“Australia hasn’t yet come to terms with the option of harm reduction”


In the wake of the TGA’s decision to maintain a ban on nicotine for e-cigarettes, research shows such restrictive environments inhibit smokers’ attempts to quit

A study published this week in Nicotine & Tobacco Research, has found regulations on electronic cigarettes may impact their effectiveness as a smoking cessation tool.

Researchers analysed surveys conducted in Australia and Canada – where retail sales of nicotine-containing e-cigarettes are effectively banned – compared with the US and the UK where they are more accessible.

They found that in the less restrictive countries, about 58% of smokers who reporting quitting without using any support tools (nicotine replacement therapy (NRT), prescription medicines or e-cigarettes) reported 30-day sustained abstinence compared to 73% who used e-cigarettes to quit, 70% who used NRT, 74% who used prescription medicines, and 68% who use a combination of methods.

In Australia and Canada, the 30-day sustained abstinence rate was 56% for those who quit without help, and the quit rate for those using e-cigarettes was considerably lower at 32%. The quit rate was 69% for prescription medicines, 60% for NRT, and 56% for a combination of methods.

Those in the more restrictive countries who used e-cigarettes to quit were significantly less likely to sustain abstinence for 30 days or more compared to those who quit without help, the researchers found.

But in the US and the UK, smokers who used e-cigarettes for their last quit attempts were almost twice as likely to quit for at least 30 days compared to those who quit without using e-cigarettes or any approved therapy.

This could be because quitters from these countries may have better access to products, more effective products, greater opportunity to access new supplies, and a generally more supportive environment, the authors suggest.

Dr Colin Mendelsohn, Associate Professor in the School of Public Health and Community Medicine at the University of New South Wales, says the findings are “absolutely what you would expect”.

“In Australia, it’s hard to get [e-cigarette] supplies and support. It’s totally unregulated and it’s not incorporated into existing smoking cessation programs,” he tells AJP.

“There’s not that government support, it’s something that’s ‘forbidden’, and so people assume it’s more dangerous than it is.

“There’s another option called harm reduction that Australia hasn’t yet come to terms with yet in the same way as in the UK has.”

He says fears surrounding small and unsubstantiated risks have taken precedence over the harm minimisation approach.

TGA decision in the firing line

The recent TGA decision to maintain the ban on nicotine for use in e-cigarettes runs against the growing evidence showing vaping to be far less harmful to users and bystanders than tobacco smoke, says Dr Mendelsohn.

He tells AJP it makes no sense that the TGA has banned low concentrations of nicotine for use in e-cigarettes to help smokers quit, yet specifically allows nicotine in “tobacco prepared and packed for smoking” to be sold widely in Australia.

“The TGA’s job is to evaluate therapeutic goods. Nicotine [for e-cigarettes] is not a therapeutic product; it’s a consumer product and an alternative to a more lethal consumer product.

“They didn’t have jurisdiction over it; they had no choice but to reject it.”

Speaking in the House of Representatives last week, MP Dr Andrew Laming (Lib, Qld) told fellow MPs he was “devastated” at the TGA’s decision.

“Everyone here would know that two-thirds of Australians who smoke are helped to an early grave not just by carcinogens, not just by toxins, but also increasingly by a nation that will not contemplate alternatives where the rest of the world does,” said Dr Laming, who had worked as a medical practitioner prior to entering politics.

He said New Zealand “put [Australia] to shame” by legalising e-cigarettes, adding that the UK has openly trialled them and that they are freely available in the US and across the EU.

“If you are going to ban e-cigarettes, how can you possibly collect the evidence?” argued Dr Laming.

“We have the rest of the developed world recognising that we can lower the years lost due to smoking by turning to these devices. Sixty-eight percent of smokers will tell you they would use them if they were a similar price of less.”

He told Parliament that the Royal College of Physicians found the dangers of e-cigarettes are less than 5% of the dangers of smoking.

“There is a net benefit of 19 out of 20, and we cannot get a trial in this country,” said Dr Laming.

“We spend billions trying to combat smoking, and here is a ready alternative available to the Australian public. But, no, we will suppress it and continue this ban purely on the argument of lack of evidence.

“We need a TGA that does not take an absolute no-risk approach. We need a balanced approach to this. With a black ban, you cannot even do the trials.”

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6 Comments

  1. Bill Godshall
    09/04/2017

    Survey data indicates that vaping has helped 10 million smokers quit worldwide, and have helped even more smokers sharply reduce their cigarette consumption.

    Virtually all vapor products are consumed by smokers and former smokers (who switched to vaping), and there is no evidence that vapor products have created daily nicotine dependence in any nonsmoker.

    Based on its ongoing actions, it appears the regulators at TGA are determined to kill as many Australian cigarette smokers as possible (by depriving them of legal access to lifesaving vapor and snus products).

    By any objective standards, this is unethical and inhumane public health malpractice.

    • Jarrod McMaugh
      13/04/2017

      A few points:
      1) Why is an american so interested in what happens in Australia?
      2) Survery’s aren’t rigorous medical data, and any medical decision cannot be based upon them.
      3) Lack of evidence does not equal evidence of a lack of vaping by non-smokers.
      4) The Australian public still has access to other nicotine replacement therapies, so your statement that the TGA wants to kill people is catastrophising the situation just a tad.
      5) I don’t think anyone could mistake your opinion as “objective”

      There may well be a growing evidence base for these products to be used medically, but the evidence isn’t strong enough yet.

      • Bill Godshall
        14/04/2017

        Vapor sales data has been consistent with the survey data for the past 8 years in every country (where vapor sales are legal).

        While nicotine gums, lozenges, patches and inhalers have been legal to sell in Australia (and are heavily subsidized by taxpayers), they only have a 5% success rate for helping smokers quit smoke.

        And the only studies looking at second/subsequent attempts to quit smoking with NRT products have found a 0% success rate.

        Besides, most smokers have already used those TGA approved Big Pharma drugs (and many have tried using multiple drugs multiple times), but have relapsed back to cigarettes.

        There is no need for medical use of vapor products, which is why many/most medical trade associations (and smoking cessation drug manufacturers) lobby to ban vapor products (and to keep them banned). As more smokers switch to vapor products, demand/sales has declined for smoking cessation drugs, as well as for cancer, COPD and heart disease treatments.

        Australia’s ban on vapor and snus sales is nothing more than crony capitalism to protect the profits of Big Pharma and Big Medicine at the expense of free markets, civil rights, and public health.

        • Jarrod McMaugh
          14/04/2017

          1) again with surveys. They hold no evidential weight. Evidence needs to be rigorous before a law is changed of medical recommendation is made.
          2) there are several factual errors in your second paragraph. QUIT rates aren’t as low as you say, and only patches are subsidised… And these subsidies aren’t “heavy” given the relative affordability of these items.
          3) your third paragraph is also incorrect, since most evidence on quitting shows that it takes on average 3-5 attempts to be successful.
          4) Big Pharma….. So either you are a conspiracy theorist, or you profit directly from the sale of vaping equipment/ingredients. Either way, you completely undermine your argument by using such a weak trope.

          Your claim is that health providers are actively preventing access to e-cigarettes in order to maintain income from treating people with life-ending illnesses? Not only is this untrue, but it reinforces the idea that you are a conspiracy theorist… And a very naive one at that.

          5) irony… Since it would seem that your motivation is to make available for sale products that do not yet have adequate safety data to ensure safe use.

          The TGA rightly considered the potential for these items to be marketed to non-smokerd, especially children. Posts like these by people who clearly have a vested interest demonstrate that this is a very valid concern.

          It is clear that tobacco companies see this as a market, and will consolidate the market within the next decade. Then we’re back to square one.

          • Bill Godshall
            15/04/2017

            Since the Australian government has banned the sale of lifesaving vapor products since 2008, and since they’ve repeated false fear mongering propaganda to justify the vapor ban since 2008, it is understandable that many folks down under have been deceived about vapor products (just as the American government intentionally deceived Americans about marijuana since it was banned 80 years ago, and about alcohol when it was banned 85-96 years ago).

            But insisting that nobody has quit smoking by switching to vaping (by claiming that all of the consistent scientific and empirical evidence has “no weight”) is scientific denialism.

            If Mr. McGough truly believes that vaping products haven’t helped any smokers quit smoking, perhaps he can explain just who bought and consumed the $8 billion of vapor products that were sold last year. Or perhaps he similarly believes there is no evidence that any vapor products were sold last year (since it wasn’t proven by a medical study).

            There is a huge and rapidly growing mountain of safety data on vapor products, and the evidence consistently indicate that vapor products are >95% less harmful than cigarettes.

            Vapor products are used almost exclusively by smokers and former smokers, and vapor products have NOT been found to cause daily dependence among nonsmokers (even after millions of nonsmokers have experimented with vaping).

            Smokers who switch to vaping (or to snus) enjoy the same many health benefits that smokers who quit smoking by other methods.

            All real public health advocates strongly support smokers switching to vapor products.

            Vapor prohibition threatens the lives of millions of smokers.

          • Jarrod McMaugh
            15/04/2017

            Gday

            First, you got my name wrong. Your lack of attention to detail is showing.

            Second, I have not said that there is no evidence or that it carries no weight, only that it is not enough evidence.

            Third, the issue of minors using the products is a legitimate concern of the TGA, and creates a need for a very large evidence-based for benefit vs risk for the entire community, not just smokers.

            Fourth, you state that only smokers and ex-smokers use these products…. And then you say millions of non smokers have used it. Which is it? Try and be consistent.

            You still haven’t answered some of my earlier questions

            Why is an American so evangelical about vaping “down under”?

            What is to stop tobacco companies dominating the market and profiting from these as well? Or creating a pathway to cigarettes et al?

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