Former GP calls for schools to adopt ‘vaping areas’

Michelle Wisbey

15/04/2024 3:59:14 PM

Allocating nicotine-addicted children a space to vape is ‘compassionate and pragmatic’ a NSW inquiry heard, but the idea has already proved divisive.

Young person smoking an e-cigarette.
Around one in six Australians aged 25–34 currently vapes, as well as one in seven children aged 14–17.

As Australia continues to crackdown on vaping and its boom among young people, one expert says a ‘prohibition’ approach is not the answer and has already led to a thriving black market.
Instead, former GP and Australian Tobacco Harm Reduction Association Chair Dr Colin Mendelsohn told a Parliamentary Inquiry on Friday that schools should create dedicated ‘vaping areas’ for students addicted to nicotine.
He said this must be done out of view from other students and with permission from parents, but that it represents a ‘compassionate and pragmatic’ solution to help young vapers.
The New South Wales inquiry was launched in September last year, with the goal of improving the state’s vaping regulation and compliance.
It is particularly concerned with vaping’s prevalence among children and young people, prevention services, potential health risks, and the effectiveness of current regulations in preventing illegal supply.
It comes as around 1.7 million Australian adults now vape, with almost 400,000 people picking up the habit last year alone.
About 20% of all 18–24-year-olds are vapers, as are one in six people aged 25–34, and one in seven children aged 14–17.
Dr Mendelsohn told newsGP he wants authorities to take a public health approach to regulating vaping, saying children should not be encouraged to vape, but ‘we can’t throw all the adult smokers under the bus either’.
‘The important thing is that regulation has to be balanced. So yes, of course there’s a valid concern and vaping isn’t for young people, but neither is smoking and neither is alcohol – there are lots of things, adult behaviours, that they shouldn’t do,’ he said.
‘We have a problem with youth vaping which is disruptive to the young people and the schools, and we haven’t found a solution to that.
‘An alternative is to allow them to use nicotine gums and lozenges at school because the fact is that these kids, some of them, are addicted and they go through withdrawal during the day, so a compassionate society will say, “we’ve got this problem, we’re not fixing it, let’s address this with the nicotine that these kids need”.’
But Associate Professor Rowena Ivers, a member of RACGP Expert Committee – Quality Care who also fronted the inquiry, told newsGP while vaping can play a positive role for some patients, its long-term effects are not yet known.
‘It’s about finding a middle ground – vaping can possibly be an option for people who are giving up smoking, but the unregulated vape access is really having a very detrimental impact on our young people,’ she said.
‘I’m personally opposed to [school vaping areas], but young people do need support … it’s about having the support of a GP, having advice on smoking or vaping cessation, having access to other therapies is important, and having a conversation about reducing nicotine exposure.
‘It’s about opening the conversation, discussing ways for people to wean down, thinking about other pharmacotherapies, and basically monitoring people and giving them support.’
Last month, the Federal Government again ramped up its vaping crackdown, introducing new plans to make it illegal to import, manufacture, supply, commercially possess, and advertise disposable single-use and non-therapeutic vapes.
The only legal vape products left would require a prescription, with patients still able to utilise nicotine vapes for therapeutic purposes as a second-line smoking cessation measure via their GP.
The RACGP had long called for this plan and supported the legislation upon its release, with President Dr Nicole Higgins urging GPs to ‘do everything we can to stop a new generation of nicotine users emerging’.
But Dr Mendelsohn described vapes as ‘the most effective quitting aid we have’, saying it works as a long-term substitute to smoking cigarettes.
‘Smoking is still the leading preventable cause of death and illness. Many people just can’t quit, and two out of three of them will die prematurely from smoking, so quitting aids have limited effectiveness,’ he said.
‘The problem is that this prescription model amounts to prohibition, and when you make a product so harshly restricted that over 90% of people refuse to follow a legal pathway, it’s clearly a form of prohibition.
‘We know from experience with illicit drugs that prohibition just doesn’t work, and we’ve seen that already evolving with vaping, we’ve got the rampant black market, widespread supply of unregulated products, easy access for young people, and difficulties with legal access for smokers.’
Dr Mendelsohn’s position is in-part formed by the belief that smoking cigarettes poses a larger health challenge than vaping, telling the inquiry that long-term vape use is highly likely to be ‘considerably less harmful’ than smoking, and that ‘no one has ever died from vaping nicotine’.
However, NSW’s Chief Cancer Officer Professor Tracey O’Brien told the same enquiry later in the day that there is still not enough evidence to determine how deadly vapes are.
‘There is no definitive evidence that vaping causes cancer, but I’d take caution at putting a full stop after that sentence, simply because we don’t have the duration of time to be able to prove that,’ she said.
‘Tobacco smoking took decades to prove that it caused cancer. It wasn’t until the 1960s that we knew that tobacco smoking caused lung cancer, and then several decades after that we now know that 15 other cancers apart from lung cancer are caused by tobacco smoking as well.
‘We do know that there are 200 odd chemicals contained with vapes, and many of those chemicals are known to cause cancer.
‘I have concerns about the health impacts in terms of cancer of the products that are currently being exposed to young people.’
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Dr Mthuthuzeli Mthimkhulu Sobantu   16/04/2024 7:20:30 AM

Now I've seen it all!

Dr Steven Jon Hambleton   16/04/2024 8:13:26 AM

I can't write what I am thinking - Mum said if you can't say something nice....... Our profession requires us to balance the risks v's the benefits for the person and the population. The best surgeon may be the one who says, "I can do it, but that is not what you need," So many times in our careers, based on the ethics of our profession it is our job to gently say no. Our social capital requires it.

Dr Peter James Strickland   16/04/2024 10:47:40 AM

The theme here is 'just give in'. Who wants our kids addicted to anything? We in the medical profession want healthy cognizant non-addicted people in our community. --it is surely our role, isn't it? All this push to legalize social drugs for everyone, eg cannabis for normally developed humans is a danger. Do we want our judges, surgeons, police, politicians etc etc high on 'legal' cannabis (as an example), and when it should be limited to childhood epilepsy or chronic pain where it is invaluable. Nicotine CAN be an antidepressant in itself, but it is highly addictive, and the chemicals in vaping solutions are known to be damaging to the body --we should all say a definite NO!

A.Prof Christopher David Hogan   16/04/2024 11:59:11 AM

What a mess !
As Curator of the RACGP museum I can attest how active GPs were in fighting the community addiction to cigarette smoking.
Our society did not heed our warnings about vaping & it has captured the young.
Time to apply our learnings from that successful battle to cigarette substitutes.
Hopefully not too many will die before vaping is removed

Dr Rosalie Schultz   16/04/2024 12:16:18 PM

Dr Mendelsohn may have been a GP but he's likely influenced by his history with the tobacco industry as it moves from cigarettes to vapes as sources of profit, including links to British American Tobacco and Philip Morris International.

The benefits of smoke free environments are established, and it is not empathic but cruel to facilitate addictive behaviours.

I do not believe that vaping at school will increase the likelihood that a child will quit smoking, which was the justification for their legalisation.

Dr Jacqueline Anne Barry   17/04/2024 12:08:16 AM

Given the vape fumes I see exhaled, and recent experience of presumably inhaling second-hand vape fumes based on the fact I could smell it, as well as the multitude of chemicals in them, why oh why does anybody believe they are in any way safer or less addictive than cigarettes. I have yet to come across a single person who consumes less vape than when they were smoking cigarettes, and will not be adding this latest vehicle of the tobacco industry to my toolkit

M   19/04/2024 6:33:45 PM

Consider the following points:

Humans have been smoking tobacco for thousands of years.
Humans have been dying from smoking tobacco for the same amount of time.
Humans still smoke tobacco knowing this.
Smoking tobacco remains the primary vehicle for nicotine, and the most harmful one at that. It remains so even after taxing it at 1000% in Australia.
Vaping is a nascent technology which has spread across the world very quickly.
All indication is that it probably isn't good for you but probably isn't as bad as smoking.
Unlike any other nicotine delivery method, it appears to be the only one with the potential to compete with smoking.
So what happens when vaping becomes more difficult to access?
I am going to guess that it's more smoking.