Towards more practicable e‐cigarette regulation in Australia

Australia's prescription model should be replaced by a more practicable, tightly regulated consumer sales model that restricts sales to adults. I thank the commentators for their thoughtful responses to my article [1]. Sharon Cox [2] agrees that Australia's prescription model has not achieved its aims. She highlights its adverse effects on social equity because smoking in Australia and other countries is increasingly concentrated among the most socially disadvantaged. Adults who smoke and wish to vape in Australia have resorted to the illicit market to obtain unregulated e-cigarettes and those who smoke cigarettes increasingly purchase smuggled cigarettes and illicitly grown and poorly processed loose tobacco [3]. Sharon Gravely & Geoff Fong [4] agree that Australia's prescription model has not worked because health professionals have been reluctant to prescribe e-cigarettes, and smokers have been discouraged by the expense and inconvenience of obtaining prescriptions. They point out that the public health impact of e-cigarettes depends critically on the extents to which e-cigarettes replace combustible cigarettes and increase adolescent nicotine use and smoking. As they note, Cochrane reviews show that e-cigarettes can assist smokers to quit, but epidemiological studies indicate that substantial proportions of e-cigarette users continue to smoke cigarettes. These 'dual users' need to be strongly encouraged to fully switch to e-cigarettes, a difficult task in Australia when some health officials misleadingly claim that vaping is 'at least as harmful' as cigarette smoking [5]. Becky Freeman [6] supports Australia's prescription model because she believes that 'addictive and harmful vapes' should 'never be sold as a consumer good'. She neglects the fact that addictive and maximally harmful combustible cigarettes are sold as consumer goods in those outlets that the prescription model prevents vapes from being sold, i.e. convenience stores, supermarkets and petrol stations. Ideally, we should not allow the sale of any tobacco and nicotine products in these retail outlets. Becky Freeman misrepresents Australia's choice of an e-cigarette policy as one between (a) allowing the sale of vapes wherever cigarettes are sold and (b) adopting a prescription model. This is a false choice, for the reasons given in my article [1]. We should limit the sale of e-cigarettes and combustible cigarettes to adult-only retail outlets, such as licensed tobacconists, and require CCTV monitoring of sales to minimize sales to adolescents. Since my article was written, the Australian Senate has rejected the legislation to enact a prescription model and instead passed a bill that allows e-cigarettes to be sold in pharmacies [7]. The pharmacy profession quickly rejected this model, citing the supposed lack of evidence for the effectiveness of e-cigarettes in smoking cessation, and the absence of any vaping products approved by Australia's drug regulator, the Therapeutic Goods Administration, for them to sell [8]. Australia's 'world leading' attempt to impose a prescription model on 1 million plus vapers is in disarray. One can hope that an unworkable prescription model will be replaced by a more practicable model that would enable adults who smoke cigarette to access e-cigarettes while minimizing adolescent access. There are no funders to report. None.