Relaxed e-cigarette laws would improve public health: Study

Matt Woodley

14/03/2019 1:11:32 PM

Researchers claim allowing people to buy e-cigarettes that contain nicotine without a prescription would result in a net health gain for Australia.

Man smoking e-cigarette
Growing evidence suggests e-cigarettes help people quit smoking, but the long-term health effects remain unknown.

The call stems from a joint Australian and New Zealand study, which utilised a computer simulation that presumed lower health risks for people who swapped smoking tobacco with vaping e-cigarettes.
It also took into account the greater health risk of vaping compared to using neither product, and used the model to estimate the likely net health impact of allowing greater access to the device.
The team applied the model to New Zealand, where it found that the population alive in 2011 would most likely have gained 236,000 health-adjusted life years over the remainder of its life span – equivalent to about 19 days each – from liberalising access to e-cigarettes.
According to the researchers, the estimate is also applicable to Australia given both countries have similar smoking and disease rates.
Aside from the net health gain, the findings also suggest easier access to e-cigarettes would lead to fewer smoking-related diseases, which had the potential to save the health system around $815 per person.
However, the results produced by the study are uncertain, with 95% of the estimates of health gain sitting between 27,000 and 457,000 health-adjusted life years.
Despite the uncertain nature of the findings, the Chair of the RACGP’s Smoking Cessation Guideline Group, Dr Nick Zwar, told newsGP the study appears ‘balanced’ and that any kind of research and modelling into e-cigarette use is welcome.
However, Dr Zwar also warned allowing widespread consumption of e-cigarettes could open a ‘Pandora’s Box’ of new harms.
‘The long-term health impacts are just not known … there are also risks around the uptake of e-cigarettes by non-smokers, which is a pretty major concern in the United States,’ he said.
‘The cautious approach in Australia has been strongly criticised by some people, but it might well be that in a couple of years’ time the cautious approach turns out to have been very wise.’

Dr Nick Zwar, Chair of the RACGP’s Smoking Cessation Guideline Group, warned that allowing widespread consumption of e-cigarettes could open a ‘Pandora’s Box’ of unknown harms.

Dr Zwar said the growing evidence of e-cigarettes’ effectiveness as a smoking cessation tool should be balanced against the need to limit any kind of nicotine consumption. As such, he said he does not understand why most of the debate around e-cigarettes has been in the context of them being a consumer product.
‘If they were a therapeutic product a think a lot of these concerns about uptake and use amongst non-smokers would be hugely reduced,’ he said.
‘It would need to go through the Therapeutic Goods Administration and be considered like a medicine … [but] it’s fair to say there’s increasing evidence that they may be a useful and quite effective form of support for cessation.
‘However, if you make them generally available in vaping shops, that’s not necessarily what they will be used for. What we need is evidence and careful consideration.’
The report’s authors attempted to allay concerns that e-cigarettes would act as a ‘gateway’ for young people to take up tobacco smoking by pointing out youth tobacco smoking rates in the US and UK had continued to fall despite a surge in e-cigarette use.
But a recent US Centers for Disease Control and Prevention (CDC) Vital Signs report found an increase in overall tobacco consumption among high schoolers last year had been driven exclusively by a ‘surge’ in e-cigarette use.
According to the CDC report, there were around 1.5 million additional high school-aged e-cigarette users in 2018 compared with the previous year, and those who used e-cigarettes were using them more often. No change was found in the use of other tobacco products, including cigarettes, during this time.
Meanwhile, a University of London clinical trial determined that e-cigarettes are almost twice as effective as nicotine-replacement treatments, such as patches and gum, at helping smokers to quit.
The multi-centre trial, which involved almost 900 smokers who also received additional behavioural support, found that 18% of e-cigarette users were smoke-free after a year, compared to 9.9% of participants who were using other nicotine replacement therapies.
The RACGP’s updated smoking cessation guidelines are due for release later this year.

e-cigarettes nicotine public health smoking

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Prof Mark Raymond Nelson   15/03/2019 8:09:42 AM

This modelling exercise seems to have looked at e-cigarettes as smoking cessation aid / 'healthier alternative'. Did it consider gateway effects that could reduce or reverse the decline in new consumers of nicotine products? Did it consider the real world effects of tobacco companies adoption of these products and marketing to this new generation? I think Nick Zwar is correct on saying a conservative approach to these products is likely to prove the correct one in the long term.