E-cigarettes – the Government’s approach
The Australian Government is taking a precautionary approach to e-cigarettes and continues to monitor emerging evidence about the direct harms they pose to human health, their impact on smoking initiation and cessation, uptake among youth, and dual use with conventional tobacco products.
Recent reports have highlighted alarming trends in youth e-cigarette use in some countries, such as the United States (U.S.) and Canada, where e-cigarettes containing nicotine are widely marketed and accessible. Increasing evidence linking their marketing and use to nicotine addiction, lung disease and smoking uptake among youth are particularly troubling and reflect the Government’s stance on e-cigarettes.
On 13 September 2019, the Commonwealth Government Chief Medical Officer and State and Territory Chief Health Officers issued a statement following an outbreak of lung disease associated with e cigarette use in the U.S. As of 27 September 2019, 805 cases of lung disease and 12 confirmed deaths have been reported to U.S. health authorities. The statement is available at: https://www.health.gov.au/news/e-cigarettes-linked-to-severe-lung-illness
The Government’s approach to e-cigarettes recognises the current state of evidence regarding their utility as an aid to smoking cessation. At a population level, there continues to be insufficient evidence to promote the use of these products for smoking cessation.
The Government is aware of claims that e-cigarettes are 95 per cent less harmful than conventional tobacco products. However, many credible health and research organisations question this estimate. Further, the World Health Organization has stated that no specific figure about how much ‘safer’ the use of e cigarettes is compared to tobacco smoking can be given any scientific credibility at present.
On 25 May 2017, the Standing Committee on Health, Aged Care and Sport commenced an inquiry into the use and marketing of e-cigarettes and personal vaporisers in Australia. The Inquiry’s final report was published on 28 March 2018 and is available at www.aph.gov.au. The Government is considering the Inquiry’s recommendations before providing a response.
Australian Government approach to tobacco control
Tobacco use was estimated to kill almost 21,000 Australians in 2015 and remains the leading cause of preventable death and disability in Australia. The Australian Government, together with the state and territory governments, is committed to reducing the prevalence of smoking and its associated health, social and economic costs, and the inequalities it causes.
At the national level, the Government continues to implement a range of tobacco control measures to reduce smoking prevalence. These include: excise increases on tobacco products; education programs and campaigns; plain packaging of tobacco products; labelling tobacco products with larger graphic health warnings and prohibiting tobacco advertising and promotion. Other measures in place include providing support for smokers to quit and minimising the illicit tobacco trade. The Government is also investing $20 million over four years from 2019-20 to develop a new National Tobacco Campaign. Collectively, these measures have been key to Australia’s success in tobacco control, which has seen smoking rates decline to historically low levels, particularly among children and youth.
Regulation of e-cigarettes and nicotine
Unlike any e-cigarette product, all smoking cessation products lawfully available for sale in Australia have been evaluated by the Therapeutic Goods Administration (TGA) for safety and efficacy, and have been registered with the TGA. There are no restrictions on who might apply to the TGA to market a smoking cessation product in Australia. However, no e-cigarettes have been approved by the TGA for smoking cessation.
Currently, nicotine for use in e-cigarettes cannot be lawfully sold in Australia. The sale of nicotine for use in e-cigarettes would require an amendment to the Standard for the Uniform Scheduling of Medicines and Poisons (the Poisons Standard). The Poisons Standard is a record of decisions classifying medicines and chemicals into Schedules for inclusion in relevant legislation of the states and territories. There is a defined process for amendments to the Poisons Standard to be considered and it is important to note this process is independent from Government. Under this process, anyone may make an application to schedule or reschedule a substance.
Although nicotine for use in e-cigarettes is not currently available for sale in Australia, it may be lawful for people to import nicotine for use in e-cigarettes for up to three months of personal therapeutic under the TGA’s Personal Importation Scheme. Under this scheme, an importer must hold a written authorisation from a registered Australian medical practitioner, and the possession and use of nicotine for this purpose must also be legal within the importer’s state or territory.
Australian Government funded research into e-cigarettes
Through the National Health and Medical Research Council, the Government has supported 13 grants and committed over $12.6 million into research into e cigarettes since 2011. Broadly, this research concerns the: efficacy of e-cigarettes for smoking cessation (including amongst disadvantaged and vulnerable populations), the health effects of e-cigarettes, uptake of e-cigarettes in children and adolescents, the potential impact of e-cigarettes on smoking uptake, and the effect of new media platforms on e-cigarette promotion and consumer behaviour.
In early 2019, the Australian Government Department of Health (Department) commissioned the National Centre for Epidemiology and Population Health at the Australian National University to conduct a public health assessment of e-cigarette use. The project was designed by the Centre and aims to provide further evidence to support high-quality decision-making on e cigarettes for the Australian context. The final report of this project is expected to be provided to the Department in December 2020.