The Australian government finally implemented the e-cigarette prescription scheme on 1 October. Thereafter, those who illegally import nicotine without a doctor's prescription will face fines of up to A$222,000.
Dr Alex Wodak, Director of Tobacco Harm Reduction Australia, and Dr Colin Mendelsohn, founding President of Tobacco Harm Reduction Australia, commented on this, saying that the October 1 crackdown on e-cigarettes will prompt smokers to return to their habit.
Below is the full text.
Every year, 21,000 Australians die prematurely as a result of smoking. This is more than the number of deaths caused by alcohol, prescription drugs, illegal substances, road traffic deaths, HIV and suicide. Governments have a moral and health obligation to reduce smoking-related deaths by adopting policies to reduce the harm caused by inhaling tobacco smoke.
E-cigarettes provide nicotine without the toxic products of combustion and are much less harmful than smoking. Policies that support e-cigarettes may help reduce the huge toll of smoking-related disease. More than 2.5 million Australians still smoke, and the National Drug Strategy Household Survey estimates that 240,000 Australians smoked e-cigarettes in 2016 and 520,000 in 2019. If the number of Australians smoking e-cigarettes continues to increase, there could be as many as 600,000 e-cigarette smokers today.
Currently, Australians can import nicotine liquid from overseas for use in e-cigarettes or buy it from a small number of participating pharmacies, provided they have a valid doctor's prescription. From 1 October, the Australian Border Force will closely monitor the importation of nicotine liquids.
Consumers who fail to include a nicotine prescription in their order will be subject to fines of up to $222,000. The new system will work if enough doctors, pharmacists, smokers and e-cigarette users are willing to comply and get enough information. As far as indications are concerned, there is little interest in compliance and most people have little information. There has been little effort to disseminate information about the new arrangements.
At present, very few people have the prescriptions they need. Most nicotine supplies are imported without a prescription or purchased from the black market. If compliance with the new arrangements is poor, then some people will return to smoking and others will buy supplies from the black market. Neither is a good outcome.
The point is that in Australia, nicotine used in e-cigarettes is considered to be a drug regulated by the Therapeutic Goods Administration (TGA), which includes nicotine liquids for e-cigarettes in its poison criteria, while explicitly excluding cigarettes. The net effect is that a much less dangerous form of nicotine consumption is severely restricted, while the cigarettes that kill up to two out of three long-term smokers are easily available from 20,000 outlets.
When these new arrangements were first announced by Health Minister Greg Hunt in June 2020, 28 government backbenchers (40% of all government backbenchers) signed a letter expressing their strong opposition. As the by-election approached, the Prime Minister instructed the Health Minister to delay implementation. A second attempt to introduce these arrangements also did not take place. This is now the third attempt.
Many former smokers who could not quit until after the switch to e-cigarettes are anxious and angry about the new arrangements. With at least 3,500 e-cigarette users in each House of Commons constituency, some seats may be decided by the votes of these angry e-cigarette users, and for them this may be the most important issue of all.
While the current dominance of COVID-19 in health policy is understandable, there will come a time when it will be curbed. The need to accelerate the slow decline in smoking rates in Australia will once again become imperative. Since e-cigarettes became popular in these countries in 2013, smoking rates in the UK and US have fallen two to three times faster than in Australia, despite strict tobacco control regulations, high cigarette prices and simple packaging. If Australia's new rules on nicotine liquids fail (which seems likely), then a different approach should be adopted.
Australia should make it easier for smokers to switch to e-cigarettes and adopt regulations that are commensurate with the risks to minimise adverse effects. Nicotine liquids should be an adult-only consumer product, as they are in all other Western democracies. in August 2020 in New Zealand, the Labour Party, New Zealand First, National and Greens all voted to pass legislation to legalise nicotine as a consumer product. Now is the time to accelerate the decline in our smoking rates. Overseas experience shows that e-cigarettes can play an important role in complementing tobacco control policies.