Views on e-cigarettes may need rethinking
In public health, the orthodoxy of harm minimisation is entrenched — especially when it comes to the use and abuse of drugs and alcohol.
The principle is that approaches of outright prohibition or abstinence towards drug and alcohol use ignore the human reality of some level of use.
It is better to recognise this fact and to develop approaches that ensure negative consequences are minimised and contained as much as possible.
Thus needle-exchange programs are funded by taxpayers because it is better that if people are going to inject drugs intravenously, they do so without the risk of spreading disease, which would worsen public health overall.
Similarly, supervised injecting rooms operate on the idea that it is better for a drug user to do their thing in a contained space rather than out on the street — and if overdose occurs it is better that this happens where there is a chance of intervention rather than lonely death.
It’s a sound approach but, curiously, it goes out the window when it comes to a product that — at the very least — holds strong potential as an aid to assist people to quit smoking and avoid premature death.
That product would be e-cigarettes — battery-operated electronic devices which heat liquid-containing cartridges to a vapour, which is then inhaled, or “vaped”.
In a week where it was revealed that the number of Australians who smoke had actually increased for the first time in decades (though rates fell marginally on a per capita basis), it is fair to ask whether anti-smoking efforts are reaching the point of diminishing returns.
And it is worth asking why smokingreduction efforts may be stalling in Australia, with its punitive taxes and plain packaging, when in the UK and US smoking rates are still falling — and there is less hostility to vaping.
E-cigarettes are widely available in WA and many people import cartridges via internet mail order.
But selling vape juice that contains nicotine is expressly prohibited by our tobacco-control laws, as is selling any product which resembles a real cigarette or cigar.
In practice, vaping devices which heat liquids that don’t contain nicotine — and make no therapeutic claims — are perfectly legal.
But as everyone knows, it’s the nicotine that makes smoking addictive, and nicotine is banned by Federal poisons laws.
Absurdly, there are carve-outs for therapeutic products approved to aid quitting smoking and — you guess it — deadly cigarettes.
Every time the subject is discussed on talkback radio, lines light up with stories of smokers who have butted out as a result of their take-up of vaping (and their stories suggest that bans on nicotine-containing liquids are easily sidestepped via the internet).
The provenance of those liquids is often China, though as manufacturing standards are unregulated, vapers are forced to take a leap into the unknown.
The precautionary principle — we don’t know the long-term effects of this stuff — is what seems to inform the great body of expert and peak-body opposition to vaping.
Government health departments, the Australian Medical Association, the Cancer Council, Heart Foundation and others argue that there is insufficient evidence to say what long-term damage will occur.
But we do know beyond doubt that smoking tobacco is awful for your health — and it is not the nicotine that is harmful.
In May, a Telethon Kids Institute study tested four e-cigarette liquids on mice and the headline finding was that they could be harmful to lung health.
“(T)wo e-juices with glycerin as the main ingredient and only trace amounts of propylene glycol were almost as damaging to lung health as traditional cigarettes,” lead author Professor Alexander Larcombe said.
But liquids where the main ingredient was propylene glycol had “only a small impact on respiratory health”.
There is clearly room for more research but in the same way that injecting drugs with a clean needle in a supervised environment is preferable to sharing infected needles in the streets, surely vaping a product that may carry a risk of lung damage is better than smoking tobacco which is a good chance to kill you.