Vaping: no moral panic, please, just evidence

IN the film, 99 Homes, Mike Carver is a Florida real estate broker intent on doing the next big deal and evicting loan defaulters against the backdrop of America’s 2008 housing crisis.

An empty shell of a man, without moral compass or much in the way of human connection, Carver constantly sucks on an e-cigarette, its barrel glowing blue with each inhalation.

When the film was released 5 years ago, that e-cigarette seemed to me emblematic of the character’s hollowness, his lack of authenticity. I mean, he couldn’t even smoke a real cigarette for goodness’ sake.

I’m not sure anybody would read the film the same way now.

Somehow, over the past decade, e-cigarettes have transmuted from products with all the glamour of a nicotine patch to hip millennial accessory.

Initially conceived as aids to smoking cessation, e-cigarettes were essentially seen as a safer way of delivering nicotine to addicted smokers seeking to quit.

These days, though, many vaping devices look more like a USB drive than a cigarette, can be plugged into your laptop to recharge, and offer thousands of flavour options – with or without nicotine.

The “techie” feel of the devices and their slightly (but not too) illicit edge have spawned lively vaping communities and gatherings online and in real life.

One user writes that he enjoys the hobby aspects – “mixing my own liquids, building my own atomisers, trying different things and methods, collecting tanks and mods, reading up on the research, hating on the politicians and assorted freaks who never tire of lying about vaping and trying to suppress it, sharing and garnering info/experiences with other enthusiasts …”

“The flavours are out of this world,” writes another. “I LOVE the dough bros coffee cream doghnut [sic].”

And then there are the cloud chasers and trick vapers, some of whom have built huge online followings based on their ability to exhale smoke clouds in particular shapes.

All in all, it adds up to what the Guardian in 2018 called “a heady blend of hobbyism, gaming, punk rock, steampunk, tattoos, piercings and activism”.

A large nationally representative survey, reported in 2018, found that 37% of American high school seniors had tried vaping, up from 28% the previous year.

In Australia, the National Drug Strategy’s 2017 survey found that 13% of high school students aged 12–17 years had tried vaping. For 17-year-olds, the figure was 21%.

When you combine flavours such as “grape slushie” and “crème brûlée” with a product that has the word cigarette in its name, you can pretty much guarantee people will start worrying about the destruction of our youth.

After all, adding super-sweet flavours to a product is an established strategy for attracting young users, as the alcohol industry has long known.

That said, moral panics are never helpful when it comes to making effective health policy. I suspect they may even help drive young people towards the substance in question.

Vaping is more regulated in Australia than in many other countries: no products can be sold to people aged under 18 years and nicotine-containing products can’t be sold to anybody (though it’s easy enough to find a way around that online).

From one perspective, it seems bizarre that highly carcinogenic analogue cigarettes can be legally sold, while the undeniably safer e-version is banned.

But such paradoxes are the legacy of the messy history of substance use and misuse, with all its accompanying irrationalities.

I like to hope that one day we may adopt a genuine harm minimisation approach to all the drugs. Pill testing, please. Now.

Who knows what harm minimisation might look like in relation to vaping. It’s hard to properly evaluate risks and benefits when the evidence is limited, sometimes contradictory, and pretty much absent in relation to long term use.

What does a daily practice do to the lungs over 10 years? How many smokers might be helped to quit? Do young people really progress from vaping to using other, perhaps more dangerous, substances?

There’s a long history of adults thinking a new craze among teenagers signals the end of the world as we know it.

Vaping may indeed prove to be highly dangerous, but the sooner we get some good research on the subject the better.

Jane McCredie is a Sydney-based health and science writer.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless that is so stated.