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Neuroethics

pp 1–9 | Cite as

A critical analysis of Australia’s ban on the sale of electronic nicotine delivery systems

  • Wayne Hall
  • Kylie MorphettEmail author
  • Coral Gartner
Original Paper
  • 101 Downloads

Abstract

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.

Keywords

Nicotine E-cigarettes Public policy Smoking Tobacco 

Notes

Funding

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.

References

  1. 1.
    Global Burden of Disease 2015 Tobacco Collaborators. 2017. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: A systematic analysis from the Global Burden of Disease Study 2015. The Lancet 389: 1885–1906.CrossRefGoogle Scholar
  2. 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. 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.
  4. 4.
    Russell, M.A.H. 1971. Cigarette smoking: Natural history of a dependence disorder. British Journal of Medical Psychology 44: 1–16.CrossRefGoogle Scholar
  5. 5.
    Gray, N.J. 2014. Nicotine yesterday, today, and tomorrow: A global review. Nicotine & Tobacco Research 16: 128–136.CrossRefGoogle Scholar
  6. 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. 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. 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. 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.
  10. 10.
    Hall, W., and R. West. 2008. Thinking about the unthinkable: A de facto prohibition on smoked tobacco products. Addiction 103: 873–874.CrossRefGoogle Scholar
  11. 11.
    Hefler, M. 2018. The changing nicotine products landscape: Time to outlaw sales of combustible tobacco products? Tobacco Control 27 (1): 1–2.CrossRefGoogle Scholar
  12. 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. 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. 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. 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. 16.
    Beauchamp, T.L., and J.F. Childress. 2001. Principles of biomedical ethics. New York: Oxford University Press.Google Scholar
  17. 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. 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. 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
  20. 20.
    Huerta, T.R., D.M. Walker, D. Mullen, T.J. Johnson, and E.W. Ford. 2017. Trends in e-cigarette awareness and perceived harmfulness in the U.S. American Journal of Preventive Medicine 52: 339–346.CrossRefGoogle Scholar
  21. 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. 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. 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. 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. 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. 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
  27. 27.
    Kozlowski, L.T., and K.E. Warner. 2017. Adolescents and e-cigarettes: Objects of concern may appear larger than they are. Drug and Alcohol Dependence 174: 209–214.CrossRefGoogle Scholar
  28. 28.
    Gartner, C. 2018. How can we protect youth from putative vaping gateway effects without denying smokers a less harmful option? Addiction. 113: 1784–1785.  https://doi.org/10.1111/add.14126.CrossRefGoogle Scholar
  29. 29.
    Banks, E., G. Joshy, M.F. Weber, B. Liu, R. Grenfell, et al. 2015. Tobacco smoking and all-cause mortality in a large Australian cohort study: Findings from a mature epidemic with current low smoking prevalence. BMC Medicine 13: 281.CrossRefGoogle Scholar
  30. 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. 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.
  32. 32.
    Russell, C., T. Dickson, and N. Mckeganey. 2017. Advice from former-smoking e-cigarette users to current smokers on how to use e-cigarettes as part of an attempt to quit smoking. Nicotine & Tobacco Research 20: 977–984.CrossRefGoogle Scholar
  33. 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.
  34. 34.
    Fagerström, K.O., and E.-B. Schildt. 2003. Should the European Union lift the ban on snus? Evidence from the Swedish experience. Addiction 98: 1191–1195.CrossRefGoogle Scholar
  35. 35.
    Rodu, B., and P. Cole. 2004. The burden of mortality from smoking: Comparing Sweden with other countries in the European Union. European Journal of Epidemiology 19: 129–131.CrossRefGoogle Scholar
  36. 36.
    Rodu, B., and P. Cole. 2009. Lung cancer mortality: Comparing Sweden with other countries in the European Union. Scandanavian Journal of Public Health 37: 481–486.CrossRefGoogle Scholar
  37. 37.
    Gartner, C.E., and W.D. Hall. 2009. Smokeless tobacco use in Australia. Drug and Alcohol Review 28: 284–291.CrossRefGoogle Scholar
  38. 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.
  39. 39.
    Chapman, S., and R. Mackenzie. 2010. The global research neglect of unassisted smoking cessation: Causes and consequences. PLoS Medicine 7: e1000216.CrossRefGoogle Scholar
  40. 40.
    Brown, J., E. Beard, D. Kotz, S. Michie, and R. West. 2014. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: A cross-sectional population study. Addiction 109: 1531–1540.CrossRefGoogle Scholar
  41. 41.
    Wang, C., N. Henley, and R.J. Donovan. 2004. Exploring children's conceptions of smoking addiction. Health Education Research 19: 626–634.CrossRefGoogle Scholar
  42. 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.
  43. 43.
    Zhu, S.-H., Y.-L. Zhuang, S. Wong, S.E. Cummins, and G.J. Tedeschi. 2017. E-cigarette use and associated changes in population smoking cessation: Evidence from US current population surveys. BMJ 358: j3262.CrossRefGoogle Scholar
  44. 44.
    Becky, F., C. Simon, and R. Matthew. 2008. The case for the plain packaging of tobacco products. Addiction 103: 580–590.CrossRefGoogle Scholar
  45. 45.
    Mckee, M., M. Daube, and S. Chapman. 2016. E-cigarettes should be regulated. Medical Journal of Australia 204: 331.CrossRefGoogle Scholar
  46. 46.
    Chapman, S. 2014. E-cigarettes: Does the new emperor of tobacco harm reduction have any clothes? European Journal of Public Health 24: 535–536.CrossRefGoogle Scholar
  47. 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. 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. 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

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Faculty of Health and Behavioural Sciences, Centre for Youth Substance Abuse ResearchThe University of QueenslandSt LuciaAustralia
  2. 2.National Addiction CentreKings College LondonLondonUK
  3. 3.Faculty of Medicine, School of Public HealthThe University of QueenslandHerstonAustralia
  4. 4.Faculty of Health and Behavioural Sciences, Queensland Alliance for Environmental Health SciencesWoolloongabbaAustralia

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