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.