Australia bans all vapes except on prescription to stem use in childrenBMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1014 (Published 04 May 2023) Cite this as: BMJ 2023;381:p1014
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Australia’s ban on the importation and sale of e-cigarettes unless supplied by prescription through a licensed pharmacist “to shut down a major health risk to the youngest generation of Australians”, as claimed by the health minister,(1) could remind us of Churchill’s words about the Munich Agreement in 1938: those having to choose between war and shame may get both.
Firstly, the epidemic of youth vaping is not a “risk” but already a public health shipwreck due to the lack of policy action despite warnings, (2) while many other nations acted swiftly, e.g. Thailand totally banned e-cigarettes as soon as 2014.(3)
Secondly, this granting of a marketing approval to e-cigarettes bypasses the Therapeutic Goods Administration, the national regulatory authority in Australia that enforces core principles for protecting the public: evidence-based medicine and pharmaceutical quality. Indeed: a) there is an enduring controversy about the evidence supporting the efficacy of e-cigarettes as a smoking cessation tool despite more than a decade of research while evidence for its carcinogenicity is accumulating;(4) b) the lack of regulatory control and the constant changes in delivery systems (heat resistance, battery voltage, puff topography capacity), that deliver breakdown products of various vectors (propylene glycol/vegetable glycerin) and contain flavorings and other additives should preclude the supply by a pharmacist. Further, this solution has shown to be ineffective as it has been documented at the global level that youth cigarette use is 5.6% in countries banning sales vs 13.4% in countries with regulation of nicotine content or 15.4% in countries with sales restrictions.(3) Indeed, prescription does not protect from misuse as experienced with benzodiazepines (6) as well as the case of fentanyl and other opioids that fueled the worst drug crisis in the history of the United States.
1. Nogrady B. Australia bans all vapes except on prescription to stem use in children. BMJ. 2023;381:p1014. Published 2023 May 4. doi:10.1136/bmj.p1014
2. Kandel ER, Kandel DB. Shattuck Lecture. A molecular basis for nicotine as a gateway drug. N Engl J Med. 2014;371(10):932-943. doi:10.1056/NEJMsa1405092
3. Sreeramareddy CT, Acharya K, Manoharan A. Electronic cigarettes use and 'dual use' among the youth in 75 countries: estimates from Global Youth Tobacco Surveys (2014-2019). Sci Rep. 2022;12(1):20967. doi:10.1038/s41598-022-25594-4
4. Braillon A, Lang AE. The International Agency for Research on Cancer and e-cigarette carcinogenicity: time for an evaluation. Eur J Epidemiol. 2023;38(4):391. doi:10.1007/s10654-023-00993-7
5. Hayhoe B, Lee-Davey J. Tackling benzodiazepine misuse. BMJ. 2018;362:k3208. doi:10.1136/bmj.k3208
Competing interests: No competing interests