Greg Hunt’s vaping inquiry is disappointing, misleading and unhelpful

September 30, 2020

ATHRA

A REPORT ON VAPING commissioned by the Health Minister from the Australian National University has provided the answers that Greg Hunt wanted. However, the results are misleading and biased, omitting important evidence, and in places just plain wrong.

The conclusions of the report in many cases do not reflect real-world experience, other recent reports on vaping and the views of the Health Departments of the UK and New Zealand.

Here are a selection of the conclusions of the study and our comments:

“never-smokers who have used e-cigarettes were, on average, around three times as likely as those who have not used e-cigarettes to try smoking conventional cigarettes”

The association between e-cigarette use and subsequent smoking is well known and is most likely due to ‘common liability’. Young people try vaping are more likely to try other risky behaviours such as smoking, alcohol, cannabis other drugs.

This association does not prove that vaping CAUSES young people who would not have otherwise have smoked to take up smoking, as implied in the media release

In fact, the evidence suggests the opposite. Most youth vaping is experimental and short-term and most young people who try vaping are already smokers. Vaping appears to be diverting youth from smoking. For example, in the US, the decline in smoking accelerated two to four times in youth after 2014 when vaping became popular.

The New Zealand Ministry of Health stated this year “Despite some experimentation with vaping products among never smokers, vaping products are attracting very few people who have never smoked into regular vaping, including young people.”

“There is insufficient evidence that nicotine-delivering e-cigarettes are efficacious for smoking cessation”

This conclusion is based on an analysis of randomised controlled trials of vaping.  However, it not consistent with two other recent reviews of the same studies, by Grabovac and the Royal Australian College of General Practitioners. Both of these meta-analyses concluded that vaping is 70% more effective than nicotine replacement.

However, a complete assessment requires ‘triangulation’, combining data from a wide range of study types. Observational trials, population studies, the rapidly declining smoking rates in countries where vaping is widely available and anecdotal data support the effectiveness of vaping.

Combining these findings with RCTs provides compelling evidence that vaping helps smokers quit

“The large majority of people successfully quitting smoking do so unaided or ‘cold turkey’ ”

This unhelpful statement implies that smokers should quit without any assistance. However, unaided quitting is the least effective quitting method and has a failure rate of 95-97 percent.  Many smokers will try ‘cold turkey’ repeatedly and quit eventually, but often after smoking-related harm has developed over many years. The best advice for smokers is to quit as soon as possible with the most effective method and vaping has proven world-wide to be one of them.

“Recent declines in smoking are largely driven by very low smoking uptake in younger people with 97% of 14-17 year olds in 2019 having never smoked”

Uptake of smoking and vaping by young people are not our main concern. The far greatest risk is for long-term addicted adult smokers. These smokers are at immediate and high risk of death and disease from smoking. The recent 2019 National Drug Strategy Household Survey reported that from 2016-2019 the smoking rate in Australian adults over the age of 40 did not decline.

For smokers who can’t quit, switching to vaping dramatically reduces their risk of death and disease which is why over 500,000 Australians have switched to vaping

“former smokers who had used e-cigarettes were around twice as likely to relapse and resume current smoking as those who had not used e-cigarettes”

This conclusion may be true but is very misleading as it implies that vaping increases the risk of relapse to smoking. Smokers who vape are different to those who don’t. They are more nicotine dependent than other smokers, have tried multiple quitting methods and have more difficulty quitting overall. The increased rate of relapse is more likely due to other factors than being caused by vaping.

“Current evidence suggests that nicotine-delivering e-cigarettes can result in prolonged exposure to nicotine through ongoing exclusive e-cigarette use”

This final statement suggests the authors do not understand the concept of tobacco harm reduction. The purpose of substituting cigarettes with vaping is to eliminate the toxic chemicals from smoke that cause almost all the harm from smoking.

Many studies have demonstrated that long-term nicotine maintenance  helps to prevent relapse and is itself of minor concern