Health Department policy on vaping flawed and harmful to public health

Posted by DrMendelsohn on 14 January, 2018

My Opinion Piece published today in The Australian, available online or below.

The Australian.JPG

Vaping may have its drawbacks but it's a lifesaver for many

The federal Department of Health has recently outlined the rationale for its policy on nicotine vaporisers, or electronic cigarettes.

Unfortunately, the report is ­seriously flawed and may be ­harmful to public health.

The policies of the department and the Australian Medical Association are both in stark contrast to those of their British counterparts, Public Health England and the British Medical Association.

Although claiming otherwise, both ignore much of the evidence. They emphasise the small potential risks of vaping but discount the huge potential benefits to public health. Both require absolute ­certainty of all the evidence before taking any risk.

Vaping is a potentially lifesaving technology. Many smokers are unable or unwilling to quit despite repeated attempts. Vaping can satisfy the smoker’s need for nicotine and while providing a “smoking experience” without the vast majority of the constituents in tobacco smoke which cause most of the harm to health. About 250,000 Australians are vaping.

Let’s take a look at some of the most egregious flaws in the Health Department’s argument:

The policy relies heavily on ­reports which are all opposed to vaping and which support its ­entrenched views. However, it ­ignores the reports of credible and independent organisations such as the UK Royal College of Physicians (RCP), Public Health ­England (PHE), Canadian Institute for Substance Use Research, the UK Centre for Tobacco and Alcohol Studies and others which are strongly in favour of vaping.

Vaping is not harmless, but the scientific consensus is that it is far safer than smoking. This is not surprising as almost all the harm from smoking is from the tar, carbon monoxide and other chemicals from burning tobacco. Vaporisers heat nicotine without combustion, so the vast majority of the 7000 toxins in tobacco smoke are absent or present at trace levels.

As regular vaping is almost ­exclusively confined to smokers and ex-smokers, any risk should be compared to the considerable risks of continuing to smoke.

After comprehensive assessments, the RCP and PHE concluded that the long-term risks are unlikely to exceed 5 per cent of the risks of smoking. Indeed, many studies have found significant health improvements when ­smokers switch to vaping.

Overseas experience and research suggests vaping is helping millions of smokers to quit, many of whom would not otherwise have succeeded. A study in 2014 estimated that six million smokers had quit in the European Union alone with vaping. A large study across the US population showed that smokers who used personal vaporisers were 75 per cent more likely to succeed than those using other methods. Randomised controlled trials with early models found them to be at least as effective as nicotine patches. Modern devices are even more effective, ­especially with daily use.

The report raises the claim that vaping may undermine the ­decline in tobacco use in Australia. However, there is currently no such decline. According to official figures, Australia’s smoking rates stagnated from 2013-16, despite Australia having the highest priced cigarettes in the world and plain packaging.

On the other hand, in many countries where vaping is legally available, smoking rates are ­continuing to fall, in some cases faster than ever, and quit rates are higher than ever.

Personal vaporisers are the most commonly used quitting aid in the UK and US. The evidence suggests vaping is contributing to the fall in smoking rates.

The report argues that we should avoid any potential risk from vaping while there is still a lack of absolute certainty about safety. Like all new drugs or treatments, the long-term effects of vaping are unknown; however, there is very little evidence so far of serious harm from 10 years of ­real-world use and from studies up to four years. On the other hand, it is well established that smoking prematurely kills up to two out of three long-term users.

Rather than being paralysed by fear and waiting 20 years to get ­definitive evidence, we need to make the best decision now on the abundant evidence available.

The report claims that vaping may establish new smokers, renormalise smoking behaviour and discourage quitting. However, overseas experience suggests the opposite: smoking rates are continuing to fall, quit rates are rising and regular use by non-smoking adults and young people is rare.

It is time for Australia to follow the lead of similar countries. ­Vaping with nicotine is legal and widely available in the United Kingdom, European Union and the United States. Canada and New Zealand are legalising ­nicotine for vaping.

Australia needs to embrace the new paradigm of vaping and leave the prohibitionist, abstinence-only policy (“quit or die”) in the past where it belongs. The lives of hundreds of thousands of Australian smokers depend on it.

Colin Mendelsohn is associate professor and tobacco treatment specialist at the School of Public Health and Community Medicine, UNSW.


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