Vaping nicotine is the most popular way to quit cigarettes, so why's it banned?

Jill Margo
Feb 8, 2019
AFR
When the young Robert Richter arrived at Melbourne University in the mid-’60s, smoking was in vogue. Hanging around the library, it made his fellow students look worldly and sophisticated, so he followed suit.
For the next 50 years he fitted in a pack-a-day, and although he often tried to quit, he was in a state of such deep addiction, he couldn’t.
Without nicotine, he couldn’t run the legal practice that has made him a celebrity barrister with a client list stretching from Melbourne’s gangland figure Mick Gatto and Ray Williams of HIH, to former Elders IXL boss John Elliott and Cardinal George Pell.
“You see, what long-term addicts want to feel most of all, is a sense of normalcy. I’m in the middle of a heavy-duty, strenuous endeavour in terms of legal practice and in order to be able to concentrate and to sleep, I need to feel normal,” says Robert Richter QC. Simon Schluter
Then early last year, during a scan for an unrelated issue, doctors happened to detect a very small cancer developing on one of Richter’s lungs.
After successfully removing it, the surgeon declared the barrister – known in court as The Red Baron – had “dodged a bullet”. No further treatment was required and although the prognosis was excellent, he was given absolutely no option but to quit.
So, Richter QC asked about inhaling nicotine vapour and was relieved at the reply. “He said it will not damage my lungs and that it is 95 per cent safer than smoking cigarettes.”
Richter was asking about vaping, which refers to the use of electronic smoking devices.
Over the past 10 to 15 years, many devices have reached the market, from e-cigs to vape pens, pod devices, mods, e-hookahs and even e-cigars – and the market is constantly innovating.
While quitting completely was the better option for Richter, he couldn’t do it.
“At present, about 19,000 smokers die prematurely in Australia each year. That’s equivalent to a jumbo crashing every week. Why is it acceptable?” asks professor Mendelsohn. Nic Walker
“You see, what long-term addicts want to feel most of all, is a sense of normalcy.
“I’m in the middle of a heavy-duty, strenuous endeavour in terms of legal practice and in order to be able to concentrate and to sleep, I need to feel normal.
“It was a no brainer. I could go out and get nicotine patches or gum but their release of nicotine is too slow to ameliorate the craving.
“As just about any addict to any kind of drug would know, what the addict craves is swift release from the cravings.
“I’ve now been vaping for a year and have been able to function regularly and sensibly. If I wasn’t vaping nicotine, I don’t believe I could. It allows my body to act normally, without the stresses and anxieties that nicotine withdrawal produces.
“But what I can’t get over is the complete hypocrisy of me being able to buy a packet of cigarettes and smoke them to relieve my craving. That is perfectly acceptable, but if I want to take something that is less harmful, I can’t go to a shop and buy nicotine liquid so I can vape it.”
This is the crux of the controversy about vaping in Australia. People can vape nicotine-free flavoured liquid, but the authorities have banned nicotine liquid from sale.
It is illegal to possess or use nicotine liquid in Australia without a prescription, but most doctors will not provide them. As a result, most vapers purchase nicotine online or from the black market and use it illegally.
Richter has a prescription for nicotine liquid from his doctor.
Harm reduction
With smoking, most of the harm is caused by the tar, carbon monoxide, toxic gases and particulate matter from burning tobacco.
Vaporisers don’t burn tobacco. They heat a liquid nicotine solution into an aerosol without combustion and far fewer chemicals. According to the UK Royal College of Physicians, the long-term use is likely to be no more than 5 per cent of the harm of smoking.
Like the controversies over pill testing and injecting rooms, the debate over vaping is about harm reduction.
The question is whether more harm will be done by legitimising nicotine vaping than by banning it.
Those on both sides of the debate want the best for Australian society but can’t agree on how to achieve it.
Richter says allowing an addict to vape is not designed to encourage addiction, but is a recognition that addiction needs to be treated, just as diabetes is treated with insulin.
“Anyone who has the slightest regard for harm reduction would recognise this is an obvious thing to do, but such is our attitude to addiction in this society that we’d rather have people die unnecessarily from continuing to smoke.
“I would find acceptable a regulatory system which includes the usual prohibition of sale to under 18s and sale to non-smokers.”
Cancer Council Australia CEO Professor Sanchia Aranda has sympathy for hardened smokers, but remains opposed to vaping, including the vaping of nicotine.
Her concern is for the overall population, particularly youth.
As one of the world’s pre-eminent experts in cancer control, she acknowledges that the needs of established smokers are important, but says there is not enough evidence to show vaping is the solution for them.
“Thousands could be saved if they just switched to the much safer form of nicotine,” says professor Mendelsohn. Peter Braig
“The evidence of e-cigarettes being better than nicotine cessation is mixed,” she says.
“That they are 95 per cent less harmful was a figure promoted by Public Health England with no evidence to support it.
“We have no understanding of the long-term harms of vaping in a generation who have never smoked. We’ve only had 10 years of this, so we don’t know what the long-term harms might be. Remember, it used to be thought that smoking was good for health.”
And after putting so much effort into de-normalising smoking – with considerable success – she worries that legitimising vaping will renormalise the ritual of inhaling damaging chemicals into one’s lungs.
“The push for vaping for established smokers does not take account of wider population health concerns. Some studies show kids are three times more likely to smoke combustible cigarettes if they have tried vaping.”
She is concerned about the long-term effects on the lungs and cites dental studies emerging on the damage to teeth of vapers who use flavourings.
During his 30-year career as a tobacco treatment specialist, Conjoint Associate Professor Colin Mendelsohn has studied all the literature and remains a passionate advocate for nicotine vaping.
He wants to provide smokers with a legitimate alternative for getting nicotine without the tobacco smoke that causes almost all of the known adverse health effects of smoking.
Currently, an estimated 250,000 Australians are vaping with or without nicotine and three million are smoking. AP
“Vaping is a much safer alternative nicotine product for adult smokers who are unable or unwilling to quit smoking or nicotine with conventional treatments.”
Mendelsohn, from the School of Public Health and Community Medicine at the University of New South Wales, says there is widespread confusion and misinformation about the effectiveness and safety of e-cigarettes.
“It is the most popular quitting aid internationally and there is no argument that it works. In fact, a large study from the UK recently found that vaping nearly doubles the quit rate compared to nicotine replacement products like the patch and gum.”
Both his father and his father-in-law were smokers, both died from it and he is dedicated to the cause.
“At present, about 19,000 smokers die prematurely in Australia each year. That’s equivalent to a jumbo crashing every week. Why is it acceptable?
“Thousands could be saved if they just switched to the much safer form of nicotine.”
False narrative
At present, it is estimated that 250,000 Australians are vaping with or without nicotine and 3 million are smoking.
“We don’t know everything about vaping and we can’t say what the future holds, but there have been 4500 scientific articles on it and we know a lot about it.
Just as the motor industry is going electric because it is better for the environment, so the tobacco industry is going electronic. Supplied
“We know nicotine is a relatively benign drug and has some positives health effects. It can improve attention, concentration and memory and there is evidence to suggest it can improve conditions such as Parkinson’s disease, ulcerative colitis and ADHD.”
He believes the push against vaping is being driven by a false narrative about the tobacco industry. The traditional anti-smoking movement cast Big Tobacco as an evil industry and wanted to see it vanquished.
The movement was successful in bringing smoking rates down and lifting Australia into position as a world leader in the field.
But now, he says, there is a fear that Big Tobacco is returning in the shape of vaping and rolling it out to hook more young kids, addict them and perpetuate smoking.
This is incorrect as Big Tobacco didn’t start the vaping business and didn’t initially recognise it as a potential disrupter.
Now it is playing catch up to try to save its business. Just as the motor industry is going electric because it is better for the environment, so the tobacco industry is going electronic.
Mendelsohn admits he made a naïve mistake in his advocacy for vaping. Last year, with a group of doctors, he started the Australian Tobacco Harm Reduction Association.
Setting up this health promotion charity cost $50,000 and they accepted funding from the public and from local vape companies. They also took a donation from a private sector public health agency in the UK which had taken two previous grants from Big Tobacco.
Although this was declared publicly and, on their website, it brought bad press. “In hindsight we shouldn’t have taken the funds and we won’t be taking any more from the vaping industry,” he says.
Australia is no longer a world leader in smoking cessation and he says despite having the highest-priced cigarettes in the world, frightening images on plain packages and other restrictions, the decline in the smoking rate has plateaued since 2013.
“In the OECD, 34 out of 37 countries allow vaping. Australia is out of step with other high-income countries.”
He says Australia’s options don’t need to be binary, its policy need not be only quit or die.