OUR NEW STUDY PUBLISHED THIS WEEK IN THE JOURNAL ADDICTION has revealed that the smoking rate in New Zealand fell twice as fast as in Australia between 2016 and 2023. The decline was especially notable in disadvantaged and Indigenous populations. The findings suggest that more liberal regulation of nicotine vaping in Australia could speed up the reduction in smoking and improve health and financial disparities.
New Zealand smokers have easy access to a wide range of regulated vaping products and flavours. Vapes are sold as adult consumer products from licensed retailers—just like cigarettes and alcohol. This aligns with the policies in the UK, the US, and Canada, where vaping is supported as a harm reduction strategy rather than seen as a public health threat.
In contrast, Australia has taken a highly restrictive, medicalised approach, designed to deter youth vaping. Legal vapes are only available through pharmacies, often requiring a doctor’s prescription. Most flavours are banned, and enforcement efforts have largely failed to curb the booming black market.
Smoking rates plummet in New Zealand
From 2016-2023, New Zealand’s adult daily smoking rate fell by an astonishing 10% per year, dropping from 14.5% to 6.8%. In contrast, Australia’s smoking rate declined by only 5% per year, from 12.2% to 8.3%
New Zealand now has a lower smoking rate than Australia for the first time.
The decline in smoking in each country closely reflected their vaping rates: in 2023, 9.7% of New Zealand adults vaped daily, nearly three times the rate in Australia (3.5%).
The age group with the highest vaping rate, young adults, also had the fastest decline in smoking.
Disadvantaged populations
Importantly, the study found striking reductions in smoking in New Zealand’s disadvantaged communities.
Smoking prevalence fell three times faster in New Zealand’s lowest socioeconomic group than in the same population in Australia (12% per year vs 4% per year)
The faster decline in smoking mirrored the higher daily vaping rate in New Zealand compared to Australia in these communities (15.8% vs 2.8%).
Historically, smokers from low socioeconomic groups quit at a significantly slower rate than other smokers. However, the decline in smoking in this disadvantaged group in NZ was even faster than the general population which had a lower daily vaping rate of 9.7%.
Similarly, smoking in New Zealand’s Māori population declined nearly three times as fast as Australia’s Indigenous population (16% vs 6% per year from 2019/20-2023)
This was in line with the higher daily vaping rate of 23.5% for Māori and just 6.5% for Indigenous Australians (ATSI).
These findings highlight the potential of vaping to reduce health and financial disparities by providing effective alternatives to smoking for high-risk groups.
Youth vaping and smoking
Youth vaping rose more sharply in New Zealand, reaching 10% daily vaping in 2023 compared to just 3% in Australia. However, most of this rise occurred prior to the introduction of regulation in New Zealand in 2021. More recent data show a decline in youth vaping to 8.7% in 2024.
This transient rise in youth vaping and subsequent decline has also been seen in other countries such as the US.
At the same time, daily youth smoking hit record lows in both countries in 2023 (0.3% in Australia and 1.2% in New Zealand).
These findings suggest that vaping has not acted as a gateway to smoking but instead may be diverting young people away from combustible tobacco
Black market sales
Australia’s restrictive, medical model for vaping has inadvertently fuelled a thriving and increasingly violent black market. Today, more than 90% of vaping products sold in Australia come from illicit sources with no safety standards and easy access for youth.
More than 220 vape and tobacco shops have been firebombed in Australia
In contrast, New Zealand’s regulated retail system has shown no significant evidence of illicit trade
Is vaping the key factor?
Vaping is an effective and widely used aid for quitting smoking. That the populations with the highest vaping rates saw the largest declines in smoking highlights its role here.
Of course, this study is “cross-sectional”, meaning it tracks population trends rather than following individuals and cannot definitively prove vaping was the cause of the rapid fall in New Zealand smoking. However, alternative explanations are unlikely. After examining multiple possible explanations, researchers found no other credible factor to explain this dramatic decline.
Conclusion
If vaping is the key driver of this success, as appears likely, then Australia’s current approach isn’t just failing, it’s costing lives.
A more liberal, consumer-driven model—similar to that of New Zealand—
- Could accelerate the decline in smoking,
- Reduce the health gap for disadvantaged and Indigenous communities and
- Diminish the harms from an unregulated black market.
The solution isn’t to ban vaping or to try to restrict it into obscurity. It’s to regulate it sensibly—encouraging smokers to switch while implementing reasonable safeguards to protect youth. New Zealand has shown us what works—it’s time we paid attention.
References
Are vapes behind NZ’s smoking rate falling faster than Australia’s? crikey.com.au 13 February 2025
Related publications
YESTERDAY MARK BUTLER REPORTED on the damning findings of Australia’s management of the COVID-19 pandemic. Yet, despite these revelations, Butler remains unaware that the same fatal flaws in decision-making and policy are being repeated in Australia’s management of vaping.
Ignoring the evidence
According to Mr. Butler, Australia’s initial approach to COVID-19 was precautionary—a cautious response in the face of limited information. However, as more evidence emerged, policies failed to adapt accordingly. There was, as he put it, a “lack of a shift from that position in the early months to a position that was more evidence-based, that balanced risks and benefits.”
As the report states, “more contentious measures, such as enforced quarantine, curfews and closing outdoor playgrounds, were not supported by pre-existing evidence”.
This same mistake is apparent in vaping policy. The initial cautious approach has become an unyielding stance, ignoring a substantial and growing body of evidence that supports vaping as a harm-reduction tool. Evidence now clearly shows that vaping can greatly improve public health if carefully regulated. Yet, instead of embracing this potential, the government continues to focus on small and hypothetical risks and a moral panic surrounding youth vaping, creating significant barriers to its uptake by adult smokers.
Double standard
One striking difference between the response to COVID and vaping is the double standard around long-term safety. COVID vaccines were widely embraced within several months of clinical trials – no concerns were raised about unknown long-term risk. However, in the case of vaping products, fear of unknown long-term harms is still cynically used to argue against vaping, which has been in widespread use globally since 2007.
Erosion of personal freedom
The COVID-19 report also underscores the personal freedoms lost due to heavy-handed, controlling regulations. Australians felt deprived of their autonomy and rights in ways that, as the report stated, “had a profound impact on the lives of ordinary Australians.”
Vaping regulations follow a similar pattern, stripping away the freedom and right of adult smokers to make choices about their health. These policies infantilize smokers, treating them as if they are incapable of making informed health decisions. By severely restricting vaping, these regulations effectively trap many smokers in their addiction, removing a viable exit path from deadly smoking.
Decline in public trust
One of the most profound findings of the COVID-19 report was the erosion of trust in public health authorities. Many Australians felt resentful and began to question the legitimacy of health information altogether, a distrust with lasting consequences for future health initiatives.
The same distrust is brewing in response to vaping restrictions. Many people who smoke or vape are frustrated, disillusioned, and left wondering how their government could enforce policies that harm rather than help. This frustration has fostered a climate of suspicion and conspiracy theories.
Hundreds of thousands of Australians are now willing to defy the law to access vaping as a health improvement measure. If the government has taken such drastic and misguided steps on vaping, why should the public trust its future health directives?
Disproportionate response
The COVID-19 report highlights how restrictive strategies—such as lockdowns, border closures, school shutdowns, and vaccine mandates—were excessive and unjustified after the pandemic’s initial wave.
Similarly, vaping regulations have become needlessly harsh and restrictive and do not match the risks of a relatively benign behaviour. It is absurd that vaping is regulated far more strictly than deadly cigarettes. The current policies make vaping less accessible, less affordable, and less appealing, pushing smokers away from a safer alternative and, in some cases, forcing them to remain with the more harmful option of smoking.
Harm to mental health
The COVID report found that harsh resrictions “increased social isolation, stress, anxiety, uncertainty, loss of control, disruption to daily routines and concerns for the wellbeing of family and loved ones, and created the conditions for either the onset of mental ill health or deterioration of existing conditions”.
This is in line with the anxiety, stress and anger of people who vape. They have been fed misinformation, subjected to arbitrary and flawed regulations and effectively denied access to appealing and legal vaping products to help them quit smoking. Many vapers have reported a decline in their mental health and have a genuine fear of relapsing to smoking. More here.
Conclusion
In summary, Australia’s handling of the COVID-19 pandemic and vaping regulation reveal a troubling pattern of rigid policy-making that disregards evidence, restricts personal freedoms, undermines public trust and has created high levels of stress and anxiety. It’s time to reconsider these approaches, taking a more balanced, evidence-driven stance that genuinely prioritizes public health and respects individual rights.
Resources
COVID-19 Response Inquiry Report. Commonwealth Government 29 October 2024
Transcript of Mr Butler’s speech, 29 October 2024
EMERITUS PROFESSOR WAYNE HALL, one of Australia’s leading researchers in the field of alcohol and drugs has reviewed Australia’s policy on vaping and finds it has failed to achieve its goals. In this article in The Mandarin, he suggests a far better alternative.
Australia’s prescription model of vaping needs to be replaced by regulated retail sales
The prescription model and retail sales ban have failed to prevent the uptake of youth vaping. Few adults have used the legal prescription pathway to access vapes
E-cigarettes (vapes, for short) have been marketed as products to assist smokers to quit and as a safer alternative than cigarette smoking for those who are unable to quit.
In England, medical and public health authorities have promoted vapes as a smoking cessation aid and as a less harmful alternative to cigarette smoking. The government has allowed vapes to be sold in retail outlets and the NHS has promoted vaping for smoking cessation and tobacco harm reduction. These policies have had the strong support of the Royal College of Physicians, Cancer Research UK, and Public Health England.
In Australia, by contrast, public health authorities adopted a much more restrictive policy that has the primary goal of preventing adolescent uptake. In 2016, Australia banned the retail sale of vapes that contained nicotine and would only allow them to be sold as prescription medicines.
The primary aim was to prevent adolescent vaping from serving as a gateway to cigarette smoking because Australian policymakers were sceptical about claims that vaping was a successful smoking cessation aid. They assumed that eventually, smokers would be able to legally access e-cigarettes that contained nicotine if the TGA approved them as effective cessation aids.
How has Australia’s policy fared?
In brief, the prescription model and retail sales ban have failed to prevent the uptake of youth vaping. Few adults have used the legal prescription pathway to access vapes, instead mainly sourcing vapes from illicit suppliers and thereby adding vapes to the illicit market for tobacco products
Australia’s vape sales ban has not prevented what has been described as a “youth vaping epidemic”. The extent of the “epidemic” has been inflated by highlighting the prevalence of lifetime vaping by adolescents (35%) while downplaying the much lower prevalence of use in the past 30 days (10%) and in the last week (less than 6%). Talk of a “vaping epidemic” has created parental and public alarm, prompted headmasters to expel students for vaping and led to calls for even more punitive policies. It has also encouraged adolescents to believe that all their peers are vaping, potentially normalising vaping and generating a ‘fear of missing out’ among those who don’t vape.
Australia’s prescription system has not increased legal access to vapes. The TGA has not approved any vapes for smoking cessation and most of the 1.6 million Australians who used vapes did so without a prescription. In 2021, regulatory reforms encouraged medical practitioners to prescribe vapes as unapproved therapeutic goods via a streamlined authorised prescriber pathway for patients who had failed to quit smoking using approved smoking cessation products (e.g. nicotine gum and patches and varenicline).
By 2023, less than 10% of the 1.8 million Australians who now use vapes had a prescription.
The factors that most likely contributed to the low rate of prescriptions were the continued easy access to illicit vapes and the reluctance of many medical practitioners to prescribe vapes
For example, the Australian Medical Association and the Royal Australian College of General Practitioners have strongly discouraged medical practitioners from prescribing vapes.
The majority of Australian vapers continued to illegally purchase vapes online and from retail tobacconists and “vape shops”. These outlets illegally sold vapes that contained nicotine, using the figleaf that they were selling nicotine-free vapes (which were legal in all states apart from Western Australia). Very few vapers were probably aware that obtaining a vape that contained nicotine without a prescription could be punished by a large fine (up to $45,000 in Western Australia) or imprisonment for up to two years in the ACT.
Illegal sales of vapes have been added to an existing illicit tobacco market
Australia’s very high tobacco taxes have produced cigarette pack prices of $40-$60 and stimulated many low-income smokers to purchase smuggled manufactured cigarettes and loose tobacco (chop chop) illicitly grown in Australia. Customs have seized large quantities of illicit tobacco cigarettes smuggled into Australia by organised crime syndicates and over 30 tobacco retail stores in Melbourne have been firebombed because their owners refused to sell illicit tobacco. The Australian Tax Office has estimated that several billions in tobacco excise have been lost to illicit sales.
In 2024 the Federal government made the personal importation of vapes illegal. It only allowed cigarette smokers to obtain vapes that complied with strict requirements (eg only tobacco or menthol/mint flavours, and restricted nicotine content) on a doctor’s prescription from pharmacists. The legislation to enact this policy was rejected by the Senate and the bill was amended to allow pharmacists to supply adults with low-dose vape products (up to 2% nicotine). Prescriptions were required for products that deliver higher doses (up to a maximum of 5% nicotine) and for products used by 16-17-year-olds. This change was rejected by the Pharmacy Guild, making it unclear how many adult smokers will be able to legally obtain vapes from pharmacies.
A false policy choice
Australian policymakers seem to have accepted the false framing presented by advocates of Australia’s restrictive vaping policy, namely that Australia must choose between (1) enforcing a prescription model and (2) allowing the unregulated sale and promotion of vapes to nonsmoking adolescents and young adults.
Australia could instead allow adult smokers to legally purchase vapes in ways that minimised youth uptake, as shown by recent US success in reducing youth vaping (and smoking) without banning the sale of vapes (Warner, 2024)
We could, for example, require plain packaging of TGA-approved vapes, ban their promotion (apart from at points of sale), restrict their sales to licensed retailers, such as tobacconists or vape shops and enforce age limits on purchases. These retail outlets would be required to comply with age restrictions on entry or risk losing their licenses. This rule could be enforced by mandating CCTV recording of all sales, as has been done in US states that have legalised the sale of cannabis products to persons over the age of 21 years. Licensing retail tobacco sellers is a long overdue reform that would also reduce the scale of illicit tobacco sales and ready access to cigarettes.
- if you do not smoke, do not vape;
- if you do smoke cigarettes, consider using vapes to quit smoking; and
- if you are unable to quit smoking by vaping, then switch completely to vaping to obtain nicotine in a far less harmful way than continuing to smoke.
Article in The Mandarin
A NATIONWIDE SURVEY OF PHARMACIES has revealed that the new regulations intended to make low-nicotine vapes (≤20mg/mL nicotine) available without a prescription (as Schedule 3 medicines) have been largely ineffective.
The survey of 305 pharmacies revealed that 99% of pharmacies (n=301) did not have low-nicotine vapes available for a walk-in customer
Just 6 more (2%) indicated they would order them upon request, underscoring widespread non-participation despite repeated assurances from the Health Minister.
The survey was conducted in metropolitan and rural areas across all Australian states and territories during the first two weeks of October, following the introduction of the new regulations on 1 October 2024.
The new regulations were meant to provide adult smokers with easier access to nicotine vapes, after the failure of the prescription model. The prescription model has been largely rejected by vapers and doctors – only 7% of vapers had a prescription in 2023 (National Drug Strategy Household Survey, 2022-23) – and has fuelled an increasingly violent black market (over 125 firebombings and 3 contract killings since March 2023) and widespread youth access.
However, the new prescription-free initiative faced challenges from the start due to a lack of consultation with the pharmacy industry and strong opposition from the Pharmacy Guild of Australia. As a result, many pharmacy chains and individual stores chose not participate in the plan.
Compounding the issue, pharmacies are prohibited from advertising that they stock nicotine vapes, making it difficult for adult vapers to find participating stores. Furthermore, certain states, such as Tasmania, have outright banned the sale of Schedule 3 vaping products, with Western Australia expected to follow.
Among the 35 vapers who collected data for the survey, none were able to purchase their usual vaping product from any of the pharmacies surveyed. Those pharmacies that stocked vapes had a very small range, usually only one or two products. The market was dominated by just two vape models, one being manufactured by tobacco giant Phillip Morris.
Adding to the dissatisfaction, available flavours are restricted to tobacco, mint, and menthol, which has little appeal for most adult vapers accustomed to a wider range of options.
Another barrier is that low-nicotine Schedule 3 vapes are effectively banned from online sales
A separate survey of 10 online Australian pharmacies selling vapes revealed that only one sold the products without a prescription. The main concern is the need for a comprehensive consultation with the pharmacist, which is difficult to conduct online. Additionally, in NSW and the ACT, pharmacists must physically hand the vape products to the customer, preventing online sales.
The prescription model failed to serve adult vapers, fuelling a thriving black market that freely supplied vapes to young people. After just two weeks, the pharmacy-only model is also proving inadequate for Australia’s 1.7 million adult vapers, most of whom are unable to legally access vaping products. As a result, some will likely relapse to smoking, a far more harmful alternative, while the majority will continue to turn to the black market for unregulated products.
Interview on 7News 20 October 2024
Comments from vapers who helped with the survey
Sue (59-year-old vaper from WA)
“I live in a remote town in Western Australia. The two pharmacies in town do not stock vapes and many local people are finding it very difficult to access legal supplies, especially older vapers who are not familiar with online purchasing. The nearest pharmacy that stocks vapes is 500 km away. One Indigenous man who previously smoked 40 cigarettes a day told me he is considering going back to smoking.”
James (61-year-old vaper from the NT)
“It seems that no pharmacies sell vapes in the Northern Territory, which has the highest smoking rate in Australia, especially among Indigenous people. I rang 19 pharmacies in Darwin, Katherine and Alice Springs. Not one stocked vapes and none had plans to do so in the future. Many vapers in the NT will have no choice but to go back to smoking.”
Pam (70-year-old vaper from WA)
“The pharmacy model is completely impractical for me. Obtaining a doctor’s prescription is difficult, the selection of products in pharmacies is very limited, and the legally available flavours are unappealing. On top of that, the cost of pharmacy vapes is significantly higher than what I used to pay.”
Paul (64-year-old vaper from Melbourne)
“Most of the chemists I spoke to were not interested in stocking vapes. The few that were stocking vapes did not stock the vapes or liquids I use and were pretty much clueless of even the most basic facts of vaping.”
Other media coverage
Shock new data shows just 1 per cent of pharmacies stock vapes. Daily Telegraph 19 October 2024
Interview on 7News. 20 October 2024
Interview with Oly Peterson on 6PR Perth, 21 October 2024
The Disaster That Australia’s Vape Prescription Model is Proving to be. VapingPost 24 October 2024
Further reading
10 reasons why the new pharmacy vape model will fail. Blog 24 July 2024
Survey results
| S3 | S4 | |||||||
| In stock | Will order | In stock | Will order | |||||
| Total surveyed | 305 | 4
1.3% |
6
2% |
29
10% |
42
14% |
|||
| Capital cities | 182 | 3
1.6% |
4
2.2% |
18
10% |
27
15% |
|||
| Other | 123 | 1
0.8% |
2
1.6% |
11
9% |
15
12% |
|||
| State distribution | NSW | Vic | Qld | SA | WA | Tas | ACT | NT |
| 47 | 85 | 65 | 37 | 32 | 10 | 10 | 19 | |
| Location | Capital city | Other | ||||||
| 182 | 123 | |||||||
| Product brands | Nicovape | Veev (PMI brand) | Wild | Relx | ||||
| 28 | 21 | 4 | 2 | |||||
Range of products available
Of the 305 pharmacies, satisfaction with the range of products was rated on a 5-point Likert scale
from 1-5: 1=very poor, 2=poor, 3=OK, 4= quite good 5= very good
Ratings: quite good: one, OK: one; poor: three.
The rest were very poor, or no products at all.
Own product available
Of the 30 vapers who conducted the survey, none reported that their usual product was available.
Survey methodology
The survey was conducted by 35 adult vapers by phone or in person from 3-15 October 2024. The Survey Questionnaire can be downloaded here.
DESPITE SOME INITIAL CONFUSION and misleading messaging, adult Australian vapers can legally purchase nicotine e-liquids from online pharmacies. However, a prescription is needed.
Clearing the confusion
Both the Therapeutic Goods Administration (TGA) and the Pharmaceutical Society of Australia (PSA) initially advised that online sales would be banned from 1 October 2024. It was stated that vaping products could only be supplied in person and could not be posted or delivered.
However, a closer review of the federal regulations has found that this advice was incorrect. There are no specific restrictions prohibiting online sales, as long as the customer has a valid prescription.
Therapeutic Goods Regulation 1990 (p247-248)
Online pharmacies
A handful of Australian online pharmacies are now dispensing nicotine e-liquids. I am not able to provide pharmacy names as the TGA regards that as ‘advertising’ and I am likely to be prosecuted! However, many can be found with a simple Google search.
Some online pharmacies now have a wide range of products, including pod vapes, vape pens and mods as well as premixed freebase and salt nicotine refills and pods in various strengths
Unfortunately, only tobacco, mint, menthol and unflavoured e-liquids are available, making these products very unappealing.
For most online pharmacies, you need to register onsite and order or upload a prescription before you can see the products available. This is a legal requirement as prescription products cannot be ‘advertised’.
The products are generally delivered via registered post, which requires a signature on delivery to comply with legal requirements.
Prescriptions are required
A prescription is required for all nicotine e-liquids >20mg/mL (Schedule 4 or S4 medicines). Many, but not all online pharmacies can arrange one if appropriate
The prescription is usually free or low-cost if you purchase your products from the pharmacy. Others charge a fee for the script if you wish to use it at other pharmacies.
You do not need a prescription to purchase empty vaping devices or accessories (i.e., the hardware).
Schedule 3 medicines not available online
Vapes with a nicotine concentration of ≤20mg/mL can be purchased from pharmacies without a prescription (Schedule 3 or S3 medicines). However, I am only aware of one online pharmacy that provides this service, because there are major barriers to online sale.
- S3 vape products require a comprehensive consultation with the pharmacist, which is harder to arrange online.
- In some states, the sale of S3 products is prevented by health department rules: (see here). For example, in NSW and the ACT, the pharmacist must “personally hand the medicine to the customer”, so online sales are not permitted.
- Both Tasmania and WA have banned the sale of S3 vape products altogether.
Why it matters
The availability of vapes from online pharmacies is critical for Australian vapers. Very few brick-and-mortar pharmacies stock vaping products, leaving many vapers with limited access. This is particularly concerning for those living in rural areas, where local pharmacy options are even scarcer.
With this very limited access to online sales, many vapers may face the risk of relapsing to smoking. Most will continue to access unregulated vapes (with a wide variety of appealing flavours) from the black market.
FROM TOMORROW, 1 OCTOBER 2024, some vaping devices and low dose e-liquid (up to 20mg/mL nicotine) will be available in Australia without a prescription from brick-and-mortar pharmacies. Sale from online pharmacies is banned. This blog outlines the latest guidelines from the TGA and the Pharmaceutical Society of Australia that take effect tomorrow.
Finding a pharmacy
Most pharmacies will not be stocking vaping products, including major chains such as PriceLine, Terry White Chemmart, Blooms the Chemist, Pharmacy 777, and National Pharmacies.
Those that do are likely to have a limited range of products. Your preferred device and e-liquid may not be available, although they can be ordered from wholesalers if listed on the TGA “Notified vape list”.
Finding a participating pharmacy may be challenging, as pharmacies are not allowed to advertise that they sell vaping products.
Some pharmacies may decide to dispense prescribed vapes only. (see below)
Sales from online pharmacies banned
The TGA has confirmed that online pharmacies cannot supply Schedule 3 (pharmacist-only) or Schedule 4 (prescription) vaping products
Under the new regulations, vapes can only be supplied in person by the pharmacist to the patient or their carer. Delivery by taxi or courier is not allowed.
In response to a query, the TGA replied
“Therapeutic vaping goods can only be supplied in person directly to the patient or their carer. It will be unlawful to dispense and supply S4 therapeutic vaping goods online”
“Vapes can only be supplied directly to the patient or their carer, regardless of whether they are supplied as a Schedule 3 or Schedule 4 medicine”
This will be a significant problem for many vapers, where local pharmacies do not stock vapes, especially for those in rural and remote areas.
Who is eligible?
To be eligible to purchase a vape without a prescription you must
- Be 18 years or over
- Be vaping to quit smoking or to manage nicotine dependence. Supply for “recreational” vaping is not permitted
- Be willing to have a detailed consultation with the pharmacist (see below) and provide personal information for health authorities
Who needs a prescription?
You will need a prescription from a doctor or nurse practitioner to buy vaping products if you
- Are under 18 years. However, in South Australia and Tasmania, the sale of vaping products to people <18 years is prohibited, even if the user has a prescription (possibly also ACT and Vic – see here)
- Want nicotine e-liquid >20mg/mL
- Have complex medical needs (see here)
- Live in Tasmania and Western Australia. These states are legislating to block the pharmacy-only model, so all vapers will need a prescription
What can you buy?
Pharmacies can only sell e-liquids and devices on the TGA Notified Vape List. These products comply with the relevant quality and safety standards. If your preferred product is on the list, the pharmacist may be able to order it.
- Flavours are restricted to tobacco, menthol and mint
- Nicotine is capped at 20mg/mL freebase equivalent without a prescription. For nicotine concentrations higher than 20mg/mL, you will need a prescription from a doctor or nurse practitioner
- E-liquids must be supplied at the nicotine concentration at which they will be used. It is not permitted to sell higher nicotine concentrations for home mixing
- A maximum of one month’s supply can be dispensed each month
- Pharmacists cannot dispense ingredients for mixing, eg PG (propylene glycol) and VG (vegetable glycerin)
- Nicotine-free liquids are also available on the same terms, from pharmacies only
First consultation with the pharmacist
A detailed consultation is required with the pharmacist at the first visit, which is likely to take 15-20 minutes. Some pharmacies will charge a fee for this service. At this visit, the pharmacist must
- Confirm that you are vaping for a ‘therapeutic purpose’ i.e. for smoking cessation or to manage nicotine dependence
- Inspect your ID documents to confirm your identity and age (even if they know you)
- Asses your nicotine dependence
- Collect other personal details for reporting and record the consultation
- The pharmacist must also
- Advise that vapes are “unapproved” therapeutic products
- Provide guidance on the appropriate use of the product, including dose, frequency of use, length of treatment suitable titration and interactions with other medicines
- Recommend switching to a closed system if you are currently using an open system
- Provide information about alternative quit-smoking medications, quitting aids and support, and contact details for support services eg Quitline
- Make a management plan
- Obtain informed consent. You may be asked to sign a consent form.
- Personally hand you the products. Vapes cannot be collected by third parties, even by your partner
- Notify the TGA within 28 days
- Report any adverse effects and defects to the TGA and the supplier.
Follow-up visits will be shorter, but still require a consultation. Confirmation of your identity and reporting to the TGA are required at every visit.
Referral to a GP
Pharmacists are advised by the PSA guidelines to refer you to a GP if
- You need e-liquid with a nicotine concentration >20mg/mL
- You are under 18 years old
- Medication is not suitable for your needs
- Vaping continues for longer than 12 weeks
- You require more than one pod per day
- You you are pregnant or breastfeeding, have cardiovascular disease, diabetes, mental illness, a substance use disorder or multiple health problems
Will the bill be disallowed?
A Senate committee recently issued a notice to disallow the Vaping Reforms bill, due to serious concerns about it. If these concerns are not resolved, the bill may be rejected. More here.
The likely outcome
The pharmacy model makes it much harder for vapers to access legally than to purchase deadly cigarettes. As with the failed prescription-only model, the likely outcomes will be
- Reduced legal access and less appealing products at a higher price
- Most vapers will continue to purchase unregulated vapes from the black market
- Many vapers will relapse to smoking
- It will be harder for smokers to switch to vaping
Overall, these changes will be harmful overall to public health and will fail within 12 months.
Sources
Therapeutic Goods Administration. Vaping hub
Therapeutic Goods Administration Notified vape list
A SENATE COMMITTEE has issued a notice to disallow the Vaping Reforms Bill, formally known as the Therapeutic Goods Legislation Amendment (Vaping Reforms) Regulations 2024. The Minister has been asked to respond
If Mark Butler’s response to the Committee’s concerns is deemed unsatisfactory, the Committee may recommend that the Senate either disallow or amend the legislation
These regulations, passed on 26 June 2024 following last-minute amendments and with the support of The Greens, have now raised significant technical concerns that the Committee (The Senate Standing Committee for the Scrutiny of Delegated Legislation) is seeking clarification and corrections from the Minister.
The regulations place restrictions on the importation, domestic manufacture, supply, commercial possession, and advertisement of vaping products. They also define commercial quantities, introduce new offences and penalties, and lay out transitional arrangements.
The latest regulations were the final part of the Minister’s plan to lock in a strictly medical model for vaping, which so far had been a resounding failure. The final amended legislation delivered a pharmacy-only model, which is also widely predicted to fail.
Key concerns raised by the committee
- Coercive powers: The inclusion of unreasonably coercive powers within the regulations.
- Unclear wording: Multiple drafting errors and ambiguities.
- Regulatory oversight: Uncertainty over whether the Attorney-General’s Department’s Guide to Framing Commonwealth Offences was followed during drafting.
- Rights and liberties: Concerns about the protection of personal rights and liberties, including privacy.
- Regulation vs. primary legislation: Questions as to why certain matters have been dealt with in the regulations instead of the primary legislation.
- Lack of clarity: Unclear rationale for some elements of the regulations, and whether all provisions are necessary.
Sloppy legislation
The sad saga of Australia’s vaping legislation continues to unfold, now with the added issue of sloppy legislative detail. Not only is the intent of the legislation fundamentally flawed, but the details are negligent and rushed amendments to secure the Greens’ support have likely also introduced significant errors.
Why have so many serious concerns been raised? Has the hasty drafting, driven by political negotiation, compromised the integrity of the legislation? The answer seems increasingly clear as this flawed piece of legislation begins to unravel.
Perhaps it is now time for the Minister to rethink this whole flawed piece of legislation and start again with the proven adult consumer model for vaping that is established in other Western countries.
Documents
Report from the Committee. Delegated Legislation Monitor 10 of 2024. 11 September 2024
Senator Deborah O’Neill’s speech to the Senate. 11 September 2024
Disallowance notice, 17 September 2024
To the President, ADA Tasmania branch
Dear Dr McCracken,
I am writing this open letter to you about the recent ADA Tasmania media statement on vaping. The statement does not align with the latest empirical evidence on vaping and its role in smoking cessation. Moreover, the prescription-only model that you advocate has been a significant failure in practice, restricting access for adult smokers while inadvertently fuelling a black market that freely sells to young people.
As a clinician, academic and researcher in smoking cessation and tobacco harm reduction for 40 years, I have contributed to the development of the national smoking cessations guidelines for the Royal Australian College of General Practitioners and served as a Conjoint Associate Professor in the School of Public Health and Community Medicine at the University of New South Wales. I have no financial or commercial ties to any electronic cigarette or tobacco company.
Below are my specific concerns with your media release.
1. “there is not sufficient evidence that e-cigarettes are an effective smoking cessation tool’
This statement is inaccurate. Vaping is widely recognised as the most effective and most popular quitting aid in Australia and many other Western countries.
- A Cochrane Review (2024) found “high certainty” evidence that vaping is 59% more effective than nicotine replacement therapy (NRT) in helping people quit smoking. (Lindson 2024) Another Cochrane Review (2023) identified nicotine vapes and varenicline (Champix) as the two most effective single treatments for smoking cessation. (Lindson 2023)
- Real-world evidence from observational studies, population data, and national declines in smoking rates supports these findings. (evidence review)
2. “Harmful substances have been found in e-cigarette liquids”
While this is technically true, it lacks important context: “the dose makes the poison.” (Bus) Harmful substances exist in the air we breathe and in tap water, but they are only dangerous at doses known to cause harm.
Vapour from e-cigarettes typically contains about 100-150 chemicals, (Heywood; Sleiman; Margham) compared to 7,000 in tobacco smoke. Most of these chemicals are present at less than 1% of the levels found in smoke and are well below occupational safety limits. (PHE; Heywood)
3. “vapours produced, which could increase the risk of lung disease, heart disease and cancer”
This phrasing implies a much higher risk than current evidence supports.
- Lung disease. To date, research has not found any significant lung damage from vaping nicotine in the short to medium term. Lung health improves significantly in smokers who switch to vaping. (evidence review)
- Heart disease. There is currently no definitive evidence that vaping increases cardiovascular risk. On the contrary, switching from smoking to vaping has been shown to reduce cardiovascular risk. (evidence review)
- Switching from smoking to vaping dramatically lowers cancer risk. Estimates suggest that the cancer risk from vaping is less than 0.5% of that from smoking. (Stephens) According to Cancer Research UK, “There is no good evidence that vaping causes cancer.” (CRUK)
- Oral health. Vaping can lead to oral health effects, but this is far less than from smoking. (Iacob) A review of 98 studies concluded that “switching to e-cigarettes may mitigate oral symptomatology for conventional smokers”. (Yang)
4. “people who take up the use of e-cigarettes are around three times more likely to take up smoking”
Studies indicate that young people who experiment with vaping are more likely to try cigarettes (and alcohol and illicit drugs). However, this does not mean that vaping causes young people to take up regular smoking. The evidence suggests that vaping is diverting young people away from smoking. In countries where vaping is readily available, such as the UK, US, and New Zealand, youth smoking rates have declined more rapidly. (evidence review)
5. “former smokers who use e-cigarettes are more likely to relapse”
The claim that vaping causes relapse is unsupported. Some studies have found that former smokers who vape are more likely to relapse than those who don’t, but this is an association, not causation. (evidence review)
The prescription-only model
You argue that a prescription-only model will ensure access to vaping devices is medically supervised and will reduce underage vaping. However, this regulatory approach has failed to achieve either goal.
- Only 6.8% of adult vapers obtained a prescription in 2023. (NDSHS 2022-23) The vast majority of Australia’s 1.5 million adult vapers have rejected the prescription model, and most doctors are unwilling to prescribe.
- A thriving and violent black market has emerged, controlled by criminal gangs, which has made it easier for young people to access vapes. These unregulated products often contain high nicotine levels and pose greater risks than legally regulated alternatives. (evidence review)
History shows that prohibition-style interventions, such as the current prescription model, are unlikely to reduce the availability of illegal vapes.
A more effective approach would be to adopt a tightly regulated adult consumer model, with licensed retailers, strict age verification, and harsh penalties for underage sales, as for tobacco and alcohol. This would align Australia with Western nations like New Zealand, the UK, and the EU, improving access for adult smokers while reducing the availability of black market products to minors.
I am happy to discuss these issues further and look forward to your response.
Kind regards,
Dr. Colin Mendelsohn
www.colinmendelsohn.com.au
25 September 2024
Media release
ADA Tasmania backs strengthened vaping legislation in Tasmania. Media release 24 September 2024
Open letter to ADA Tasmania President, Dr Katelyn McCracken. 25 September 2024
THE TASMANIAN BRANCH OF THE AMA (Australian Medical Association) issued a media release yesterday criticising an opinion piece by Senator Tammy Tyrrell on vaping. The AMA’s response reveals a striking level of ignorance and bias about vaping, perpetuating myths that contradict the existing body of scientific evidence.
Let’s take a closer look at some of the AMA’s most misguided claims.
Claim 1: “Vaping does not reduce smoking”
This claim ignores the overwhelming scientific evidence that vaping is an effective quitting aid. Rigorous Cochrane reviews of randomised controlled trials have found vaping to be more effective than nicotine patches and gum and at least as effective as varenicline (Champix). Findings from real-world studies including observational studies, population studies, improvements in national smoking rates and studies of accidental quitting support this.
To deny the effectiveness of vaping as a quitting tool in the face of such robust evidence is reckless and harmful. Smokers who are struggling to quit need options that work, and vaping has proven to be the most effective to date. By dismissing vaping’s effectiveness, the AMA is doing a disservice to public health.
Claim 2: “The idea that vaping is a safer alternative is a highly dangerous narrative pushed by tobacco companies”
This is not an argument pushed by the tobacco industry—it is a statement of fact supported by a wide range of reputable, independent public health organisations, such as Public Health England, the Royal College of Physicians and NASEM, based on comprehensive reviews of the evidence.
The AMA’s claim is a deliberate attempt to discredit the science behind vaping by linking it to Big Tobacco, a common tactic used by anti-vaping advocates to incite fear and mistrust. This only serves to confuse the public and delay harm reduction efforts.
Claim 3: Vaping is “linked to acute lung injury and popcorn lung”
There is no evidence that vaping nicotine causes either of these conditions. This is another desperate and dishonest attempt to stoke fear and misinformation.
Claim 4: “Vaping has become a gateway to smoking”
This is one of the most persistent myths about vaping, yet the research shows the exact opposite. Vaping is diverting young people away from smoking overall and is accelerating the decline in youth smoking rates. Once again, the AMA is ignoring the real-world evidence and clinging to disproven fears.
The association between vaping and smoking is not causal and is based on the ”common liability” of some young people to both vape and smoke. AMA is making the fundamental error of confusing association with causation.
Claim 5: Restrictions will “mitigate, not encourage, illicit trade”
The AMA dismisses concerns that further restrictions on vaping will lead to the growth of the black market, calling it an “industry ploy.” This claim is not only factually incorrect, but it also ignores the current situation in Australia. As criminologist Dr James Martin explained to the Victorian Parliamentary Inquiry recently:
“The black markets for illicit tobacco and vaping products in Victoria and around Australia are large and growing…The massive black market for these products is the direct result of increased government restrictions”
The solution for this black market is not more harsh restrictions, but rather to replace it with a legal, regulated one.
Claim 6: “GPs are very happy to help” with vaping
Finally, the AMA claims that general practitioners (GPs) are ready and willing to help patients with vaping. This is far from the truth. While some GPs are supportive of vaping as a harm reduction tool, the majority are either ill-informed or reluctant to prescribe or recommend nicotine vaping products.
Many smokers report frustration when approaching their GPs for help with vaping, often being turned away or given inaccurate information. This reality contrasts sharply with the AMA’s rosy depiction of GPs as champions of vaping support.
Conclusion
The Tasmanian branch of the AMA has done a disservice to public health with its misguided and factually inaccurate statements on vaping. Its media release not only dismisses the robust evidence supporting vaping as the most effective quitting aid but also spreads fear and misinformation about its safety and role in smoking cessation. Instead of engaging in evidence-based dialogue, the AMA has chosen to perpetuate outdated myths and ignore the harm reduction potential of vaping.
It’s time for the AMA to acknowledge the overwhelming body of scientific evidence and support vaping as a vital tool for reducing smoking-related harm in Australia.
References
Vapings dangerous myths. Media release. AMA Tasmania 16 September 2024
Senator Tammy Tyrrell. Nanny state needs to take a breath. The Mercury 1 May 2024
ONCE AGAIN, AUSTRALIAN RESEARCHERS have jumped on the bandwagon, making alarmist claims that vaping causes young people to start smoking. But let’s be clear: this study proves no such thing.
The researchers behind the Generation Vape study followed up 14-17-year-olds who had tried vaping and found they were five times more likely to also try smoking (even just “a few puffs”) at a later date.
This association is unsurprising, but it does not prove that vaping caused subsequent smoking as claimed
It’s long been recognised that some young people are simply predisposed to experiment with nicotine, whether through cigarettes, vaping, or other means. Surely the authors know this.
Causality requires more than surface-level associations. In this case, it would take more robust, sophisticated longitudinal studies to even begin establishing a causal relationship. Nonetheless, the authors claim their findings “indicate that vaping markedly increases the risk of subsequent smoking initiation.” They went a step further in their media release, declaring that vaping poses a real threat to increasing youth smoking rates, calling for tighter regulations.
Typically, these flawed conclusions had widespread media coverage in Australia and internationally
A far more likely explanation: common liability
A far more plausible explanation for the observed association is “common liability.” (Vanyukov 2012) In short, young people who try both vaping and smoking are simply different from their peers. They are predisposed to experiment with nicotine, driven by many underlying smoking predictors like peer pressure, parental smoking, and socio-economic status.
While this study adjusted for four smoking predictors (risk factors), it ignored a host of others. Crucial influences that increase the risk of smoking like school performance, genetic predisposition, personality type and mental health factors such as anxiety and depression were left out.
Studies that adjust for a broader range of risk factors (confounders) tell a very different story
Two such studies, which accounted for 14 and 22 risk factors, found that the link between vaping and later smoking vanished entirely. (Sun 2023; Kim 2019) A further study accounted for 34 risk factors which eliminated almost all (87%) of the association between vaping and smoking. (Lee 2019)
Where are all the smokers?
If vaping truly acted as a gateway to smoking, we’d expect to see a dramatic rise in youth smoking since the introduction of vaping in Australia.
Yet, the opposite is true – youth smoking has almost disappeared
In the most recent 2022-2023 ASSAD survey, just 0.3% of Australian students aged 12-17 reported daily smoking. Only 2.1% had smoked within the last week. Similarly, the NDSHS 2022-23 survey showed that only 3.5% of 14-17-year-olds had smoked in the past 30 days.
In fact, youth smoking rates have been falling faster than anticipated since vaping entered the scene. (Delnevo and Villanti 2021; Pesola 2021 Levy 2019; Meza 2021; NHS Digital UK 2022; ASH NZ 2022),) Studies suggest that youth vaping may actually be displacing smoking rather than encouraging it. (Foxon 2020, Selya 2021, Sokol 2021)
Experimentation vs. sustained smoking
One particularly misleading aspect of this study is its definition of “smokers.” A young person who takes “a few puffs” of a cigarette is classified as a smoker, but this is hardly equivalent to habitual smoking. Much adolescent cigarette use is fleeting, a brief experiment rather than the start of a smoking habit.
A recent analysis found that very few young people who tried smoking developed a regular smoking habit two years later, regardless of whether they had vaped beforehand. (Sun 2023) Another analysis showed that roughly two-thirds of youth who had tried smoking never progressed to regular use. (Friedman 2019)
Conclusion
This paper has sparked unnecessary alarm with its misleading claim of causality, feeding into the growing moral panic about youth vaping. By confusing correlation with causation, the authors have made a fundamental error. It’s hard to believe this wasn’t a deliberate decision.
Unfortunately, the recommendations from this paper—calling for stricter regulations on vaping—could ultimately do more harm than good. If these restrictions affect adult smokers, the public health consequences could be severe. We must prioritise evidence-based policy decisions, not reactions driven by alarmist studies that overstate the risks.
References
Is vaping a gateway to smoking?. Blog