Hostility to harm reduction in smoking: expert


man with e-cigarette in one hand and six cigarettes in the other

An application to the TGA to increase the accessibility of nicotine for e-cigarettes to reduce tobacco smoking is unlikely to succeed, says an addiction expert, because harm minimisation strategies are rarely applied to smoking.

The TGA is seeking comments from interested parties on a proposed amendment to the Poisons Standard which would exempt nicotine from Schedule 7 at concentrations of 3.6% or less of nicotine, for self-administration with an electronic nicotine delivery system for the purpose of tobacco harm reduction.

But Professor Wayne Hall, Inaugural Director of the Centre for Youth Substance Abuse Research at the University of Queensland, told the AJP that opposition to the change is likely to be strong and result in the application’s failure.

“I expect the proposal to be strongly opposed by the majority of people in the Australian tobacco control community, for example Simon Chapman, Mike Daube, Melanie Wakefield which will make it unlikely to be accepted by the TGA,” Prof Hall says.

Earlier this year Prof Hall wrote in MJA InSight that Australia had “reached the end of the road” in terms of reducing smoking via tax increases.

He said that opposition to vaping, whether using nicotine in electronic cigarettes or not, represents the dominant view in the tobacco control public health community in Australia, “and it’s often hard for government to adjust policies where there’s such strong opposition”.

“I welcome any move to make it easier for smokers who wish to switch to e-cigarettes to do so,” he says.

He says that there’s value in the TGA assessing the proposal, and that it is useful to debate the pros and cons of e-cigarettes, as there has been little public discussion on the subject to date.

“I share concerns people have about the dangers of allowing these products to be freely sold and marketed, promoted to young people, but there are different ways of making them available,” he says.

“I think allowing pharmacies to sell these sorts of products to adults would be a way to go a fair way towards reducing people’s anxieties about them being promoted by corner stores – in London you see them all over the place in off-licences and they are regulated only as consumer products.”

Prof Hall says that overall, there is a “refusal” to see vaping in the same light as other medicines available through pharmacy to combat addiction.

“There’s historical hostility to the idea of harm reduction in the tobacco field, and it goes way back to the absolute disaster of the filtered cigarettes and low tar cigarettes used by the tobacco industry as a way to offer a safer alternative – it became very clear that it was not the case at all that they were safer.

“So there’s understandable scepticism about the claims, but e-cigarettes do substantially reduce harm.

“There’s enough evidence there from the toxicology of the constituents of inhaled vapours to indicate that these products are less harmful than smoking cigarettes.

“It seems to be a silly policy to have the most harmful tobacco products available almost anywhere, but there are these restrictions on the much less harmful alternative.”

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