“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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