It Seems This Has Become A Complex Public Health Emergency Under Our Very Noses.

This appeared last week and frankly reveals a public health disaster…. 

The vape ban has utterly failed. What now?

Vaping rates have exploded, organised crime controls the trade, and Australia stands on the brink of a public health disaster. Is it time we followed New Zealand’s lead?

By Natasha Robinson

March 15, 2024

Australia stands on the brink of a public health disaster. The failure to regulate vaping in the past three to four years has created an illicit disposable vapes market that is rampant and looks to be impossible to stamp out. Vaping rates have exploded despite disposable vapes being made illegal. Organised crime controls the trade, lured by massive profits.

The federal government has embarked on a mammoth effort to kill the illegal trade and slash vaping rates via the toughest policies in the world that ban the importation, sale and personal use of nicotine vapes unless they are obtained by prescription – something no other country has attempted.

If the prescription model fails, as it has so far, such a policy comes close to amounting to prohibition. Prohibition has never worked at any point in history for any other illicit substance.

“This is a public health menace, particularly impacting younger Australians,” federal Health Minister Mark Butler said when he announced the tough vaping policies that formed part of a renewed attack on tobacco smoking in Australia, casting the tobacco industry as the driver of an insidious vaping threat to teenagers. “It is a deliberate strategy, I think, of Big Tobacco to create a new generation of nicotine addicts, and we simply can’t stand by and let that happen. It’s hooking our kids to nicotine and providing a gateway to cigarette smoking for them.”

There’s little doubt that vaping is harmful. How harmful the practice is, is contested. The long-term effects will be seen only in decades to come. The Cancer Council of NSW lists an alarming suite of health impacts, including lung inflammation and scarring caused by chemical inhalation, cell death and DNA damage. It points to the toxic chemicals contained in vapes, including chlorine, formaldehyde, the bug spray benzene, mercury, arsenic and acrolein, a substance found in weed killer.Vapes are technically illegal in Australia - but the colourful devices are still more present than ever.

These are the substances highly likely to be found in the illegal disposable vapes that have flooded the Australian market and account for at least 90 per cent of the e-cigarettes most of the nation’s 1.7 million vapers are smoking. People have no way of knowing whether these harmful products are in the vape they’re smoking because unlike New Zealand, Britain, Canada and many other countries, we do not have a highly regulated market that aims to deliver some measure of quality control.

The public health sector has lined up almost universally behind Butler’s quest to stamp out vaping. While the National Health Service in Britain distributes posters telling the public that e-cigarettes are “95 per cent less harmful to your health than normal cigarettes” and promotes a vaping-to-quit smoking policy, and the foremost institute, Public Health England, states expert reviews have found “there is no evidence so far that e-cigarettes are acting as a route into smoking for children or nonsmokers”, Australian public health leaders remain sceptical.

‘Shop owners are being stood over by gangsters telling them to sell these products or we’ll firebomb your shop.’

Public Health Association of Australia chief executive Terry Slevin says the possibility that the harms from vaping that emerge in coming decades could be as significant as those of smoking cannot be dismissed. “That’s entirely within the realms of possibility,” Slevin says. “I can’t tell you that with certainty, but anybody who dismisses that possibility is doing so naively.”

A war over statistics is playing out over the impact of rising vaping rates on smoking reduction and the true position on the connection between vaping uptake and transition to tobacco smoking. Butler cites research that indicates vapers are three times more likely to transition to tobacco smoking.

Yet the recent publication of the National Drug Strategy Household Survey 2022-23 – the most comprehensive Australian source of information on smoking and vaping, among other substances – showed a 25 per cent decline in daily smoking in the past four years, a drop four times faster than the historic average. Adult daily smoking rates now sit at 8.9 per cent, down from about 20 per cent about 20 years ago, and the rate is 0.9 per cent among 14 to 17-year-olds, down from 1.9 per cent in 2019.

At the same time, vaping rates tripled across the population. One in five people aged 14 and older in Australia reported having used e-cigarettes at least once in their lifetime. That figure was 49 per cent among 18 to 24-year-olds and 28 per cent in 14 to 17-year-olds. But only 3.5 per cent of those youth reported vaping daily. Proponents of vaping as an alternative to tobacco smoking point to the inverse relationship between declining smoking rates and rising vape use as probably causative.

“There are now more young adults using vapes almost entirely illegally than smoking cigarettes. And from a public health point of view, that’s a big win,” says University of Melbourne tobacco control researcher Ron Borland, a previous Cancer Council Nigel Gray Distinguished Fellow in Cancer Prevention. “Now, some people claim that just because they’re going in opposite directions, it’s not necessarily causation. And that’s absolutely true. But there’s lots of other evidence that it’s likely to be causative. The fact that the big wins in smoking reduction have been gained by people having to behave illegally is somewhat ironic.”

While other countries have moved to regulate the vaping industry via networks of specialised vape retailers and imposing standards on products those outlets are able to sell, Australia four years ago made the importation of nicotine vapes and liquid nicotine illegal, and legislated a medical model in which nicotine vapes only could be prescribed by a doctor and supplied at a pharmacy. The subsequent uptake of prescription vapes was low, with GPs shunning the program, and an illicit trade flourished as organised crime stepped in to supply consumer demand.

The profits on offer are enormous. Most of the disposable vapes in Australia – many of which deliver a high concentration of nicotine – come out of Shenzhen in China, and are sold to wholesale suppliers here for about $5 or $6 a device. Retailers pay the wholesalers about $20 a vape and sell them to consumers for about $38.

“This is now a vast, vast network,” says Louis Upton, sales director at Sydney vape manufacturer Oceania Liquid Labs, one of a dwindling network of nicotine-free vape suppliers that set up in Australia about a decade ago expecting nicotine-containing e-cigarettes to eventually become a regulated industry. Upton’s laboratory operates to high standards and produces products with ingredient labels. The legitimate vape industry in Australia is being squeezed into non-existence by the black market.

“The volume of illegal vapes coming into this country is a tsunami,” Upton says. “This can’t be stopped by the government saying they are banned because they’ve always been banned. These organised crime groups are not going to stop. Shop owners are being stood over by gangsters telling them to sell these products or we’ll firebomb your shop. That’s how lucrative it is. It is terrifying. And that’s happening every day in Australia.”

The Australian Border Force has told the government frankly that it cannot stem the tide of illegal vapes at the border. The prospect of policing vape sales at every convenience store in the country appears a herculean task beyond the capacity of health authorities and not a job that state police forces have the resources to incorporate into their purview.

The Australian National Advisory Council on Alcohol and Other Drugs told the government before the vape ban legislation that a policy of prohibition would make the problem only worse. Its members were scathing that the Therapeutic Goods Administration appeared unwilling to consider harm or demand reduction strategies, and raised concerns that young people would end up being criminalised.

Butler has stated that is unequivocally not the aim, yet a few weeks ago a 13-year-old boy in the NSW country town of Deniliquin who was vaping in a supermarket on a shopping trip with his mum was approached by police and violently tackled to the ground when he refused to hand over his vape.

Nicole Lee from the National Drug Research Institute is a member of the advisory council. She predicts the prohibitionist stance taken by Butler – who nominated vape control as his hoped legacy as a health minister – will fail.

“In general, with any drugs or essentially banned substances, the more restrictive you are with access, the more likely people will go to the black market, and the less control you have over anything,” Lee says. “We’re the only country in the entire world that is going in this direction. In terms of regulation, the problem we’re going to encounter with the prescription route is that GPs are already overstretched. And people don’t want to have to pay $100 to go to their GP to get a prescription for vapes.

“So what they do is just go around that system and go to the black market. I think in terms of the black market, the whole horse has already just kind of bolted. If you take illicit drugs, for instance, we spend an enormous amount of policing and customs time and effort and money to try to stamp out that market. And it’s made absolutely no difference whatsoever.

“When we take a law enforcement approach rather than instituting a public health response, there’s a high risk that the response will be disproportionate to the harms that the drug causes.

“Meanwhile, we see that black markets thrive and serious crimes are committed. And once we’ve got a black market thriving, kids have much better access. So if we’re trying to restrict access to children, then regulation for adults is the way to do that.”

Deakin University senior lecturer in criminology James Martin agrees. “Supply-side restrictions in any illicit market are difficult to pull off, and nearly impossible to pull off when they’re already established and when they exist in the context of strong demand,” he says.

“Drug trafficking syndicates see these policies as a business opportunity. And frankly, the stiffer the penalties, as long as the demand and the supply is there, the more profitable business opportunity is.

“And when you have a situation where you can go into any corner store or supermarket and purchase cigarettes but you need a prescription to purchase vapes that are a less harmful alternative, that seems to defy logic.”

Australia’s close neighbour New Zealand has taken a diametrically opposite approach. The New Zealand government began to heavily regulate the vaping industry in 2020. A legal industry was required to comply with a notified products register and a Vaping Regulatory Authority was established and tasked with approving specialised vape retailers, which must be bricks-and-mortar stores that could not be located within 300m of a school. A regime of compliance was instituted.

In the past four years New Zealand has recorded a 40 per cent decline in smoking rates. Its smoking rate is now just under 7 per cent. Smoking rates in Maori women have dropped from 40 per cent four years ago to 18 per cent. Australian Indigenous smoking rates have fallen substantially in recent years but still sit at a devastating 37 per cent and much higher in remote areas.

“We’ve got quite an interesting natural experiment going on between Australia and New Zealand, whereby our laws on cigarettes and tobacco are pretty much identical, but the only real difference is that New Zealand’s had a legal, permissive approach to vaping,” says longtime tobacco control campaigner Ben Youdan, director of the New Zealand independent campaign organisation Action for Smokefree 2025, which aims to eliminate the death and harm caused by tobacco.

Youdan recently visited Australia and briefed parliamentarians on New Zealand’s approach and outcomes. “Vaping has been unbelievably disruptive to smoking rates in countries which have had permissive approaches, in the UK and New Zealand, even in the US. And actually, weirdly, it appears to be the case even in Australia through the illicit market as well. That’s an awful lot of people who are not going to die as a result of smoking.

“Putting vapes in a situation where they’re through prescription, where there’s prohibition, doesn’t make any sense when smoking is overwhelmingly in the lower socio-economic populations, marginalised populations, Indigenous populations, populations who don’t have fair access to health systems, populations who face multiple systemic barriers in accessing GPs and healthcare. And those are the folks who just are not going to be able to get their hands on vapes to help them stop smoking.

More here:

https://www.theaustralian.com.au/inquirer/australias-vape-ban-has-utterly-failed-what-now/news-story/d4eedd2321c647a841d4e5e46c628077

Ms Robinson has outlined a real ripper of a dilemma here!

One really is left wondering what next for this mess. We have a legal and very harmful product (cigarettes) and an illegal but much safer alternative that it might be a very bad idea to promote – for its long term harm.

Frankly this is a really crazy mess now – we have a legal very harmful product and an illegal but much less harmful one that can replace it. It is hard to think just what move the Government can make to sort out the mess and eventually reach the desired state: i.e. minimal to no use of nicotine products – which, given how addictive they are, has to be very unlikely!

What would you do in this situation as Health Minister? I am rather short of realistic suggestions!  I am also pretty worried about the organised crime links - not good!

David.