Written by Colin Mendelsohn, UNSW Associate Professor and Tobacco Treatment Specialist.
Originally published on The Sydney Morning Herald.
The future of electronic cigarette regulation is starting to be defined. Reviews and guidelines have recently been published in Britain, the US and European Union, with attitudes and recommendations varying widely from one jurisdiction to another. Australian federal and state governments are also developing legislation that will have life-or-death implications for hundreds of thousands of smokers.
Electronic cigarettes (e-cigarettes) are battery-powered devices that simulate a smoking experience. The devices heat a nicotine-containing liquid to produce a mist that the user inhales. The inhaled vapour does not contain tobacco, tar or carbon monoxide, and is generally agreed to be much safer than smoke; probably about 95 per cent safer. Nicotine itself has relatively minor health effects.
Risk assessment: Laws should reflect the health reality of the smoking replacement products rather than ideological or political bias. Photo: AP
E-cigarettes are at least as effective as nicotine patches or gum in helping smokers to quit. For those who are unable to quit, e-cigarettes can substitute for smoking by providing the nicotine to which smokers are addicted without the smoke that causes almost all of the harm ("tobacco harm reduction").
Australia currently has a de facto ban on e-cigarettes due to a historical classification of nicotine as a schedule 7 dangerous poison. Sale, possession and use of nicotine in a vaporiser is an offence.
But e-cigarettes are freely available as consumer products in the UK and have been warmly embraced by the scientific and public health communities. A landmark report published last week by the Royal College of Physicians concluded that e-cigarettes have the potential to make a major contribution towards preventing premature death and disease due to smoking, and encouraged their widespread use by smokers. The report was in agreement with a comprehensive report commissioned by Public Health England in 2015.
Attitudes to e-cigarettes are much more cautious in the US and the European Union, where they are regulated as tobacco products. Under the American Food and Drug Administration's new "deeming regulations" and the EU's revised Tobacco Products Directive, all devices and solutions will require extremely costly and onerous approval, which will force all but the very largest companies out of the market. Prices will increase, innovation will be reduced and a black market created. On the other hand, deadly cigarettes and other smoked tobacco products will remain freely available.
Prohibition is not working in Australia, and it is easy to purchase nicotine online or through a thriving black market. The federal government has commissioned a discussion paper to guide e-cigarette policy, prepared by the Public Health Unit at the University of Sydney and Cancer Council NSW, both of which have previously expressed negative views on e-cigarettes. Also of concern is that the process is shrouded in secrecy and is only taking advice by invitation.
Decisions on how to regulate e-cigarettes should be based on evidence, not on ideology, politics or other bias. Some organisations have been historically locked into a single-minded focus of destroying tobacco companies, cigarettes and nicotine. It can be difficult to see that using nicotine to reduce harm may now be part of the solution. Our priority should be to reduce the health risks for current smokers, of whom two out of three will die as a result of their habit.
Overseas research has found that many of the concerns raised about e-cigarettes are not grounded in evidence. E-cigarettes are much safer than smoking and have helped millions of smokers to quit. There is no evidence of a "gateway" (that e-cigarettes lead non-smokers to smoking) or that they "renormalise" smoking in the community – vaping is almost exclusively confined to smokers and recent ex-smokers.
E-cigarettes should be regulated, but in a proportionate way that reflects their real level of risk. It is irrational to apply severe restrictions to a much safer product while allowing widespread access to deadly cigarettes. Well-intended but inappropriate regulation could have harmful unintended consequences, such as reducing the appeal of e-cigarettes, slowing product innovation and raising costs. This could have the perverse effect of protecting the cigarette trade and leading to more smoking.
E-cigarettes should be regulated as consumer products, not as tobacco or medicines. Consumer law ensures that products are safe and fit for purpose, and will allow e-cigarettes to compete favourably in the marketplace with the much more dangerous tobacco products. Appropriate light-touch regulations include:
- Child resistant containers
- Accurate labelling
- No advertising or sale to people under 18 years
- Low or no taxes to maintain a competitive advantage over tobacco
- Good manufacturing practice, with safe, high-quality ingredients
- Appropriate marketing practices
The right balance of regulations could substantially improve public health and save hundreds of thousands of Australian lives. We cannot afford to get it wrong.
Dr Colin Mendelsohn is a medical practitioner and Tobacco Treatment Specialist at The Sydney Clinic in Bronte.