E-cigarette regulation through pharmacy?

man choosing between smoking cigarettes and e-cigarettes

As the Senate Economics References Committee conducts its public hearing on e-cigarettes, stakeholders have put the case for them forward – but one public health expert told the AJP that ‘vaping’ needs regulation, perhaps with access through pharmacy

Fairfax reports today that Terry Barnes, former health advisor to Tony Abbott and designer of the GP co-payment, says policy on issues such as lockout laws, bike helmets and e-cigarettes containing nicotine are “arse over tit”.

Slamming “nanny state” regulations, Barnes says Australia has adopted a “ban first, ask questions later approach” instead of giving e-cigarettes the benefit of the doubt.

And Dr. Stephen Jenkins, director regulatory and medical affairs, Nicoventures Asia Pacific, said in a statement to the media that he believes the ban on e-cigarettes is making it difficult for Australian smokers to reduce and cease their tobacco consumption.

He says e-cigarettes are 95% less harmful than smoking and are “proven to be the most successful smoking cessation tool, 50% better than traditional gums and patches”.

But public health expert Professor Simon Chapman told the AJP that while evidence on smoking cessation with e-cigarettes is being gathered, their availability should be regulated, perhaps through community pharmacy.

“There are indications both from England and the US—where the FDA and National Institute of Health have just put out preliminary results from a very large national sample of 46,000—and they’re finding the number of smokers who are using e-cigarettes on a daily basis is very low indeed,” Prof Chapman told the AJP.

“If you read between the lines, most are dual using. So they continue to smoke, and they’re occasionally using e-cigarettes. And a lot of the data, especially the British data, also indicates that around 70% of even daily vapers continue to smoke cigarettes.

“The central platform of their appeal is that by using e-cigarettes you’re likely to quit smoking, but that’s far from the case.

“What we know so far is they tend to use both, and so the real concern, from a public health perspective, is that e-cigarettes may have a net effect in populations of keeping people in smoking, rather than pulling out.”

Prof Chapman says that many smokers also use vaping to cut down on smoking traditional cigarettes, thus believing they are significantly reducing their risk of smoking-related illness. However, the effects of cutting down, rather than quitting altogether, is limited to non-existent, according to large-cohort studies.

He compared the advent of e-cigarettes to “two large experiments over the last few decades with harm reduction and tobacco, which were failures”.

“The first was filters, which were heralded as greatly reducing the risk; that was a total failure. People just suck deeper, and tar is still pulled into the lungs.

“The second was ‘lights’ and ‘milds,’ and around 80% of smokers switched to the so-called lights and mild cigarettes. In 2005 the ACCC had to intervene and tell consumers that these labels were deceptive, and not delivering appreciably less harmful constituents. They fined manufacturers and those descriptions are now banned in Australia.

“My attitude to e-cigarettes is that it would be wonderful if they did what their advocates say they promise to do, but there’s precious little evidence to say they do,” Prof Chapman says.

“The prudent thing to do would be to regulate them as pharmaceutical products, and create maybe some way of getting hold of e-cigarettes through a pharmacy, whether on prescription or with some other form of restriction, as with pseudoephedrine.

“Just allowing the law to continue as is and watching what happens is a national health experiment.

“I think pharmacists have the training and counselling knowledge that the girl at the supermarket desk or petrol station attendant doesn’t, so I think it would be appropriate, if we are to let e-cigarettes in, that they ought to be regulated in this way.

“There’s a tsunami of highly motivated material out there about e-cigarettes that is, naturally, saying they’re the best thing since sliced bread; there’s a commercial agenda behind a lot of it and pharmacists need to be highly circumspect.”

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