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New ‘Quit or Die’ dogma from Queensland - demonstrating why it’s better to regulate than prohibit

12, Jul, 2016

By Tom Pruen

Australia has, of recent times, demonstrated an utter hostility to Tobacco Harm Reduction (THR). The latest from the Queensland government not only demonstrates this, but a quick examination of the reasons they use to attempt to justify their position also emphasises the dangers of such an approach.

The approach is quite extraordinary - those practising harm reduction are urged to

This isn’t entirely due to the stupidly dogmatic attitude of the government though – there are legal implications

This of course raises particular problems for vapers:

 

The clear prohibitive view is however clearly indicated by this exhortation:

Report your neighbours for practising THR? That’s a bit more Third Reich than ‘land of opportunity’.

The basis for this is given as:

Safety concerns

Electronic cigarettes may:

  • deliver unreliable doses of nicotine
  • leak their contents
  • be a poisoning risk, particularly for children
  • not list the presence and/or actual strength of nicotine on the product label
  • contain other unknown, possibly toxic chemicals
  • have incorrect or inconsistent labelling and unsafe packaging
  • encourage the uptake of smoking
  • have no child safety measures
  • be unsafe to use during pregnancy.

These concerns fall into two categories – those that could and should be fixed by regulation, and those that are just wrong.

Wrong

  • deliver unreliable doses of nicotine

The ability of smokers to self-titrate nicotine from smoking has been long demonstrated. It’s also been demonstrated that vapers do the same thing[i]. Users can therefore adjust their usage pattern to suit the delivery from their device.

  • leak their contents

Most designs of e-cig either don’t leak at all, or only leak trivial amounts under certain conditions. Better designs could be supported by regulation – and a black market will be more concerned about price and ease of transport than quality, so a prohibition is likely to make this problem worse.

  • contain other unknown, possibly toxic chemicals

As stated, this is just wrong (what incentive is there for a manufacturer to poison their customers?), but is better considered as a regulatory gap.

  • encourage the uptake of smoking

This gets bandied about a lot, and it’s a legitimate concern. However, there’s no evidence to suggest that this actually happens to any significant extent, and without doubt the most common route into regular smoking is….. experimental smoking.

  • be unsafe to use during pregnancy.

It is true (although the actual safety implications of this are still uncertain) that nicotine crosses the placental barrier and may have an effect on the foetus. In an ideal world, no one would use nicotine during pregnancy. However, there can be no question that the use of e-cigarettes will still be safer than smoking, since most of the potentially toxic exposures from smoke are either absent from vapour or at massively lower levels, and both contain nicotine.

Regulatory needs

  • be a poisoning risk, particularly for children
  • not list the presence and/or actual strength of nicotine on the product label
  • have incorrect or inconsistent labelling and unsafe packaging

These are listed together, because they are so closely connected. Currently, since the products are illegal, it is impossible for them to be correctly labeled. Clearly regulation could and should address child resistant packaging, mandated safe handling and storage instructions. Most regulatory frameworks have requirements for labeling and packaging of consumer products that could be potentially dangerous, for example the European CLP[ii] regulations. These are specifically formulated to regulate (but permit) the use of potentially toxic chemicals in consumer products. Bleach and many other cleaning products also have potential poisoning and skin absorption risks, and these are mitigated by regulation. This is not a new or controversial approach and indeed, from next year, Australia’s approach[iii] will closely mirror that of CLP (both are derived from a global approach designed and recommended by the UN[iv]).

All of these problems could therefore be mitigated by regulation, and contrarily can be expected to be exacerbated by prohibition.

  • contain other unknown, possibly toxic chemicals

It would not be difficult to specify prohibited ingredients, purity standards or manufacturing requirements - IF a regulatory approach was taken.

Prohibiting a product is the ultimate in deregulation. As the war on drugs has shown, the total absence of standards - combined with the pressures of operating in a black market - make  prohibited products more dangerous than they would otherwise be.

However, none of this addresses another significant issue - why should it be illegal for adults to choose a safer nicotine delivery method? Why should this even be considered?

Then there is another aspect of this – social engineering. The message is that smoking is bad – but vaping is dangerous and illegal. Does this seem like a policy that is likely to encourage people to switch to massively less harmful alternatives, or carry on smoking?

Crushing the less harmful alternative might make sense if Australia had reached its ‘endgame’, but it still has a daily smoking prevalence of over 16%[v]. This is not a great number (the endgame is usually considered to be less than 5%), and as a clear proof of concept, it’s lower in Sweden where THR through snus is widespread. This also ignores the fact that, inevitably, smoking prevalence is linked to socioeconomic status – the health burden falls disproportionately on the poor, unemployed and ethnic minorities.

None of this appears to have had even the barest effect on policy.

The message from the Queensland government is clear, and devoid of any humility or empathy – if you smoke you can quit, or die.

 

Comments

Thanks for this eminently rational response to a dire state of affairs here in Australia. It's so nice to feel understood in the midst of so much fear and scorn down here in the 'land of opportunity'. Much appreciated.

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