A critical analysis of Australia’s ban on the sale of electronic nicotine delivery systems
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Australia does not allow adult smokers to buy or use electronic nicotine delivery systems (ENDS) that contain nicotine without a prescription. This paper critically evaluates the empirical and ethical justifications provided for the policy by Federal and State governments, public health advocates and health organisations. These are: (1) that ENDS should only be approved as products for smoking cessation when there is evidence from randomised controlled trials that they are effective; (2) that as a matter of precaution we should not allow the sale of ENDS to smokers as consumer products because we do not know what their long-term effects will be; and (3) that allowing ENDS to be sold as consumer goods will enable the tobacco industry to market ENDS to young people which will also lead to an increase in youth smoking. We show that the arguments and evidence offered in support of all these claims is very weak. We also argue that even if the evidence were stronger, it would not justify denying adult smokers the right to use ENDS either to quit smoking or as a long-term alternative to smoking cigarettes. We outline ENDS policies that would more ethically address the public health concerns that motivated the current policy by allowing adult smokers to access ENDS for smoking cessation or tobacco harm reduction under tight regulations that discourage commercial promotion and adolescent use.
KeywordsNicotine E-cigarettes Public policy Smoking Tobacco
This work was funded a Wellcome Trust grant titled “E-cigarettes: history, evidence and policy.”
Compliance with Ethical Standards
Conflicts of Interest
The authors have no conflicts of interests.
- 2.World Health Organisation. 2008. WHO Report on the Global Tobacco Epidemic. Geneva. Retrieved from: http://www.who.int/tobacco/mpower/2008/en/. Accessed 7 Mar 2019.
- 3.Royal College of Physicians. 2016. Nicotine without smoke: Tobacco harm reduction. Retrieved from: https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0. Accessed 7 Mar 2019.
- 6.McNeill A., L. Brose, R. Calder, L. Bauld, and D. Robson. 2018. Evidence review of e-cigarette and heated tobacco products 2018: A report commissioned by Public Health England. Retrieved from: https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco-products-evidence-review. Accessed 7 Mar 2019.
- 7.West R., E. Beard, and J. Brown. 2016. Trends in electronic cigarette use in England. Retrieved from: http://www.smokinginengland.info/sts-documents/. Accessed 7 Mar 2019.
- 8.Kavuluru, R., S. Han, and E.J. Hahn. 2019. On the popularity of the USB flash drive-shaped electronic cigarette Juul. Tobacco Control 28: 110.Google Scholar
- 9.Aspire 2025. 2017. Research for a Smokefree Aotearoa. Achieving smokefree Aotearoa by 2025. https://aspire2025.org.nz/hot-topics/smokefree-action-plan/. Accessed 7 Mar 2019.
- 12.National Drugs and Poisons Scheduling Committee. 2017. Final decisions and reasons for decisions by delegates of the Secretary to the Department of Health: Therapeutic Goods Association, Australian Government Department of Health. Retrieved from: https://www.tga.gov.au/sites/default/files/scheduling-delegates-final-decisions-23-march-2017.pdf. Accessed 7 Mar 2019.
- 13.Douglas, H., W. Hall, and C. Gartner. 2015. E-cigarettes and the law in Australia. Australian Family Physician 44: 415–418.Google Scholar
- 14.Irby R. 2017. Liquid nicotine 'poison' lands man in court: NewsMail. Retrieved from: https://www.news-mail.com.au/news/liquid-nicotine-an-honest-mistake/3220549/. Accessed 7 Mar 2019.
- 15.Australian Government Department of Health. 2018. Principles that underpin the current policy and regulatory approach to electronic cigarettes (E-cigarettes) in Australia. Retrieved from: http://www.health.gov.au/internet/main/publishing.nsf/Content/principles-underpin-current-policy-regulatory-approach-electroniccigarettes-eeCigarettes-australia. Accessed 7 Mar 2019.
- 16.Beauchamp, T.L., and J.F. Childress. 2001. Principles of biomedical ethics. New York: Oxford University Press.Google Scholar
- 17.Byrne S., E. Brindal, G. Williams, K. Anastasiou, A. Tonkin et al. 2018. E-cigarettes, smoking and health: A literature review update, Australia: Commonwewalth Science and Industrial Research Organisation (CSIRO). Retrieved from: https://www.csiro.au/en/Research/BF/Areas/Nutrition-and-health/E-cigarettes-report. Accessed 7 Mar 2019.
- 18.U.S. National Academies of Sciences Engineering and Medicine. 2018. Public Health Consequences of E-Cigarettes. Washington, DC: The National Academies Press. Retrieved from: https://www.nap.edu/catalog/24952/public-health-consequences-of-e-cigarettes.Google Scholar
- 19.Brose, L.S., J. Brown, S.C. Hitchman, and A. McNeill. 2015. Perceived relative harm of electronic cigarettes over time and impact on subsequent use. A survey with 1-year and 2-year follow-ups. Drug and Alcohol Dependence 157: 106–111.Google Scholar
- 21.PA Department of Health. 2019, 21 January. E-cigarettes, e-cigs, e-hookahs, mods, vape pens or vapes—whatever you call them, they are NOT safer than other tobacco products. Learn how you can help protect you child's health by talking about the dangers of vaping [Twitter Post]. Retrieved from: https://twitter.com/PAHealthDept/status/1087424595211083776. Accessed 7 Mar 2019.
- 22.Glantz S. 2018, 27 December. Using e-cigs increases exposure to toxic chemicals for most users; they would be better off just smoking [Twitter Post]. Retrieved from: https://twitter.com/ProfGlantz/status/1078439444644917248. Accessed 7 Mar 2019.
- 23.Wolfenden, L., E. Stockings, and S.L. Yoong. 2017. Regulating e-cigarettes in Australia: Implications for tobacco use by young people. Medical Journal of Australia 208 (1): 80-89.Google Scholar
- 24.Soneji, S., J.L. Barrington-Trimis, T.A. Wills, et al. 2017. Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: A systematic review and meta-analysis. JAMA Pediatrics 171: 788–797.Google Scholar
- 25.Leventhal, A.M., D.R. Strong, M.G. Kirkpatrick, et al. 2015. Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence. JAMA 314: 700–707.Google Scholar
- 26.Gartner C. E.,and W. Hall. 2017. Submission to the Standing Committee on Health, Aged Care and Sport: Inquiry into the use and marketing of electronic cigarettes and personal vaporisers in Australia (Submission 282).Google Scholar
- 30.Chapman S., M. Daube, D. Bareham, and M. Peters. 2017. Submission to the Standing Committee on Health, Aged Care and Sport on Electronic Cigarettes and Vapourisers (Submission No. 0313).Google Scholar
- 31.Morphett K., M. Weier, R. Borland, H.-H. Yong, and C. E. Gartner. 2019. Barriers and facilitators to switching from smoking to vaping: Advice from vapers, Drug and Alcohol Review https://doi.org/10.1111/dar.12907.
- 33.Hajek, P., A. Phillips-Waller, D. Przulj, F. Pesola, K. Myers Smith, et al. 2019. A randomized trial of e-cigarettes versus nicotine-replacement therapy. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa1808779.
- 38.Sandee L. 2019. UK study shows e-cigarettes help adult smokers quit, but US experts urge caution. CNN. Retrieved from: https://edition.cnn.com/2019/01/30/health/e-cigarette-adult-smoking-cessation-study/index.html. Accessed 7 Mar 2019.
- 42.West R., P. Hajek, A. Mcneill, J. Brown, and D. Arnott. 2015. Electronic cigarettes: What we know so far. A report to UK All Party Parliamentary Groups. Retrieved from: www.smokinginengland.info/reports/. Accessed 7 Mar 2019.
- 47.National Health and Medical Research Council. 2017. NHMRC CEO Statement: Electronic Cigarettes (E-cigarettes). Retrieved from: https://nhmrc.gov.au/about-us/publications/ceo-statement-electronic-cigarettes. Accessed 7 Mar 2019.
- 48.Public hearing into the Parliamentary Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia, 5 October 2017.: Standing Committee on Health, Aged Care and Sport; 2017.Google Scholar
- 49.White, V.M., C.D. Warne, M.J. Spittal, S. Durkin, K. Purcell, and M.A. Wakefield. 2011. What impact have tobacco control policies, cigarette price and tobacco control programme funding had on Australian adolescents' smoking? Findings over a 15-year period. Addiction 106: 1493–1502.CrossRefGoogle Scholar