The Australian Therapeutic Goods Administration’s (TGA) recent interim decision to effectively ban nicotine-containing e-cigarettes is a harsh blow to smokers.
Australian smokers will be denied access to life-saving technology estimated to have helped millions of smokers to quit overseas.
Those most affected will be from lower socio-economic and disadvantaged groups, which have the highest smoking rates and are hardest hit by the cost of smoking.
Currently, nicotine-containing e-cigarettes are effectively prohibited in Australia. If the TGA’s interim decision is made final in March 2017, e-cigarette users (or vapers) in Australia will still not be able to buy or import nicotine for vaping without a prescription. Their only legal option would be to ask their doctor for a prescription, which doctors are generally reluctant to provide.
If the current ban remains, vapers will still be forced to source nicotine solutions (e-liquids) from an unregulated and illegal black market, placing them at even greater risk. Without regulation, the contents of nicotine refill bottles are a mystery, labels are inaccurate, childproof bottles are not mandated and there is no quality control or manufacturing standard.
Other users will buy large quantities of highly concentrated nicotine online and mix their e-liquid at home, with the risk of exposure to children and dosage errors.
Meanwhile, vapers who try to quit smoking are branded criminals. The fine for possessing nicotine for vaping in Queensland is up to A$9,108 and the government encourages the public to report any offenders. This fear will lead some vapers to return to smoking.
Out of step
The TGA’s decision also leaves Australia out of step with other similar countries. E-cigarettes with nicotine are legal and available, or are in the process of being legalised, in the United Kingdom, European Union, United States, Canada and New Zealand.
Their approach to smoking cessation products is in sharp contrast to policy in Australia, which has missed the opportunity to welcome e-cigarettes as a harm reduction tool, and a safer alternative, for smokers. Meanwhile, the most lethal nicotine products, cigarettes, are freely available in Australia and do not need TGA approval.
In making its decision, the TGA focussed on unsubstantiated risks, for example, e-cigarettes will increase smoking in young people and re-normalise smoking in the community.
However, comprehensive independent reports have found no evidence for these claims. In fact, e-cigarettes may be diverting young people from smoking and helping smoking rates decline.
The TGA also says there is little evidence of the safety of long-term nicotine exposure via e-cigarettes. However, this ignores 50 years of experience with snus (moist, oral tobacco used in Sweden) and 30 years of nicotine replacement products.
The TGA also overlooks the huge potential public health gains from using e-cigarettes, or vaping. Based on overseas experience, vaping can save the lives of hundreds of thousands of Australian smokers, making the risk-benefit balance very favourable. Smoking kills up to two out of three Australian smokers prematurely. So, it seems reasonable to tolerate a small amount of risk and uncertainty when such devastating harm can be reduced.