The Woolcock Institute of Medical Research

Last week, Australian Health Minister Mark Butler announced a major policy shift on vaping, pushing for stronger regulation and enforcement of all e-cigarettes, including new controls on their importation, contents and packaging.

The government’s goal is to make it harder for children and non-smokers to access vapes, and to allow people using the devices as stop-aids to access nicotine vapes with a prescription. 

But the measures, while positive, have some experts questioning whether they will be effective in the long term. Respiratory diseases expert at the Woolcock Institute of Medical Research, Professor Brian Oliver, says that nicotine-filled vapes are already banned and that all the government is doing is extending this ban to non-nicotine devices.

“This ban may help stop the illegal importation of nicotine containing vapes from overseas,” he says. 

“Because it is difficult to tell from the outside whether the device contains nicotine 'juice', it is hard to monitor the imports.”

Professor Oliver adds that while disposable devices will be banned, it seems that refillable devices will still be available, meaning that people could still find ways to access nicotine “juice” fairly easily on the black market. 

WHAT ARE E-CIGARETTES AND VAPING?

E-cigarettes (electronic cigarettes) are battery-operated devices that heat an e-liquid (referred to as juice/e-juice or liquid/e-liquid) to produce a cloud of aerosol, often referred to as vapour, that can contain nicotine, flavour and other chemicals.

Originally disposable, e-cigarette design and technology has moved with the times – pre-filled pods, then re-fillable Tanks or Mods with adjustable heating, to the current wave of pre-filled Pod Mods that often use nicotine salt with higher nicotine levels.

Users of e-cigarettes inhale the vapour the same way as you would inhale a tobacco cigarette - the process is known as vaping.  The next generation of electronic tobacco delivery systems include Heat Not Burn (HNB) devices, where the tobacco is mixed with resin which is heated but not to the point of combustion.

VAPING AS A QUIT AID

Professor Oliver also questions the effectiveness of vapes with helping people quit smoking cigarettes. He cites a 2019 randomised, controlled trial of e-cigarettes vs nicotine-replacement therapy published in The New England Journal of Medicine as the study underpinning the role of vapes in quitting smoking. 

In the study, 886 participants who were trying to quit smoking were randomly assigned to either nicotine-replacement products of their choice (provided for up to 3 months) or an e-cigarette starter pack. The primary goal was sustained abstinence for one year. 

At the end of the study, 18% of participants from the e-cigarettes group had stopped smoking cigarettes compared to 9.9% in the nicotine-replacement group.  However, 80% of the e-cigarette group who quit smoking were still vaping after one year, while only 9% of the quitters in the other group were still using nicotine-replacement treatments.  

“From my point of view, having nearly 10% of people totally nicotine free is better than having 18% of people transition addicted to e-cigarettes, which probably have more nicotine than a normal cigarette,” Professor Oliver says.  

Professor Oliver adds that nicotine – classified as a poison in Australia and already restricted – is freely available in other forms such as nicotine sprays, patches and lozenges, which provide adequate quit aids.  

“There’s quite a few nicotine replacement products on the market already, and I don’t think that vapes necessarily offer a lot more than patches, sprays and lozenges,” he says. 

Find out more

• Read more about the long-term dangers of vaping in The Sydney Morning Herald
• About Respiratory Services at the Woolcock Clinic