The Failure of Nicotine Vaping Prescription Policy in Australia

Dr. Colin Mendelsohn is a member of the expert advisory group responsible for developing the Australian national smoking cessation guidelines for the RACGP. He is also the founding chairman of the Australian Tobacco Harm Reduction Association, a registered health promotion charitable organization that works to increase awareness of low-risk nicotine products as a smoking alternative for those who are unable to quit smoking.

Dr. Mendelsohn previously served as an Associate Professor at the School of Public Health and Community Medicine at the University of New South Wales from 2016-2020, and as the former Vice Chair of the Australian Association of Smoking Cessation Professionals, the leading body of smoking cessation experts in Australia. According to Dr. Mendelsohn, "The review found that the policy did not achieve its objectives and instead made the situation worse. It created a thriving black market, led to a sharp increase in youth drug use, and made it harder for adult smokers to access legal smoking products.

The use of drugs among young people is increasing rapidly. Illegal and disposable drug products can be easily purchased from tobacco shops, convenience stores, and social media, with law enforcement and prosecution rates being negligible. Instead, teachers are bearing the burden of this policy, with some schools removing bathroom doors and installing e-cigarette detectors to prevent students from using drugs.

Government-funded propaganda campaigns have only disseminated erroneous information about the dangers of electronic cigarette products, and are therefore ineffective in preventing youth from using them.

At the same time, less than 1% of Australian general practitioners are willing to prescribe nicotine, and very few pharmacies distribute electronic cigarette products. Currently, 88-97% of adult electronic cigarette users are using them illegally because they have not obtained a prescription for nicotine.

Australia is the only western country that regulates nicotine consumption products in this way. In countries such as the United States, the United Kingdom, and New Zealand, nicotine inhalers are sold as consumer products to aid adult smokers in quitting and are subject to strict age verification to restrict usage among young people. These laws have proven successful and have greatly contributed to a decrease in smoking rates.

Recently conducted simulation research estimated that by 2080, relaxing current policies would save the lives of 104,000 Australians and prevent over 2 million life years lost. The TGA announced in September 2021 that they would conduct their own review of regulations six months after implementation. However, the review has been postponed with no suggestion of when it will begin.

The main findings of the 12-month pure prescription model review are as follows: 1. A thriving black market has emerged, selling illegal, unregulated, high-nicotine disposable e-cigarette products. 2. Teen drug use has skyrocketed, becoming a crisis for schools and parents nationwide. 3. Access to legal smoking products has become increasingly difficult and expensive for adult smokers, forcing many into the black market or illegal imports without prescriptions. 4. This model has faced opposition from smokers and drug users, causing a catastrophic loss of confidence and trust in public health. 5. Currently, almost all e-cigarette products are purchased on the black market or from overseas, meaning they do not need to pay taxes to the Australian government.

Based on the failure of this policy, the following suggestions have been made: 1. exempt liquid nicotine with a concentration of ≤6% from poison standards and allow it to be used as a harm reduction measure for smoking tobacco. 2. Allow licensed retailers to sell these products and strictly verify the age of buyers. 3. Allow the ACCC to supervise and regulate the industry. Dr. Mendelsohn summarizes, "The Australian government's prescription model for nicotine e-cigarettes is a clear and foreseeable public health policy failure. The black market is expanding at an alarming rate nationwide, and young people are taking up harmful drugs quickly. Meanwhile, adult smokers who could live longer and healthier lives by switching to vaping products are forced to compete with the same black market or continue to smoke more harmful traditional cigarettes sold on every street corner.

Australia urgently needs to catch up with other Western countries by allowing adult smokers access to nicotine vaping products while implementing strict restrictions on their use by minors. Without immediate action, the black market will continue to grow leading to more smoking-related deaths and a continued increase in youth vaping rates.

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