‘Next big health issue after COVID’: NHMRC hardline stance on e-cigs

Public health

By Geir O'Rourke

27 Jun 2022

There is no convincing evidence that electronic cigarettes assist patients to quit and vaping may lead non-smokers to take up tobacco smoking , the NHMRC has warned.

The agency released its updated national advice on Thursday, warning that younger people were using e-cigarettes or vapes more frequently, with one-in five people aged 18-24 who had never smoked having tried vaping.

Most vapers were using the devices recreationally and only one-in-three of those who had used e-cigarettes had done so to help quit smoking, the report said.

When first using e-cigarettes, 64.5% of those aged 14–17 and 39% of young adults aged 18–24 were never smokers.

Among those who had tried them, frequency of use also increased, with more people using them at least monthly (from 10.3% in 2016 to 17.9% in 2019), weekly (from 2.9% in 2016 to 5.1% in 2019) and daily (from 5.8% in 2016 and 9.4% in 2019).

Commonwealth chief medical officer Professor Paul Kelly said reducing the risks posed by e-cigarettes was becoming a national priority.

“In fact, one of our colleagues has said recently that e-cigarettes are the next big health issue after COVID, and I think that’s a really important statement to take on board,” he told reporters in Canberra.

“People who take up e-cigarettes are more likely to start to continue on with smoking for the rest of their lives. And we know the devastation that has had in Australia over many decades.”

“Nicotine is a very addictive drug, and we need to make our efforts very strong with our young people to protect them from that lifelong issue.”

The evidence summary, updated for the first time since 2017, also found the number of e-cigarette-related calls to Australian poisons information centres had doubled between 2020 and 2021.

“The design and technology behind e-cigarettes continue to evolve but the method is the same – e-cigarettes deliver harmful substances direct to the lungs,” said NHMRC CEO Professor Anne Kelso.

“If you have never used e-cigarettes, don’t start. The evidence shows there is a possibility you will go on to smoke tobacco cigarettes. “

The NHMRC report sparked an angry reaction from vaping advocate Dr Colin Mendelsohn, founding chair of the Australian Tobacco Harm Reduction Association, who described it as “evidence free”.

“The NHMRC recommendations are irresponsible and deny the growing science that supports vaping,” he said on his website.

“Unfortunately they will be referenced by anti-vaping groups and will guide Australian policy.

“More smokers will be deterred from switching, some vapers may relapse to smoking and the cigarette trade will prosper. More people will die unnecessarily from smoking.”

PBAC backs expanding access to nicotine replacement therapy
The NHMRC warning on e-cigarettes comes after the PBAC recommended expanding the PBS subsidies for nicotine replacement therapy (NRT) at its intracycle meeting last month.

Under the proposed changes, patients would be eligible for an additional 12-weeks of subsidised NRT per year for retreatment after an unsuccessful quit attempt.

Extra PBS-funded NRT would also be available for those who have ceased smoking during the initial 12 weeks of therapy to prevent relapse.

The PBAC recommended allowing combinations of an NRT patch with short acting formulations to be used concomitantly on the PBS; but where combination NRT is prescribed, subsidy be limited to up to two different forms

However, it rejected a proposal to fund combination therapy of varenicline and NRT on cost effectiveness grounds.

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