Lung cancer

TSANZ comes out strongly against e-cigarettes

The TSANZ’s long-awaited position statement on e-cigarettes has been released with a firm rejection of their use for smoking cessation on the grounds that vaporised nicotine products are unproven and unsafe.

The TSANZ has now joined other health groups such as the Lung Foundation in strongly opposing any role for e-cigarettes in reducing the harm of smoking, advising that vaping should not be recommended and also that smokers who want to try it  should be directed instead to approved products and behavioural therapy.

In its position statement the TSANZ acknowledges that some authorities such as Public Health England (PHE) are supporting smokers to switch to vaping on the grounds that it is much less harmful than smoking tobacco.

But the TSANZ says it does not accept the evidence underlying the PHE’s report and instead relies on reports from the National Academies of Sciences, Engineering and Medicine (NASEM) and CSIRO “as better reflecting the published literature.”

In conjunction with feedback from members, the TSANZ therefore concludes that e-cigarettes should not be recommended because they have adverse lung effects and the harmful effects of their long-term use are unknown.

It also warns that vaping poses a significant public health risk through addiction to nicotine, making e-cigarettes unsuitable consumer products for recreational use, part-substitution for smoking or long-term exclusive use by former smokers.

Not only does it back the current government approach to banning sales of e-cigarette products, but says this doesn’t go far enough because the current personal importation mechanism is difficult to enforce and has been widely flouted.

“Restrictions relating to the sale and importation of e-cigarettes must be strengthened, and decades of prioritising public health over corporate interests must continue,” it says.

The TSANZ concludes that the best evidence for smoking cessation is for counselling combined with TGA-approved pharmacotherapy.

“Smokers who enquire about using e-cigarettes as a cessation aid should be provided with appropriate information about approved medication in conjunction with behavioural support,” it advises.

“For smokers who express a desire to use e-cigarettes for cessation, health professionals should ensure the smokers have access to, and are utilising, behavioural support with the aim of achieving complete smoking cessation and subsequent cessation of e-cigarette use as promptly as possible. It should be clearly communicated that no product can be recommended, and nor can an assurance be provided as to either effectiveness or safety,

Professor Matthew Peters, a lead author of the TSANZ statement, says it is intended to protect against a resurgence in nicotine promotion by the tobacco industry after public health efforts reduced smoking rates in Australia to among the lowest in the world.

“Australia has had remarkable success in preventing the uptake of smoking by young people and we must ensure that e-cigarette use does not see us lose these hard-won gains.

“Even if a link between e-cigarettes and smoking cessation were to be firmly established, it would be irresponsible  to liberalise access without first considering the harms widespread availability of e-cigarettes would have on addiction and lung injury in young Australians who otherwise have an extremely low likelihood of smoking initiation. For this position to change, further high-quality research is required,” he said.

TSANZ notes that young adults are most likely to be attracted to e-cigarettes, with recent figures showing a doubling in the number of 18-24 year old Australians reporting having tried e-cigarettes over a three year period.

“Australia and New Zealand must remain focused on proven effective population tobacco control strategies to reduce prevalence rates. We must also ensure that smokers have access to behavioural support and, where required, therapeutic products which have been through stringent regulatory approval processes,” the statement concludes.

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