Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697633890249.pdf (Australia)
Committee Secretary Select Committee on Tobacco Harm Reduction Department of the Senate PO Box 6100 Parliament House CANBERRA ACT 2600 PUBLIC SUBMISSION TO THE SELECT COMMITTEE ON TOBACCO HARM REDUCTION Dear Committee Members, Thank you for the opportunity to make a submission to the Select Committee on Tobacco Harm Reduction.

Personal Experience At 31 years of age, a harm reduction worker and Masters of Law student – and I have been smoking since I was 15.
In the beginning, I promised myself I would quit by the time I was 20.

However, eventually that benchmark got pushed further and further into the future.

It seemed very unlikely that I would actually ever quit smoking.

However, after reading the evidence around vaping as a harm reduction tool, I made the swap 2 years ago and am now no longer a smoker.

Getting vaping right was hard.


As nicotine vaping devices are ultimately banned within Australia, finding access to the right information and support was incredibly difficult.

After trying multiple devices and liquids, for at least a year I found what works me.

However, during that time I was a dual user, and this is an exceptionally common experience.1 Smoking cessation takes time but is possible through the use of vapes.
I also want to note, that if I was unable to access flavor liquids, I would likely return to smoking.

It has been finding a device and flavour that works for me that has allowed me to quit smoking.

Flavours are central, not incidental, to the smoke free proposition offered to smokers.2 It is illogical to – falsely3 – interpret the precautionary principle as a means to limit, ban and criminalise the use of nicotine vaping devices.
A precautionary approach is consistent with adopting risk-proportionate regulatory measures and is limiting potentially lifesaving tobacco harm reduction measures.. Australian tobacco control is guided by the National Tobacco Strategy,4 which is a sub strategy of the National Drug Strategy (NDS) and is grounded within the three pillars of supply, demand and harm reduction which together define the Australian harm minimisation approach.
However, to date, tobacco control in Australia has focused on, and invested in, demand reduction strategies, such as increased taxes, banning advertising and display, creating smoke-free public places, plain packaging and graphic health warnings, mass media campaigns, and education and smoking-cessation support.4 Increased commitment to harm reduction can, and need to, complement the traditional tobacco-control strategies, that although once effective appear to no longer be sufficient.
Providing Australian smokers with legal access to appropriately regulated nicotine vaping products has the potential to rejuvenate smoking cessation and improve public health.

It would also mean that I would have safe legal access to a harm reduction strategy that would greatly improve my health outcome.

1 Zhuang, Y. L., Cummins, S. E., J, Y. S., Zhu, S. H. Long-term e-cigarette use and smoking cessation: a longitudinal study with US population.

Tobacco Control 2016; 25: i90-i5.


2 7Etter JF, Bullen C: Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy.

Addiction 2011;106:2017–2028 http://bit.ly/2mtjWk5; Farsalinos K., Patterns of flavored e-cigarette use among adult vapers in the United States: an internet survey.

Submission to United States FDA.

August 2018 http://bit.ly/2muaFbD; Cooper M, Harrell MB, Perry CL.
Comparing young adults to older adults in e-cigarette perceptions and motivations for use: Implications for health communication.

Health Educ Res.

Narnia; 2016 Aug 1;31(4):429–38.

http://bit.ly/2o1uYO4; Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Spyrou A, Voudris V: Impact of flavour variability on electronic cigarette use experience: an internet survey.
Int J Environ Res Public Health 2013;10:7272–7282 December 2013 www.ncbi.nlm.nih.gov/pmc/articles/PMC3881166/; Dawkins L, Turner J, Roberts A, Soar K: ‘Vaping’ profiles and preferences: an online survey of electronic cigarette users.

Addiction 2013; 108:1115–1125.

3 Gruszczynski, L. (2019).

The regulation of e-cigarettes : international, European and national challenges .

Edward Elgar Publishing.

4 Greenhalgh, EM, Scollo, MM and Winstanley, MH.

2020.

Tobacco in Australia: Facts and issues.


Melbourne: Cancer Council Victoria.
Available from www.TobaccoInAustralia.org.au 1 Tobacco Harm ReductionSubmission 172 I address the terms of reference below: 1. the treatment of nicotine vaping products (electronic cigarettes and smokeless tobacco) in developed countries similar to Australia (such as the United Kingdom, New Zealand, the European Union and United States), including but not limited to legislative and regulatory frameworks; Vaping with nicotine is legal in most comparable countries, such as the United Kingdom, United States, 27 countries of the European Union, Canada and New Zealand.
Yet Australia has been slow to accept vaping as a pragmatic tobacco harm reduction measure.

Many of these countries have taken a risk-proportionate harm reduction approach to regulating e- cigarettes by creating a dual regulatory pathway that classifies-cigarettes as either a medicinal or a consumer product.

When vaping products are regulated as consumer goods they are regulated as such and required to meet specific safety standards.
This is the approach taken by countries such as Canada, United Kingdom and Europe.

2. the impact nicotine vaping products have had on smoking rates in these countries, and the aggregate population health impacts of these changes in nicotine consumption Available evidence is conclusive - vaping is much less harmful than smoking.
This has been shown by the UK Royal College of Physicians which found that: 5 Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products and may well be substantially lower than this figure.
While more cautious, a systematic review providing the evidence on tobacco harm reduction was conducted by US National Academies of Sciences, Engineering and Medicine (2018) similarly found:6 There is conclusive evidence that completely substituting e-cigarettes for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes.
There is substantial evidence that completely switching from regular use of combustible tobacco cigarettes to e-cigarettes results in reduced short- term adverse health outcomes in several organ systems.

(emphasis in original) Smoking rates in countries where e-cigarettes are widely available are falling faster than in Australia.
It is widely believed that e-cigarettes are a contributing factor to this rapid decline.4 Vaping devices are now the most popular quitting aid in the United Kingdom,7 United States8 and the European Union9.

A recent study examining the US and UK found that use of e- cigarettes (vaping) has increased smoking cessation in these two nations by 10-15%.10 3. the established evidence on the effectiveness of e-cigarettes as a smoking cessation treatment; 5 Royal College of Physicians (London).

2016.
2016.

Nicotine without smoke: tobacco harm reduction https://bit.ly/244lizV 6 National Academies of Sciences, Engineering and Medicine.

2018.

Public Health Consequences of E-Cigarettes, National Academies Press, Washington, DC, available at: https://www.nap.edu/catalog/24952/public-health-consequences-of-e-cigarettes .

7 West R, Brown J.

2019.

Smoking Toolkit Study.

Smoking in England 2019.


Available at: www.smokinginengland.info/latest-statistics/ 8 Caraballo RS, Shafer PR, Patel D, Davis KC, McAfee TA.

2017.

Quit methods used by US adult cigarette smokers, 2014–2016.

Prev Chronic Dis; 14: E32.

9 Directorate-General for Health and Food Safety.

2017.

Attitudes of Europeans Towards Tobacco and Electronic Cigarettes, Special Eurobarometer 458.
Available at: https://data.europa.eu/euodp/en/data/dataset/S2146_87_1_458_ENG 10 Mendez, D., & Warner, K. E. (2020).

A magic bullet?

The potential impact of e-cigarettes on the toll of cigarette smoking.

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, ntaa160.

Advance online publication.


https://doi.org/10.1093/ntr/ntaa160 2 Tobacco Harm ReductionSubmission 172 There is significant evidence for the harm reduction potential of e-cigarettes as a cessation treatment.

As early as 2013, a NZ randomised controlled trial was the first to demonstrate the potential of e-cigarettes as a cigarette cessation treatment.

These findings were supported by a 2014 Cochrane review11.
With improved technologies, more recent studies have definitively shown the effectiveness of e-cigarettes as a smoking cessation treatment.
A 2018 Cochrane review found that e-cigarettes with nicotine were more effective than e-cigarettes without nicotine, and more effective than the licensed types of NRT.13 A 2019 French study found 27% of smokers who tried to quit used vaping compared to 18% who used NRT.12 A landmark randomised controlled trial of nearly 900 smokers in the UK found that those who were randomised to use a modern vaping device with nicotine were nearly twice as likely to have quit 12 months later as those using conventional nicotine replacement products like the patch and gum, alone or in combination.13 However, in a Special Committee on Harm Reduction, the focus on abstinence is misleading.
framing e-cigarettes solely in terms of abstinence is not a harm reduction measure and ignores the extensive evidence that demonstrates vaping is a successful tobacco harm reduction measure.

Tobacco harm reduction, through vaping, is a pragmatic solution that complements traditional tobacco control strategies.
4. the established evidence on the uptake of e-cigarettes amongst non- smokers and the potential gateway effect onto traditional tobacco products; The concern that e-cigarettes will increase tobacco smoking by renormalising the act of smoking and acting as a gateway to smoking is a political concern not based in evidence.
In countries where there has been a rise of vaping, such as the UK and US, there has been rapid falls in adult smoking.4 Indeed, evidence demonstrates the inverse is actually true, as “the available evidence to date indicates that e-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by confirmed smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely”.12 5. evidence of the impact of legalising nicotine vaping products on youth smoking and vaping rates and measures that Australia could adopt to minimise youth smoking and vaping; Once again, this is unsubstantiated concern which has been enflamed by anti-vaping rhetoric and fear mongering media sensationalism.
Where vaping is widely available youth smoking rates continue to fall.14 There is no evidence of causation between vaping and smoking in young people.
Frequent vaping is uncommon amongst teenagers and is nearly entirely confined to current and ex-smokers – and in most cases smoking precedes vaping.15 6. access to e-cigarette products under Australia’s current regulatory frameworks; Under Commonwealth law, nicotine is classified as a Schedule 7 ’dangerous poison’ in the Poisons Standard and its use is strictly regulated.
In Australia, nicotine vaping products are regulated by the Therapeutic Goods Administration which must approve nicotine products for human use as a therapeutic good before they can be sold.

However, in the absence of any approved products, their sale is effectively banned.
In all states and territories, it is illegal to possess and use nicotine for vaping without a prescription from a medical practitioner.16 There are serious penalties for using or possessing liquid nicotine unless it is prescribed by a doctor.

Financial penalties vary from a $45,000 fine in Western Australia to $1,100 in 11 McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction.

Vol.

2014, Cochrane Database of Systematic Reviews.


John Wiley & Sons, Ltd; 2014. https://bit.ly/2kNmB7q.

12 Gomajee, R., El-Khoury, F., Goldberg, M., Zins, M., Lemogne, C., Wiernik, E., ... & Melchior, M. (2019).

Association between electronic cigarette use and smoking reduction in France.

JAMA internal medicine, 179(9), 1193-1200.


13 Hajek, P., Phillips-Waller, A., Przulj, D., Pesola, F., Myers Smith, K., Bisal, N., Li, J., Parrorr, S., Sasieni, P., Dawkins, L., Ross, L., Goniewicz, M., Wu, Q. and McRobbie, H.J.

2019).

“A randomized trial of e-cigarettes versus nicotine-replacement therapy”, New England Journal of Medicine, Vol.

380 No.

7, pp.

629-637.

14 Levy DT, Warner KE, Cummings KM, et al.

2018.


Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check.

Tob Control.

15 Etter JF.

2018.

Gateway effects and electronic cigarettes.

Addiction; 113 (10): 1776-1783 16 Morphett, K., Hall, W. and Gartner, C., 2020.

The misuse of the precautionary principle in justifying Australia's ban on the sale of nicotine vaping products.
Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco.

3 Tobacco Harm ReductionSubmission 172 New South Wales.

Offenders can potentially be jailed for up to 2 years in the ACT and Tasmania and 12 months in the Northern Territory.17 The number of Australians vaping has doubled since 2016.
In 2019, 2.5% of Australians were currently vaping, compared to 1.2% in 2016 and there are now approximately 520,000 Australian vapers.18 Considering, the nicotine vaping products cannot be sold as consumer products, making it very difficult for smokers to legally access these products domestically, there is great concern that Australia’s current regulatory frameworks are unfairly criminalising a large proportion of the population.
In addition, the ban on vaping has produced a thriving black market for nicotine vaping products in the absence of any regulation or quality control.

The ban is forcing smokers who wish to quit with vaping to commit a criminal offence and remove consumer regulations leaving vapers to access products without a minimum standard of product control.19 There are a number of risks and consequences to Australia’s blanket and illogical ban on vaping and e-cigarettes.
A ban on the sale and use of nicotine is an unnecessarily restrictive and illogical policy – which not only undermines current tobacco harm reduction efforts and but also potentially compromises public health.

Conclusion Nicotine in its most lethal form (tobacco prepared and packed for smoking) is exempt from the Poisons Standard and is freely available, while the far safer substitute (liquid nicotine for vaping) is restricted to prescription-only access.

This amounts to a de facto ban.


Most doctors are unwilling to provide prescriptions as vaping is discouraged by health authorities.

This inconsistency is unscientific and unethical.

Evidence-based tobacco harm reduction approach that allows adults access to nicotine vaping products.

These products are a demonstrably safer and healthier alternative to traditional cigarettes.

I recommend that make nicotine for vaping be made available as a consumer product in NSW.
To allow me and increasing numbers of Australians to access these potentially life saving harm reduction products legally and without fear of committing criminal offenses.

Yours sincerely, Alice Pierce 17 Australian Tobacco Harm Reduction Association (ATHRA) The law.

2018.

Available at: www.athra.org.au/the-law/ 18 Australian Institute of Health and Welfare.

2020.

National Drug Strategy Household Survey 2019.

Canberra: AIHW.

19 Mendelsohn, C.P.

and Hall, W., 2020.


Does the gateway theory justify a ban on nicotine vaping in Australia?.

International Journal of Drug Policy, 78, p.102712.

4 Tobacco Harm ReductionSubmission 172