Vaping theology: 11 The sky is about to fall in as nicotine vaping starts to require a prescription in Australia

28 Tuesday Sep 2021

Irrepressible vaping advocates Colin Mendelsohn and Alex Wodak were at it again in the Sydney Morning Herald yesterday with their usual litany of gloom about the apocalypse that starts from Oct 1 when anyone wanting to legally vape nicotine will need to have a prescription authorising purchase or imports.

Vaping advocates have had 15 months to spruik their message about the scheme to Australia’s 23,000 practising GPs, but have often lamented that only a handful have been willing to issue prescriptions, an option that has been allowed for several years already.

So how has it happened that nearly 100% of Australian GPs have apparently decided that prescribing vaping was not such a good idea? What do they know that our good doctors don’t? Perhaps they’ve read some of the 16 reviews and major cohort studies published since 2017 that say the evidence for vaping being good for quitting smoking is poor? Or one of the many reviews of cardio-respiratory disease markers that point to very worrying developments? (eg here, here, here)

Political support for vaping has always been dominated in Australia by the extreme right of politics. The 28 MPs who signed the Matt Canavan initiated letter included a who’s who of deep political conservatism, climate science denialism, sports rort facilitation and ex-Institute of Public Affairs staffers. Here’s the letter the 28 sent to Greg Hunt.

The Nationals received $55,000 from Philip Morris as “gold” level support in 2019-20. Money well spent!

Mendelsohn and Wodak suggest Australian politicians should be quaking about the uprising of angry vapers coming down the tracks, 3500 in every seat, who may tip out sitting members at the next election. That threat has worked so well in the past when at various elections the now fully politically plucked Liberal Democrats told vaping voters they would fix things for them. So who will these angry voters turn to? Not the LNP, who have given them the loathsome prescription scheme. Not Labor or the Greens who support it. Maybe One Nation? That seems like a plan.

British American Tobacco Australia’s lobbyist Michael Kauter (second from left) with Pauline Hanson

Australia might have 600,000 vapers now, they say. Of course no source is given for that nice fat number. It’s 80,000 above the 2019 National Drug Strategy Household Survey figure for the number of Australians who were “currently” vaping then. That “current” number included those who vaped less than monthly, so was about as meaningful as saying that we should count “current” French champagne drinkers as everyone who has as much as one glass in the last year.

There are 2.9 million Australians who smoke at all, with 2.3 million smoking daily. If, switching to vaping is the factor driving down smoking rates faster in the US and UK than in Australia, and our two numbers men say we might have 600,000 who vape today, then that’s a 21% fall in smoking prevalence they might predict when the next national survey is due next year. Nothing remotely like that has ever been recorded.

Of course this utterly fanciful stuff isn’t going to happen and it’s not happening in the UK or the USA where the evidence is that most vapers keep smoking and have higher rates of relapse back to smoking than quitters who don’t vape.

A 2019 US PATH longitudinal paper reported that former smokers who had quit a long time ago but who vaped were far more likely than those who had never vaped to relapse back to smoking and that vapers were far more likely than those who had never vaped to have transitioned from being never smokers to smokers:

“Distant former combustible cigarette smokers who reported e-cigarette past 30-day use (9.3%) and ever use (6.7%) were significantly more likely than those who had never used e-cigarettes (1.3%) to have relapsed to current combustible cigarette smoking at follow-up (P < .001). Never smokers who reported e-cigarette past 30-day use (25.6%) and ever use (13.9%) were significantly more likely than those who had never used e-cigarettes (2.1%) to have initiated combustible cigarette smoking (P < .001). Adults who reported past 30-day e-cigarette use (7.0%) and ever e-cigarette use (1.7%) were more likely than those who had never used e-cigarettes (0.3%) to have transitioned from never smokers to current combustible cigarette smokers (P < .001). E-cigarette use predicted combustible cigarette smoking in multivariable analyses controlling for covariates.

A 2020 paper from the ITC four country (Australia, USA, UK, Canada) survey found that after 18 months:

“smokers with established concurrent use [smoking and vaping] were not more likely to discontinue smoking compared to those not vaping … it is clear that the rates of transitioning away from smoking remain unacceptably low, and perhaps current vaping tools at best bring the likelihood of quitting up to comparable levels of less dependent smokers. The findings of our international study are consistent with the findings of the US PATH transition studies, and other observational studies, in that most smokers remain in a persistent state of cigarette use across time, particularly the daily smokers.”

But cigarettes don’t need a prescription!

Mendelsohn and Wodak reel off the argument that cigarettes are sold freely from 20,000 retail outlets while nicotine vapes require a prescription. How wrong is this, they ask. As I argued here, every conceivable error was made in allowing tobacco products to be sold freely from the nineteenth century onward. We’ve been pulling political teeth since the 1970s to win the suite of policy and legislation that today sees tobacco highly taxed, plain packaging, a total advertising and sponsorship ban, graphic health warnings, personal import bans, a duty free limit of one pack, universal smokefree legislation and the lowest adult and youth smoking rates ever recorded.

I do not recall either of them playing any role in the struggles for that. And I must have missed them editorialising for a ban on the sale of cigarettes.

The prescription model will allow adults who want to vape nicotine to do so, but will make it so much harder for kids to buy these products from vape shops and convenience stores where selling will attract huge fines.

The $220,000 fines for possession or importing without a prescription will of course never be applied to an individual vaper but are set as a maximum for industrial level importing and illegal sales, just as they would be for criminals importing commercial quantities of tax- evading tobacco or prescribable opiates. Without such serious deterrents, many would take their chances with getting a wrist-slap level fine.

The Herald’s sub-editor who captioned the photograph below accompanying their article got it very right, writing “Vaping can help accelerate smoking levels”. Every tobacco company in Australia is strongly opposed to the TGA’s prescription approach. That ought to tell us all we need to know.

Other blogs in this series:

Vaping theology: 1 The Cancer Council Australia takes huge donations from
cigarette retailers. WordPress 30 Jul, 2020

Vaping theology: 2 Tobacco control advocates help Big Tobacco. WordPress 12 Aug, 2020

Vaping theology: 3 Australia’s prescribed vaping model “privileges” Big Tobacco WordPress Feb 15, 2020

Vaping theology: 4 Many in tobacco control do not support open access to vapes because they are just protecting their jobs. WordPress 27 Feb 2021

Vaping theology: 5 I take money from China and Bloomberg to conduct bogus studies. WordPress 6 Mar, 2021

Vaping theology: 6 There’s nicotine in potatoes and tomatoes so should we restrict or ban them too? WordPress 9 Mar, 2021

Vaping theology: 7 Vaping prohibitionists have been punished, hurt, suffered and damaged by Big Tobacco WordPress 2 Jun, 2021

Vaping theology: 8 I hide behind troll account. WordPress 29 Jun, 2021

Vaping theology: 9 “Won’t somebody please think of the children”. WordPress 6 Sep, 2021

Vaping theology: 10: Almost all young people who vape regularly are already smokers before they tried vaping. WordPress 10 Sep, 2021

Vaping theology: 11 The sky is about to fall in as nicotine vaping starts to require a prescription in Australia. WordPress 28 Sep, 2021

Vaping theology: 12 Nicotine is not very addictive WordPress 3 Jan 2022

Vaping theology 13: Kids who try vaping and then start smoking,would have started smoking regardless. WordPress 20 Jan, 2023

Vaping theology 14: Policies that strictly regulate vaping will drive huge
numbers of vapers back to smoking, causing many deaths. WordPress 13 Feb, 2023

Vaping theology 15: The government’s prescription vape access scheme has failed, so let’s regulate and reward illegal sellers for what they’ve been doing. WordPress 27 Mar 2023

Vaping theology 16: “Humans are not rats, so everybody calm down about nicotine being harmful to teenage brains”. WordPress 13 Jul, 2023

Vaping theology 17: “Vaping advocates need to be civil, polite and respectful” … oh wait. WordPress 3 Oct, 2023

Vaping theology 18: Vaping is a fatally disruptive “Kodak moment” for smoking. WordPress Oct 30, 2023

Vaping theology 19: Vaping explosions are rare and those who mention them are hypocrites. WordPress 17 Nov, 2023

Vaping theology 20 : Today’s smokers are hard core nicotine dependent who’ve tried everything and failed – so they need vapes. WordPress 14 Dec, 2023

Vaping theology 21: Australia’s prescription vapes policy failed and saw rises in underage vaping and smoking. WordPress 10 Jan, 2024

Vaping theology 22: “Prohibition has never worked at any point for any other illicit substance”. WordPress 17 Mar 2024

Vaping theology 23: “84% of the Australian public are opposed to the way the government will regulate vapes” WordPress 2 Apr, 2024

Vaping Theology 24: “Tobacco control advocates are responsible for vape retail store fire bombings and murders. WordPress 27 May, 2024

Vaping theology: 10 “almost all young people who vape regularly are already smokers before they tried vaping”

10 Friday Sep 2021

Posted by Simon Chapman AO in Blog

≈ Leave a comment

On September 3, 2021 the very busy vaping advocate Dr Colin Mendelsohn published a blog on his website where he critiqued a large report in the Sydney Morning Herald on the inundation of disposable flavoured nicotine vaping products into Australia. Early in his blog, Mendelsohn made three statements about the prevalence of vaping in underage, young people.

1.“Official government figures show that underage vaping is rare in Australia, and frequent vaping is very rare. Less than two per cent of Australian teenagers vaped in 2019 and more than 90% had never tried vaping. News reports suggest vaping has increased since then but we have no data to confirm that, just ‘anecdotal’ reports.”

2. “What the article didn’t say is that almost all young people who vape regularly are already smokers before they tried vaping.”

3. “They also forgot to mention that most vaping is infrequent and short-term and one in three young vapers do it only once or twice.”

In his blog, Mendelsohn switches between two data sources, the National Drug Strategy Household Survey (NDSHS), conducted in 2019 and published in July 2020, and the Australian Secondary Students’ Alcohol and Drug (ASSAD) survey, conducted two years earlier in 2017.

Let’s look closely at how his statements align with what the two reports actually say.

Statement 1: Less than 2% of Australian teenagers vaped in 2019

Here, he links to the 2019 NDSHS as his source. There are 17 data tables on vaping in Australia at the NDSHS link. Table 2.19 shows any lifetime vaping (ie even experimental puffs) for 14-17 years olds at 9.6% and Table 2.24 that current use is 1.8%, a doubling since 2016.

Statement 2: That “almost all young people who vape regularly are already smokers before they tried vaping”

Here Mendelsohn linked the 2017 ASSAD schools survey to support his statement. But the ASSAD report states “Of the students who had ever used an e-cigarette (n = 2,403), 48% reported that they had never smoked a tobacco cigarette before their first vape”.

We can also look at the NDSHS data on this issue. Table 2.27 shows that 64.5% of 14-17 year olds who had vaped were never smokers when they initiated use of e-cigarettes.

So Mendelsohn is very wrong here regardless of which data set he might have chosen to support his assertion.

Statement 3: “most vaping is infrequent and short-term and one in three young vapers do it only once or twice.”

Mendelsohn again links to the NDSHS data to support this statement. Here it seems likely that he used Table 2.28 for support here because the “big” numbers in the table for “I only tried them once or twice” appear consistent with his claims. However it should be noted that Table 2.28 has no data specific to teenagers; it relates to all users aged “14 and over”. The definition of ‘current smoker’ used in this table includes ‘social smoker’ and ‘occasional smoker’ as well as ‘regular smoker’. This is important because some of the people included in that column may be young people who had only experimented with smoking in a very limited way. Relevant here, the ASSAD report found that “Of the students who had smoked before they tried e-cigarettes, 20% had only smoked a few puffs of a cigarette, 11% had smoked fewer than 10 cigarettes”.

The ASSAD report found:

that for all 12 to 17 year old students overall in 2017, around 14% indicated they had ever used an e-cigarette at least once, and 32% of these students had used one in the past month (Tables 3.11 and 3.12)

Of those who had tried e-cigarettes, younger students were more likely to have used them recently. Around 37% of 12 to 15 year old users and 27% of 16 and 17 year old users reported vaping at least once during the past month. Younger vapers were also more likely to have used e-cigarettes at least three times in the past month (12-15: 16%; 16-17: 10%).”

“Around 12% of students reported buying an e-cigarette themselves.”

The huge inundation of disposable flavoured vapes into Australia rapidly accelerated from mid-2020 and therefore are not reflected in the 2019 NDSHS data let alone the 2017 ASSAD data. If you Google “vaping in schools”, there are many reports of what Mendelsohn dismisses as anecdotes from school principals, teachers and parent, nearly all expressing alarm at the obvious surge in teenage vaping.

More blogs in this series: