1 October 2021
Melissa Davey. Source: The Guardian
New laws aim to curb the use of vapes among young people, but concerns are already being raised about websites aiming to get around them
In a recent three-week period, a major Western Australian hospital treated a teenager suffering seizures after vaping too much nicotine, a toddler with cardiac issues after drinking e-cigarette liquid, and a death attributed to drinking e-cigarette liquid.
It is cases like these which public health physician Prof Emily Banks hopes will be prevented through new vaping laws which came into effect on Friday.
They mean nicotine-containing vaping products can only be obtained via a prescription from a doctor.
Research provided by Banks, an epidemiologist with the Australian National University, was instrumental in informing the laws.
“These laws are a result of a comprehensive review of the worldwide evidence,” Banks said.
“We know nicotine is highly addictive, that it is not good for the developing brain, and that non-smokers who use them have three times the chance of going on to become regular smokers than those who have not used e-cigarettes.
“We have information about impacts like seizures and other health issues among some users. It’s heartening we finally have an evidence-based policy. We have seen, over the years, increasing illicit use of these products, particularly in schools.”
Banks collected discarded e-cigarette packaging from her daughter’s high-school, finding the wrapper from one vape packet revealed the product contained the equivalent nicotine of nine packets of cigarettes.
She said for most smokers, e-cigarettes are not effective tools to assist them to quit, and the majority of people who vape in Australia are not using the products as smoking cessation devices.
“If we look at all the people using e-cigarettes, 54% are current smokers as well and they’re what we call ‘dual users’,” she said. “According to the data they’re using e-cigarettes at the same time as smoking because they believe e-cigarettes are more socially acceptable, and can be used in some places where tobacco smoking is banned, and because they are cheaper. They’re not using them to quit.”
About 16% of current e-cigarette users are non-smokers who have never inhaled tobacco, Banks said, while the remaining third are ex-smokers. There are about 400,000 e-cigarette users in Australia.
“You hear these vaping advocates saying, well, all those people using e-cigarettes out there are using them to quit smoking,” she said. “It simply isn’t true.”
The Royal Australian College of General Practitioners [RACGP] is releasing best practice guidelines to support GPs if they are approached by smokers and nicotine vapers to prescribe the products. However, the guidelines will state that because of the limited evidence supporting their use in cessation, nicotine vaping products should be considered a last resort.
The president of the Australian Medical Association (AMA), Dr Omar Khorshid, said GPs should not feel pressured to prescribe the e-cigarette nicotine products.
“The AMA are a cautious supporter of these changes, because … we think the laws will be beneficial in that they will close the fairly open-door policy for illegal importation of nicotine which has resulted in pretty free access, and we really want to reduce the chance of teenagers and other young children accessing these products,” he said.
“But on the negative side we’ve got doctors who are quite concerned about the idea of being asked to prescribe a substance for which there’s really no compelling scientific evidence of their efficacy or safety. But if people have tried other smoking cessation mechanisms, and if they’re committed to coming off cigarettes, then we’ve accepted that even in the absence of the evidence, it is not an unreasonable thing to try vaping for a short period.
“As long as the intention is to come off the cigarettes.”
The government has introduced a new telehealth medicare item number for smoking cessation consults, where they can write scripts for nicotine-replacement products, including nicotine-containing vaping products.
Already, vaping websites have compiled a list of GPs they say are willing to prescribe products. One websites claims to be able to link consumers with a GP who can provide a vaping script in minutes.
A significant portion of the global e-cigarette market is now owned by big tobacco, who are turning to e-cigarettes in countries where tobacco control laws have made it more difficult to advertise cigarettes.
Khorshid said the emergence of websites was concerning.
“It is very important for doctors participating in this sort of thing to be aware of their obligations under the telehealth item numbers,” he said. “The item numbers are to be used for smoking cessation consults, not specifically to prescribe these products.”