Put e-cigs to the test

AUSTRALIA needs a change of tack when it comes to reducing smoking rates, which includes allowing some e-cigarettes to be sold legally, says a leading expert.

Professor Wayne Hall, inaugural director of the Centre for Youth Substance Abuse Research at the University of Queensland, told MJA InSight that “we’ve gone as far as we can with tax increases – I think we’ve reached the end of the road”.

“By making low risk e-cigarette products available for purchase, it would be easier to justify more restrictions on tobacco cigarettes. If you can have a less harmful product there in the shops, why would you keep cigarettes available?”

Professor Hall was commenting on research published today in the MJA which explored how and why tobacco smokers and recent quitters in NSW use e-cigarettes.

The research was based on the Cancer Institute Tobacco Tracking Survey, which included phone interviews with 2966 tobacco smokers and people who quit smoking in the past 12 months.

The authors found that 9% of the sample reported currently using e-cigarettes, and this rate was highest among 18–29 year olds at 16%. For people aged over 30 years, the most common reasons for using e-cigarettes was to help them either quit smoking or cut down on their smoking. There is a larger number of younger people (25%) than older people (16%) who reported the reason for e-cigarette use as the perception that it was not as bad for their health as smoking cigarettes, though this finding did not reach statistical significance.

The authors said their results showed that while e-cigarette use remained low, some people are using these products to try to reduce smoking-related harm.

They recommended that physicians and public health authorities should be aware of tobacco smokers’ interest in e-cigarettes, and inform smokers that e-cigarettes are currently unregulated and untested as smoking cessation aids.

In a statement to MJA InSight, a spokesperson from NSW Health backed up this message, saying that there was insufficient evidence on the benefits and harms of using e-cigarettes to quit smoking.

• Related: MJA -- E-cigarettes should be regulated
• Related: MJA -- How are tobacco smokers using e-cigarettes? Patterns of use, reasons for use, and places of purchase in New South Wales
• Related: MJA -- The future of electronic cigarette growth depends on youth uptake
• Related: MJA -- Prevalence of e-cigarette users in New South Wales

“Electronic cigarettes have not been approved by Australian health authorities as a smoking cessation aid or nicotine replacement therapy. There are concerns among health experts about safety because of unregulated doses of nicotine, other chemicals used in e-liquids, exposure to particulate matter and the safety of the e-cigarettes themselves.”

An accompanying MJA editorial said that e-cigarettes had at least two distinct roles.

On the one hand they are a product that may assist in smoking cessation, with possible but as yet unproven benefits. On the other, e-cigarettes are a means for the tobacco industry to circumvent restrictions on promoting their image and their tobacco products.

“This dual role implies the need for parallel regulatory tracks,” the authors wrote. The first involves the application of existing provisions for the authorisation, marketing and sales of therapeutic goods. The second involves applying existing controls on all promotions that may encourage smoking, including exposure of young people to advertising and promotion of smoking or tobacco-related imagery.

“This twin-track approach offers a means for evaluating and maximising any potential benefits while minimising risks of harm.”

Professor Hall said it was important to remember that not all e-cigarette products were created equal, adding that “there is a variety of these products on the market, of varying quality”.

However, it was very difficult to acquire any meaningful data about the effects of these different products in Australia when they are prohibited. For this reason, it would be worthwhile to allow less harmful e-cigarette products to be legally sold in Australia under restrictions, he said.

“We have to find ways of trialling the devices with lower toxic risk.”

Professor Hall said that research from the UK would be a good starting point for determining which products to trial in Australia.

“The British experience has been that ‘tanks’ are more effective than cigalikes.”

Tank e-cigarettes are designed to be refilled with nicotine-containing liquids, whereas cigalikes have disposable or replaceable cartridges.

Professor Hall also expressed concerns that tobacco industries would use e-cigarettes as a means to bypass the advertising restrictions. 

To this end, Australia should avoid following a precedent set in the US, where new guidelines could allow tobacco industries to monopolise the e-cigarette market. 

Regulations from the Food and Drug Administration require manufacturers of vapour or e-liquid devices to submit a costly pre-market tobacco application for each product.

“Only big tobacco industries will be able to afford this. Smaller start-ups won’t be able to,” Professor Hall said.