Legalise nicotine vaping as a harm reduction solution for tobacco smoking

The 7th WHO Conference of the Parties (COP7) is coming soon to sunny Delhi, India and on the agenda for the 180 odd countries and international associations will be the spectre of tobacco.

We've known about the full devastation of tobacco for decades now. We know that it is one of the most potent carcinogens in the world. We also know that it is also one of the world's most lucrative drugs… for governments – a veritable coughing and sputtering cash cow.

But at a time when it is costing our public healthcare system millions of dollars and killing many Australians despite our best efforts to tax it and to replace its labelling with edgy pictures of decomposing organ tissue, it is time to consider any practical harm-reduction alternative that has proven its effectiveness.

E-cigarettes or 'vapes' are one of these alternatives. More than 6 million citizens of the EU have kicked their tobacco habit by puffing vapes loaded with nicotine instead. Nicotine, a component of cigarettes which satiates cravings, is a non-carcinogenic, non-pharmaceutical which is already incorporated into anti-smoking aids such as gums. Nicotine-loaded vapes are now openly recommended as one of the most effective smoking cessation tools by both public and independent health authorities in the UK.

It poses no significant long-term health risks when used in concentrations appropriate or commonly favoured by vapers.

Yet paradoxically, Australia's health bodies have failed to catch up with the times and nicotine solutions for vaping are still listed under Schedule 7 of the Australian Poisons Standard which renders them illegal for sale. Though they are available for 'therapeutic' use, (read: with a doctor's prescription), this makes them hard to access and makes it even harder for smokers looking for a safe alternative.

What makes this state of affairs more bizarre is that nicotine dissolved in water is treated the same way as highly addictive and harmful opiates. All the while, tobacco-laced cigarettes which are far more dangerous to both active and passive smokers continue to be accessible.

Detractors contend that vaping represents an untested danger – by legalising it, we risk presenting it as 'cool' and therefore attracting a large segment of non-smokers including easily impressionable children.

But the evidence we have says otherwise. A 2014 US study from the American Journal of Preventative Medicine found that despite the prevalence of e-cigarettes in that country, it was highly unlikely that anyone who was a non-smoker of regular cigarettes had taken up e-cigarettes. It also found that of the small number who had smoked only e-cigarettes, the frequency of use was 1-2 days a week on average. This indicates that the net benefit of legalising nicotine-loaded e-liquids outweighs the risk that non-smokers will adopt e-cigarettes.

Other research available demonstrates that the harms associated with nicotine use are overwhelmingly caused by its delivery to the lungs within toxic particles released when a tobacco leaf combusts, as it does when you fire up a cigarette, not by nicotine itself. The harms are significant and well documented. Smoking is a major cause of cancer, cardiovascular disease and respiratory illness, as well as degraded welfare and wellbeing. Each year, smoking kills an estimated 15,000 Australians and costs Australia $31.5 billion in social (including health) and economic costs.

Nicotine vaping is a relatively new technology and there are currently no studies confirming the precise effects of long-term vaping. But given the value of nicotine-loaded vaping as a harm minimisation and tobacco cessation tool advocated by multiple studies and the overwhelming evidence that it is far less harmful than legal tobacco, the sale of safe quantities of nicotine-loaded e-liquids should be legalised in Australia. It is both the moral and the pragmatic thing to do.

It would also be in keeping with the policy of the UK, the EU and recently, New Zealand, which have reported significant net benefits in reducing the severity of this leading cause of mortality and illness in Australia. New Zealand's legalisation of these solutions means that we could even be looking at a large and tough to regulate black market in Australia and this should compel us to take action.

16% of Australian adults are currently engaged in smoking and when it comes to harm reduction, time is of the essence.