New rules to limit access to vaping products to people with a prescription are aimed at curbing a worrying rise in youth smoking. By Martin McKenzie-Murray.

Crackdown on vaping targets youth addiction

A young woman smokes an e-cigarette.
A young woman smokes an e-cigarette.
Credit: Nikolay Vinokurov / Alamy

It was the sense of a broken promise that compelled the federal Health minister, Mark Butler, to announce Australia’s most muscular regulation of vaping products to date. E-cigarettes, Butler argued, had been solemnly promoted as a way of helping smokers to quit – but had since flourished as a recreational product, and one increasingly marketed to young people.

“Vaping was sold to governments and communities around the world as a therapeutic,” Butler said last month. “It was not sold as a recreational product – especially not one targeted to our kids, but that is what it has become.”

The reforms effectively change vaping products from consumer goods to strictly therapeutic ones, by allowing access by prescription only, and limiting their sales to pharmacies. Individuals will no longer be able to import products, as is currently permissible with a prescription, and the federal government would work with the states to help enforce the ban on sales in retail premises.

“Young people who vape are three times as likely to take up smoking,” Butler said. “So, is it any wonder that under-25s are the only cohort in the community currently recording an increase in smoking rates?”

The move to a prescription model had already begun under the previous government, when then health minister Greg Hunt introduced a law that limited individual imports of nicotine-enhanced e-liquids to people with a GP’s prescription. While the sale of e-cigarettes and associated hardware was legal, the sale in Australia of nicotine-infused liquids was not.

In response, a black market for nicotine products has thrived and schools across the country have reported alarming increases in vaping. Researchers found an abundance of retailers selling nicotine goods under the counter, and ostensibly nicotine-free disposable devices sold in convenience stores have been increasingly found to contain traces of the addictive chemical. Butler argued the previous regime was insufficient and poorly policed. “To his credit, the former Health minister Greg Hunt tried to put border controls in place, but there was a revolt in his party room and that regulation was overturned within two weeks,” Butler said in his speech to the National Press Club in early May. “Instead, the former government created the perfect conditions for an unregulated – essentially illegal – market to flourish right before our eyes, in convenience stores, tobacconists and vape shops. Sometimes deliberately set up down the road from their target markets – schools. A so-called prescription model, with no prescribers. A ban, with no enforcement. An addictive product, with no support to quit.”

The increasing use of vape products by young people has been central to the government’s new regime. Data released this week by NSW Health shows the proportion of the state’s 16- to 24-year-olds who are vaping has grown in just the past two years from 4.5 per cent to 16.5 per cent. It’s considered such a problem that, from next month, the New South Wales government will begin installing vape detectors in all public high schools across the state.

“The most emotional moment for me was the day after Butler’s announcement,” the president of the Australian Medical Association, Dr Steve Robson, tells The Saturday Paper. Robson was a member of the federal Health minister’s roundtable for regulating vaping. “A school principal rang me, someone I know, and who was almost in tears. He said, ‘I can’t thank you enough.’

“It was resonating with people. With teachers and principals. They’d seen the extraordinary levels of addiction in their schools. Of kids who can’t sit through a class without going outside to vape. These kids are genuinely hooked and it’s incredibly disruptive.”

There is, more or less, uniform praise and support for Butler’s measures from peak health bodies and public health experts, who agree that vaping’s therapeutic benefits served as a “Trojan horse”.

“The tobacco industry is utterly ruthless and predatory and has almost limitless resources,” Emily Banks, a professor of epidemiology and public health at Australian National University, tells The Saturday Paper. “It also has decades of experience addicting children. That’s when they get people. The machinery is all worked out. Your brain is still forming up until about the age of 25, so to get a lifetime customer you need to get them early.

“E-cigs are a cross between a Trojan horse and Pandora’s box – Pandora’s horse, if you will. They say it will help smokers quit, but you open it up and out come bubblegum or unicorn-poop flavoured vapes. They’re designed to appeal to children. There’s a teddy bear-shaped vape. There’s a vape that’s designed to look like a highlighter pen. Another that looks like an asthma ventilator. There are thousands of flavours. I found a vape packet outside my daughter’s school – it was pink and bubblegum-flavoured and packed with nicotine,” says Banks, who recently co-authored a major study of vaping.

“So here’s a thought experiment: imagine it was just therapeutic, then what would it look like? Well, you’d have regulatory approval from the bodies that approve such things. But they haven’t submitted them to the FDA [United States Food and Drug Administration], or Europe’s equivalent, or to the TGA [Therapeutic Goods Administration] here. They’re not approved smoking cessation products. Now, one reason they haven’t submitted them for approval to regulatory bodies is that it would narrow their market. If you look at the market they’re interested in, it’s a broad consumer market.”

Cancer Council Australia was equally supportive. “The federal government’s announcement is fantastic, because smokers can still have access to these,” the chair of the council’s tobacco issues committee, Alecia Brooks, tells The Saturday Paper. “There’ll be testing, transparency. But it helps limit access to young people. There’s ANU data that shows for every non-smoker who vapes, they’re three times as likely to use real cigarettes. That’s what we should focus upon. These devices aren’t useful for the 89 per cent of the population that aren’t smokers.”

But there are sceptics of the new measures. Dr Colin Mendelsohn is a retired GP who also served as conjoint associate professor in the UNSW Sydney’s School of Public Health and Community Medicine. He is the founding chairman of the Australian Tobacco Harm Reduction Association and the author of the provocatively titled book Stop Smoking Start Vaping. In an open letter to Mark Butler, written last month and with 40-odd signatories, Mendelsohn wrote that vaping was “associated with accelerated declines in national smoking rates in countries where it is easily accessible … A well-designed adult consumer regulatory model is most likely to achieve the two goals we all seek, i.e., making vaping products readily available as a quitting aid for adults who smoke and minimising access by young people. While measures to protect non-smoking youth are essential, excessive regulation that makes vaping less accessible, less appealing, more expensive or less effective perpetuates adult smoking and increases smoking-related death and illness.”

Mendelsohn tells The Saturday Paper that Australia is unusually, and unjustifiably, hostile towards vaping. The British equivalents of our Australian Medical Association and Cancer Council, he says, are more receptive to vaping’s use as a less harmful alternative to smoking. He also points to New Zealand, where he says smoking rates fell by 33 per cent in the two years after the country legalised vaping in 2020. In this country, daily smoking rates have more or less plateaued around 11 per cent, while Australia’s National Tobacco Strategy aims for a rate below 5 per cent by 2030.

New Zealand’s official position on vaping certainly seems more relaxed than Australia’s. “Expert opinion is that vaping products are much less harmful than smoking tobacco but not completely harmless,” the New Zealand Ministry of Health’s position statement reads. “A range of toxicants have been found in vapour including some cancer causing agents but, in general, at levels much lower than found in cigarette smoke or at levels that are unlikely to cause harm. Smokers switching to vaping products are highly likely to reduce the risks to their health and those around them.”

The AMA’s Steve Robson denies there’s any “groupthink” among Australian professionals, or that, as a country, we’re much different from international counterparts. “If I speak to my colleagues overseas, I get the same sense of horror,” he says. “Now, if you look at the UK, sure, you see op-eds produced by economic think tanks, but if you drill deeply enough, you see they’re funded by Big Tobacco. There’s a lot of aggressive PR put out there. But when I speak with public health people, they’re just as worried as I am.”

Mendelsohn argues that the constant invocation of Big Tobacco is an emotional furphy – that the large tobacco firms control very little of the global vaping market. He says the surfeit of consumer vapes in schools is the result of poorly policed crime cartels saturating our markets.

But suspicion of the industry among public health experts might be forgiven: Big Tobacco has been practising dirty tricks for decades. At Britain’s University of Bath, researchers have developed a “taxonomy of tactics” the tobacco industry uses to exercise influence. Their analysis is supported by millions of pages of documents made public through various litigation, and a pattern emerges: of industry producing its own flattering research, through the use of ostensibly independent think tanks, and then propagating this research through the media and its citation in lawsuits.

Robson says he has encountered “tainted” research personally. Emily Banks says it’s rife. Earlier this year, the Royal Australian College of General Practitioners issued a warning about the potential use of compromised research from the Foundation for a Smoke-Free World, an organisation that has received hundreds of millions of dollars in funding from the world’s largest tobacco company, Philip Morris International, and has produced dozens of research papers on vaping in recent years. Several Australian research centres, including the CSIRO, declared they would not accept any research from the foundation.

In another attempted insinuation from the tobacco company last year, a scheme devised by Philip Morris to pay Australian pharmacists for stocking, prescribing and selling its VEEV e-cigarette was paused after condemnation from doctors and public health experts. “Big tobacco’s attempt at financial kickbacks shows absolute contempt for pharmacists,” the Pharmaceutical Society of Australia said. “Contempt for their integrity. Contempt for pharmacist’s professional and ethical obligation to put the health and wellbeing of their patients first. Multinational tobacco companies have no place in health care.”

For now, there remains a swirl of claims and counterclaims about the safety and efficacy of vaping – a confusion encouraged by the abundance of industry-funded research. As the technology is relatively new, there’s an absence of longitudinal studies about the long-term effects. But, Robson warns, “the absence of evidence is not evidence of absence”. He adds: “I’m an obstetrician by training. I help people start their lives; I help young families. And the thought that a new generation of kids are getting hooked on inhaling garbage is distressing to me. I commend the government on what they’ve done. I think it’s courageous.”

This article was first published in the print edition of The Saturday Paper on June 3, 2023 as "Vaping trail".

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