Exclusive interview with Australian tobacco control experts: Prescription patterns surge and black market e-cigarettes should be as easy to obtain as cigarettes

Exclusive interview with Australian tobacco control experts: Prescription patterns surge and black market e-cigarettes should be as easy to obtain as cigarettes

Two Firsts 2FIRSTS conducted an exclusive interview with Dr. Colin Mendelsohn, an Australian tobacco control expert. Colin said Australia's prescription e-cigarette purchase model inhibited legal purchases, causing consumers to turn to the black market and triggering a series of crimes.

The Australian government stipulates that e-cigarettes must be purchased with a prescription from a general practitioner. This policy aims to regulate e-cigarettes through medical channels to ensure their safe and reasonable use. However, it is not easy for e-cigarette companies to promote products through medical channels. This has resulted in a very limited range of e-cigarette products in the Australian compliance market, triggering widespread controversy and discussion.

 

Recently, Two Supremes 2FIRSTS conducted an exclusive interview with Dr. Colin Mendelsohn, an Australian tobacco control expert, hoping to explore the current status, challenges and future development direction of Australia's e-cigarette policy through his perspective.

Colin said Australia's prescription e-cigarette purchase model inhibited legal purchases, causing consumers to turn to the black market and triggering a series of crimes. He noted that current regulations amount to a ban and that history has proven difficult for law enforcement and border controls to reduce the supply of illegal e-cigarettes.

He believes e-cigarettes, nicotine pouches, snus and heated tobacco should be sold as adult consumer products through licensed retail outlets with age verification, without a prescription, and should be as accessible as cigarettes.

Colin suggested that Australia should classify nicotine-containing e-cigarette liquids as consumer goods and be regulated by the Australian Competition and Consumer Commission (ACCC) instead of the Australian Therapeutic Goods Administration (TGA).

 

 

2FIRSTS: What do you think of the current development of the Australian e-cigarette market? What direct impact will Australia's recent strict controls on e-cigarettes have on the market?

 

Colin: Australia's prescription-only e-cigarette model has largely failed. E-cigarette users need to obtain a nicotine prescription from a doctor and purchase e-cigarette liquid and e-cigarette hardware from a pharmacy. However, 90% of e-cigarette users reject this legal approach, and few doctors are willing to prescribe it. Smokers do not believe they need medical treatment, and dispensaries offer a limited range of products at higher costs, further discouraging legal purchases.

 

The result is that most e-cigarette users turn to the black market, which is controlled by criminal networks. Free black market sales to young people have led to a high rate of e-cigarette use among teenagers. Turf wars between different criminal groups have led to arson attacks, homicides, extortion and intimidation at tobacco and vaping shops. E-cigarettes have now become Australia's second-largest illicit drug market after cannabis.

 

These regulations inadvertently increase teen vaping rates because the black market makes e-cigarettes more accessible to young people. Not allowing vape shops to sell e-liquid or vaping equipment has resulted in many stores closing. The manufacturing industry is also gradually shrinking.

 

Current regulations amount to a ban, and history shows that further law enforcement intervention and border controls are unlikely to significantly reduce the supply of illegal e-cigarettes.

 

2FIRSTS: In your opinion, what are the problems with Australia's current e-cigarette regulatory policy?

 

Colin: The classification of e-cigarette products as drugs is a fundamental issue that creates barriers for adult smokers who wish to quit smoking. Most e-cigarette users purchase from the black market, which sells unregulated products, increasing the risks of use and making these products more accessible to teenagers. The black market has made it easier, not harder, for teens to obtain e-cigarettes, leading to rapid growth in teen e-cigarette use.

 

 

2FIRSTS: You mentioned before that "the prescription e-cigarette model is a failure." Is this still your view?

 

Colin: The prescription-only model is a barrier to legal access to e-cigarettes for adults, leading to a thriving black market controlled by criminal gangs. It also increases teen vaping rates because young people have easy access to black market e-cigarettes. This model makes safe alternatives to cigarettes more difficult to obtain.

 

 

2FIRSTS: From the perspective of tobacco harm reduction, what role do you think e-cigarettes play in helping smokers quit smoking?

 

Colin: E-cigarettes are an effective smoking cessation aid, more effective than nicotine replacement therapy and at least as effective as bupropion. It's especially useful for smokers who enjoy a "hand-to-mouth" and sensory experience. E-cigarettes are a valuable aid for smokers who are unable to quit smoking through other means. They are the most popular smoking cessation aid in Australia and may reduce population smoking rates more than any other intervention.

 

 

2FIRSTS: How do you assess the differences in health risks between e-cigarettes and traditional tobacco products?

Colin: A comprehensive systematic review by the UK government in 2022 concluded that "e-cigarettes are at least 95% less harmful than smoking" and that "the risks posed by e-cigarettes are only a fraction of the risks of smoking".

 

Most of the harmful toxins in cigarette smoke are absent or in much lower concentrations in e-cigarette smoke. E-cigarette users experience significant reductions in biomarkers of toxins and carcinogens and significant health improvements. The cancer risk from e-cigarettes is estimated to be less than 0.5% of the risk from smoking. After 15 years of e-cigarette use in many countries, there have been no deaths and serious health effects are extremely rare.

 

2FIRSTS: How do you think the government should strike a balance between public health and e-cigarette market regulation?

Colin: To balance public health and market regulation, Australia needs to open access to nicotine e-cigarettes to adult smokers while limiting access to youth. Regulations should minimize barriers faced by adult smokers by: allowing licensed retail outlets to sell adult-only products, supporting a wide range of products and flavors, limiting advertising to smokers, implementing low-risk proportionality of taxes.

 

Strategies to reduce youth exposure include strict age verification at the point of sale, strict fines, and license suspension for youth sales of e-cigarettes. Advertising should be restricted and regulated to prevent marketing from attracting teenagers. Public and youth education should position e-cigarettes as smoking cessation tools rather than targeting young people or non-smokers. Flavor names that attract young people should be banned, and packaging should be simple without bright colors and images that appeal to young people. Honest and accurate education on the risks of vaping should be provided, and monitoring installed mandatory at the point of sale to ensure compliance.

 

2FIRSTS: What support should the government provide to e-cigarette consumers, especially smokers seeking help to quit smoking?

 

Colin: The government should provide accurate information about the risks of e-cigarettes relative to smoking and encourage adult smokers to switch to e-cigarettes if they cannot quit smoking by other means. Providing practical advice on how to switch and support for e-cigarette shops, which is vital to providing professional advice and increasing quit rates.

 

2FIRSTS: You are calling on the government to provide smokers with safer alternatives, including e-cigarettes. Can you share some specific suggestions or solutions?

Colin: E-cigarettes, nicotine pouch products, snus and heated tobacco products should all be available as adult consumer products, sold from licensed retail outlets with strict age verification, similar to tobacco or alcohol. These products should not require a prescription and should be at least as accessible as combustible cigarettes. Different smokers respond differently to different treatments, so a diverse product offering is necessary.

 

 

2FIRSTS: How do you think Australia should adjust its e-cigarette regulatory policies to more effectively promote public health?

 

Colin: Australia should classify nicotine-containing e-cigarette liquids as consumer goods and regulate them by the Australian Competition and Consumer Commission instead of the drug regulatory agency, the Australian Therapeutic Goods Administration. . Regulations should balance legal access for adult smokers with restrictions for teenagers. Preferred is a strictly regulated consumer model with licensed retail outlets and strict sales age verification. E-cigarette products should be at least as accessible as cigarettes, and regulations should reflect the lower risks of e-cigarettes.

 

2FIRSTS: What are your predictions for the future development of the Australian e-cigarette market?

 

 

 

2FIRSTS: How is Australia's e-cigarette regulatory policy different from other countries? What international experiences are worth learning from?

Colin: Australia's prescription-only model is inconsistent with other Western countries, which regulate e-cigarette products as adult consumer products. Data suggest this pattern contributes to accelerated declines in smoking and generally lower rates of youth e-cigarette use.

 

Australia should look to New Zealand for guidance. New Zealand and Australia have similar tobacco control policies and similar demographics. However, since New Zealand legalized and regulated e-cigarettes in 2020, adult smoking rates have fallen by 43% between 2020-2023, more than twice the rate of decline in Australia. The rate of decline in smoking has been particularly impressive among Aboriginal Māori and the most disadvantaged groups. Teen e-cigarette use, which increased before regulation, has begun to decline. There is no significant black market in New Zealand and the government collects substantial tax revenue.

 

 

 

Colin is the founding president of the Australian Tobacco Harm Reduction Association. Founded by doctors, the Association is a health promotion charity focused on raising public awareness of the risk-reducing potential of combustible tobacco alternatives.

 

An expert with over 40 years' experience in tobacco treatment and tobacco harm reduction, Colin was previously an Associate Professor in the School of Public Health and Community Medicine at the University of New South Wales. In addition, Colin is also an important member of the Royal Australian College of General Practitioners' National Smoking Cessation Guidelines expert advisory group, providing valuable insights and guidance for the development and updating of smoking cessation guidelines, helping doctors and medical professionals more effectively support smokers to quit smoking.