Compliance is understandable. Taking a contradictory view on vaping risks career and funding opportunities, and disapproval from peers. It is safer to “follow the flock.”

At a national level, the Australian health organizations are locked in an echo chamber of groupthink on vaping. Organizations typically justify their position based on the support of other groups with similar views.

8. Fear of Innovation and New Technology

New technologies generate fear and skepticism and are often resisted even when there are substantial benefits.

In the book, Innovation and Its Enemies: Why People Resist New Technologies, the late Professor Calestous Juma from Harvard University explains how innovations that are widely accepted today, such as coffee, margarine and refrigeration were ferociously opposed when first introduced. He writes:

“Claims about the promise of new technology are at times greeted with skepticism, vilification, or outright opposition—often dominated by slander, innuendo, scare tactics, conspiracy theories, and misinformation. The assumption that new technologies carry unknown risks guides much of the debate. This is often amplified to levels that overshadow the dangers of known risks.”  

9. Financial Conflicts of Interest

Vaping is a serious financial threat to organizations that benefit from tobacco taxes.

Tobacco taxes generated AUD$17.4 billion in Australia in 2019-20, the fourth highest tax after company tax, income tax and goods and services tax. As tobacco researcher Dr. Carl Phillips notes, “Governments derive enormous revenue from taxing cigarettes and generally lose that when smokers switch to vaping.”  

It is often said that the government is addicted to tobacco tax revenue more than people are addicted to smoking.

The Australian government frames tobacco tax increases as a public health strategy. However, most smokers believe it is a cynical tax grab by a greedy government, exploiting and punishing smokers for their addiction. Tobacco taxes are having a diminishing effect on smoking rates at the current eye-watering levels but they certainly help to balance the budget. The vast majority of this money goes into general revenue and only a tiny portion is used to help smokers quit, the stated aim of the policy.

Without combustible products, there is no need for tobacco control organizations. Their existing infrastructure was built on the harms of smoking and it has to find new harms to maintain its relevance and funding.

Phillips says, “The very people who lead anti-smoking efforts have a serious financial conflict of interest about succeeding,” and vaping is clearly a threat. 

Vaping nicotine is also opposed by Big Pharma in Australia. Vaping improves health and reduces the need for medicines generally and stop-smoking medication in particular.

In the United States in 1998, 46 states and some territories came to an agreement with the tobacco industry called the Master Settlement Agreement (MSA). The industry agreed to pay the states each year a sum based on their smoking rate to compensate for the costs of treating sick and dying smokers. Some states arranged to borrow against this future income stream but got into difficulties when the decline in smoking rates fell faster than anticipated after vaping became popular. The states with the greatest resulting financial debt are also the very states most hostile to vaping.

Funding of organizations by philanthropists can also influence policy. Billionaire Michael Bloomberg is strongly opposed to vaping and funds a range of organizations which support his agenda, such as the World Health Organization and the Campaign for Tobacco-Free Kids in the US. Many authorities have questioned the influence of this funding over the scientific integrity of these organizations.

10. Viewing Vapes as Medical Products

There is a fundamental difference between how medical organizations and consumers view vaping.

The traditional medical model involves going from smoking to complete abstinence as a medical treatment, with professional support and counseling and pharmaceutical aids. Medical treatments are not “enjoyable.” They are delivered by doctors and are managed by the medicines regulator, the Therapeutic Goods Administration. Success is when smoking and nicotine are completely eliminated.

However, many vapers see it differently. To them, vaping is about replacing one pleasurable consumer behavior with another, far less harmful one. Vaping allows them to continue to enjoy nicotine as well as the many rituals, sensations and social pleasures of smoking. They learn about vaping from other vapers, Facebook groups and online reviewers. Many appreciate the supportive subculture and hobby component of vaping. Success is when smoking is eliminated.

When a large number of Australians tell lawmakers that something is working well for them, they should listen carefully and respectfully. They should acknowledge their lived experience, “meet them where they are” and empower them to make better decisions about their health.

Vaping nicotine should be regulated by the Australian Competition and Consumer Commission like other consumer products. No other Western country treats nicotine for vaping solely as a medicine and none requires a doctor’s prescription.

* Warner KE. How to Think—Not Feel—about Tobacco Harm Reduction. Nicotine Tob
Res. 2018

**Newman J. Evidence-based policy or risk minimisation? The regulation of e-cigarettes
in Australia. Evidence & Policy. 2019

Top photograph by Waldemar Brandt on Unsplash

Stop Smoking Start Vaping, by Dr. Colin Mendelsohn, dispels the myths about vaping nicotine and outlines the evidence in an easy-to-read style with over 400 scientific references. It also provides step-by-step advice on how to make the switch from smoking tobacco, and why vaping is controversial.

The post Ten Underlying Reasons Behind Opposition to Vaping appeared first on Filter.

Australia essentially has a de facto ban on vaping. The possession and use of nicotine e-liquid for vaping is illegal under federal poisons regulation. Vaping products are regulated as a tobacco products under state laws, with harsh restrictions similar to smoking. 

Australia was once a world leader in tobacco control, but smoking rates have stagnated in national surveys for the last six years. For the remaining smokers who can’t quit with approved treatments, Australian law determines that their only legal option is to keep smoking. 

Australians have the right to assume our governments will give us truthful advice on health matters, based on the latest science—not mere ideology. But where vaping is concerned this hasn’t been the case, and bad policy is propped up by misinformation. 

This is especially true in Queensland, the “sunshine state” of 5 million people. For the third time in little over a year, Queensland Health, the government department that runs the state health system, has been caught out misleading the public. 

Queensland Health recently updated its online information on vaping, drastically misrepresenting the science and clearly exaggerating—deliberately or not—the risks involved. Many of its claims omit important information or are fundamentally untrue.

Queensland Health claims e-cigarettes are a smoking product. They’re not. They heat a liquid into an aerosol. They don’t burn tobacco, so cannot produce smoke. This is important because it is the smoke from burning tobacco which causes almost all the harm to health from smoking cigarettes.

Queensland Health also misrepresents the health risks of vaping with the alarming claim that e-cigarettes are “dangerous” and have “many known harms.” However, while vaping is not risk-free, it is far less harmful than smoking—a point that’s omitted.

According to Public Health England, Queensland Health’s English counterpart, vaping is at least 95 percent less harmful than smoking. This comparison with smoking is a vital part of any meaningful risk communication.

If there is a gateway from vaping to smoking, it is extremely small—and is swamped by traffic in the opposite direction.

Queensland Health states that vapor contains toxic and cancer-causing chemicals. This is true, but again misleading. The chemicals in vapor are mostly in concentrations well below what is required to cause harm to humans—another omission by Queensland Health. 

The mere presence of chemicals in the environment is a part of modern life. There is arsenic in tap water and there are carcinogens in coffee. It is the dose which determines whether there is a material risk to health.

Queensland Health also makes the claim—familiar to US observers—that vaping is a “gateway” for young people to start smoking. This has not been borne out by international experience. 

Most vaping by youth is experimental and short-lived, and frequent vaping is rare amongst teens who have never smoked. If there is a gateway from vaping to smoking, it is extremely small—and is swamped by traffic in the opposite direction: adult smokers using vaping as a way out of smoking.

Recent research suggests that vaping is up to three times more effective than nicotine patches, gum or lozenges at helping smokers quit. Vaping is also the most popular quitting aid in most countries where it is available. It is no surprise that the decline in smoking rates in countries like the United States and United Kingdom has accelerated since vaping became widespread. 

Australian smokers deserve to be told that there are safer alternatives available, as is happening in the UK and now in neighbouring New Zealand. Only last month, the New Zealand Ministry of Health launched the Vaping Facts website to inform smokers about vaping and encourage them to make the switch.

The evidence is clear. Banning vaping is detrimental to public health. Queensland Health and many other authorities spreading mistruths and misleading the public doesn’t help smokers quit—it just leaves many with no other option than to keep smoking. 

Like their international counterparts, Australian governments desperately need to put the ideology aside, look at the evidence and tell the truth about vaping. The lives of two in three Aussie smokers depend on it.

Photo of Australian bush fire via Wikimedia Commons

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