Committee Secretary, Select Committee on Harm Reduction Department of the Senate PO Box 6100 Parliament House CANBERRA ACT 2600 AUSTRALIA

22nd October 2020

Contents

Submission Introduction Summary Key points – Tobacco Harm – Harm Reduction Using Vaping How Can Be Addressed (My Recommendations) Discussion – Tobacco Harm – Harm Reduction With Vaping – Anti-vapes Propaganda and Bias – Involvement in the Selling and Marketing of E- References

Submission Introduction

I’m deeply concerned about health and welfare harms resulting from the ongoing high levels of prevalence in Australia, and the influence of an entrenched toxic tobacco ecosystem that has worked tenaciously in its own self-interest to stop the technological innovation of vaping being legally available to disrupt legacy tobacco toxic smoking. I thus welcome the reconsideration of vapes legislation by the Senate.

Whilst not a smoker nor a vaper, I have witnessed disability, disease and deaths from toxic smoking in my immediate family, and therefore I’m motivated to make a submission at this time since the dead can’t speak for themselves nor for future generations.

My father died aged 66, from cancer, from regular smoking. My first wife died aged 68, from cancer, from regular smoking. My aunt, toddler , died aged 2, burned alive when playing with matches left with tobacco on a kitchen table.

I have witnessed my adult son, addicted to tobacco, quit smoking as an early adopter of vaping, after being diagnosed with chronic obstructive pulmonary disease and prescription medicated. In prior quitting attempts quit pharmaceuticals and Varenicline were ineffective and had significant side effects. Subsequently, after 8 years of vaping his lung function is much improved and unmedicated 6 years. He is now vaping 0.8% e- liquid having begun with a stronger 1.8% nicotine e-liquid. Both of us dread him either being pushed back to toxic cigarettes by the banning of personal importation and the Government’s de facto reckless and risk- disproportionate prohibition of vapes, or resorting to the criminal black-market’s dangerous e-solution supply.

Summary

Tobacco harm reduction is a ‘no brainer’ as signalled by contemporary vaping regulations in other countries including New Zealand, Canada, United Kingdom, United States of America and European Union countries.

The magnitude of known tobacco health and welfare harms warrants a more effective tobacco mitigation strategy, and vaping should be part of a rational solution, as is now being experienced in other like countries.

Vapes should be available without being absurdly restricted more than toxic cigarettes are.

A tobacco harms crisis of 56 years duration, to date, seems too long a crisis to endure, by far.

Submission to The Senate Select Committee on Tobacco Harm Reduction – RIS October 2020 Page 1

Key points

Tobacco Harm

The known health harms of tobacco are unequivocally established and well known since 1964.

In Australia each year there are in the order of 20,000 deaths, 1.7 million hospital inpatient episodes and $136 billion in social costs, caused by the past and current smoking of toxic tobacco.

The right to health is a fundamental human right, enshrined in international laws and United Nations treaties. Government core obligations should facilitate health, not unnecessarily and recklessly block it.

Vaping regulations should rationally consider the appropriate mitigation of toxic harms.

Harm Reduction Using Vaping

There is a compelling case for Australia to ease unjustified and risk-disproportionate vaping restrictions and implement much more carefully balanced, finessed and proportionate regulations that protect and satisfy vaping consumers without compromising the considerable potential benefits of toxic tobacco harm reduction.

Regulatory strategy should take a balanced and realistic approach in seeking to ensure product safety, enable and encourage smokers to use vaping instead of smoking tobacco, and detect and prevent effects that inhibit the overall goals of mitigating unacceptable and certain tobacco health and welfare harms.

Nicotine e-liquids are not medicines and therapeutic claims cannot be realistically made about them, so it is inappropriate that the Therapeutic Goods Administration(TGA) intends to heavy-handedly and radically medicalise the consumer supply of vapes (but significantly, while exempting unquestionably toxic cigarettes).

Safety standards are needed to ensure that consistently high quality vaping liquids are available for adult smokers who wish to switch to vaping innovation as a substitute for deadly toxic smoking. Packaging and labelling standards can also reduce unsafe e-liquids access by children and minimise the rare accidental risk in the poisoning of both children and adults.

Nicotine is addictive but is relatively benign in the low concentrations used for vaping, so e-liquids don’t meet the medical criteria required for e-liquids inclusion in the Poisons Standard, when nicotine is specifically exempted for 20 times more unsafe tobacco. Furthermore there are over 100 nicotine based quit pharmaceuticals that are considered safe by the TGA to be registered therapeutics for retail sale.

Reducing the use of all nicotine-related products, including vapes, amongst youths is important, but this should not be achieved by eliminating legal tobacco harm reduction for adults and by unconscionably pushing more people to slaughtering resumption of toxic smoking, which is at least 20 times more unsafe.

How Tobacco Harm Reduction Can Be Addressed (My Recommendations)

1. Exempt nicotine e-liquid in concentrations ≤ 2 % for vaping from the Poisons Standard as per tobacco packaged for smoking, Schedule 7 exemption; 2. Regulate nicotine e-liquid by the Australian Competition and Consumer Commission as for tobacco, not by the TGA, as presently; 3. Establish mandatory safety and quality standards for nicotine liquids; 4. Limit e-liquid refill container capacity to 10ml, consistent with EU regulation; 5. Do not restrict vapes more than what restrictions apply to retail cigarettes sales, and allow availability where ever tobacco is retailed; 6. Licence specialist vape shops (like tobacconists), to facilitate specialist knowledge and vaper support; 7. Raise tobacco harm reduction messaging to increase awareness of the health risks of vapes relative to smoking toxic tobacco; 8. Set an Australian smoking prevalence smoking reduction target of <5 % by 2025, as per New Zealand.

Submission to The Senate Select Committee on Tobacco Harm Reduction – RIS October 2020 Page 2

Discussion

Tobacco Harm

Harm from smoking is caused by the thousands of toxic chemicals and tars released when tobacco is burned.

Scientific evidence has unequivocally established that tobacco consumption and exposure to tobacco smoke cause death, disease and disability, and that there is a time lag between the exposure to smoking and the onset of tobacco-related diseases, WHO Framework Convention On (FCTC), 2003.

Smoking is the biggest avoidable cause of death, disability and social inequality in health, in Australia.

In 12 months (financial year 2015/16) there were 20,032 deaths from smoking-related causes in Australia, about 1.7 million smoking-related hospital inpatient episodes and $136.9 billion of costs. ‘Identifying the Social Costs of Tobacco Use to Australia in 2015/16’3, Robert J.Tait et al, The National Drug Research Institute, Curtin University, 2019. The potential, need and urgency of tobacco harm reduction is clear.

A total of over 4,500 accidental fires of all types caused by cigarettes were identified in the 2015/16 year.

22% of all cancers are due to tobacco smoking, ’Cancer in Australia 2019’, Australian Institute of Health and Welfare, March 20194. The vast majority of lung cancers are the consequence of smoking.

Harm Reduction with Vaping

Most of the toxins known to be formed when tobacco is burned are either absent or are present at very low levels in e-liquid vapour. Many studies find cancer potencies in e-liquid vapour to be <1 % of tobacco smoke.

The UK Royal College of Physicians and Public Health England (RCP) estimated that long-term vaping is unlikely to be more than 5% of the risk of smoking - the possibility of some as yet unknown harm from long-term e- cigarette use cannot be dismissed due to inhalation of ingredients other than nicotine, but is likely to be very small, and substantially smaller than that arising from tobacco smoking, and at levels that are unlikely to cause harm. E-cigarettes are marketed as consumer products and are proving much more popular than NRT as a substitute and competitor for tobacco cigarettes.

E-cigarettes and long-term harm - The RCP’s' report, ‘Nicotine without smoke: tobacco harm reduction’ 20162, has concluded that e-cigarettes are likely to be beneficial to UK public health. The RCP have confirmed this conclusion each year since 2016, including in its 2020 update report7.

Modelling and simulation studies have predicted a significant net long-term public health benefit.

Vaping provides the nicotine smokers are addicted to, as well as hand-to-mouth ritual and sensations, and social aspects of smoking. Making it a satisfying alternative to cigarettes for smokers, if conveniently available.

It is certain that many habituated smokers have succeeded in quitting to smoke simply by substituting vapes for toxic cigarettes. Most studies find vaping more effective than nicotine pharmaceuticals quitting methods.

Vaping is almost exclusively used by smokers and ex-smokers. Suggestion that it’s encouragement to take-up smoking fails the test of reality. Vapes are a gateway FROM toxic smokes, not an ‘on-ramp’ to smoking.

Public Health England, Cancer Research UK, British Lung Foundation and many others are all clear that – vaping isn’t completely risk free, but it is far less harmful than smoking toxic tobacco and has helped millions of smokers quit. In the UK there are approximately 4 million vapers, and worldwide over 40 million.

Cigarette look-alike vaping products are undesirable and dangerous vaping liquids should be banned.

Vaping may not be perfect in suppressing smoking harms, but it’s an excellent risk - benefit choice to make.

Submission to The Senate Select Committee on Tobacco Harm Reduction – RIS October 2020 Page 3

Anti-vapes Propaganda and Bias

The USA is not a signatory to the FCTC owing to the political power of the USA tobacco industry. Much of the same power is also being used to covertly protect toxic tobacco sales across the World. Vaping is a direct threat to tobacco sales and as a consequence, fake ‘research’, biased reviews, anti-vaping propaganda, science quack- , disguised shilling and political lobbying are now ubiquitous, in attempts to restrict vapes.

It’s distressing to observe an Australian toxic tobacco ecosystem, which includes Big Pharma and ‘quit NGOs’, seize on propaganda to protect self-interests in government funding and nicotine pharmaceutical sales exclusiveness. This despite the tobacco harm reduction concept being specifically endorsed in FCTC - Article 1.

TGA bias example, June 2020: “Why is the government introducing this [vaping] regulation? The [Victorian Poisons Information Centre] VPIC reported 41 cases of liquid nicotine poisonings in 2019, up from 21 in 2018. In July 2018, a Victorian toddler died from e-cigarette liquid” - The truth of the matter (ref. Baby J. Coronial Inquest 2018 27735) is a Victorian baby was killed by drinking dangerous black-market nicotine concentrate being used to home manufacture e-liquid by a mum. A deadly and predictable outcome from the TGA’s historical inappropriate poison scheduling of low strength nicotine e-liquid. - Non-disingenuous analysis of the 33,695 VPIC cases for 20186 shows the liquid nicotine poisonings issue is exaggerated when compared to the magnitude of other cases not initiating bans: soap 280 , aspirin 239, Ibuprofen 1,326, fragrant oil/potpourri 194, air fresheners 122, sunscreen/suntan 99, antismoking (, lozenges, patches; varenicline) 79, caffeine 47, cigarettes & tobacco 145, pens/ink (including stamp pad ink, textas) 194, chest rubs 118 … (the 2019 VPIC statistics are not yet published).

Tobacco Industry Involvement in the Selling and Marketing of E-cigarettes

Frankly, if Big Tobacco is selling vapes (that are not cigarette look-a-likes) then this diversification from toxic tobacco would be great news and good progress, as it’s means less lethal tobacco sold and consequent less harms. It evidences tobacco harm reduction.

It’s usual that when waring countries stop shooting/bombing then normality soon resumes, rather than unnecessary hatred let ferment and influence good decisions. The ‘Tobacco Wars’ seem an exception to peace. It may be reasonable to insist a tobacco company stops selling cigarettes altogether if electing to sell vapes.

I cannot imagine how selling vapes by anyone undermines wider tobacco control work, indeed the exact opposite, as tobacco harm reduction is obvious.

References

1. ‘Regulation of nicotine e-liquids for vaping in Australia - a discussion paper’. ATHRA, September 2020 https://www.athra.org.au/wp-content/uploads/2020/10/ATHRA-Vaping-Discussion-Paper-8Sept2020.pdf 2. ‘Nicotine without smoke: tobacco harm reduction’, UK Royal College of Physicians, April 2016 https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction 3. ‘Identifying the Social Costs of Tobacco Use to Australia in 2015/16’, Robert J.Tait, Steve Whetton & Steve Allsop, The National Drug Research Institute at Curtin University, May 2019 https://ndri.curtin.edu.au/ndri/media/documents/publications/T273.pdf 4. ‘Cancer in Australia 2019’, Australian Institute of Health and Welfare, March 2019 https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2019 5. Coronial Inquest Baby J. Victoria 2018 https://www.coronerscourt.vic.gov.au/sites/default/files/2019-07/Baby%20J_277318.pdf 6. Austin Health, Victorian Poisons Information Centre Annual Report 2018 https://www.austin.org.au/Assets/Files/VPIC%20Annual%20Report%202018.pdf 7. ‘Vaping in England: an evidence update including mental health and pregnancy, March 2020’, PHE https://www.gov.uk/government/publications/vaping-in-england-evidence-update-march-2020/vaping-in-england-2020- evidence-update-summary

Submission to The Senate Select Committee on Tobacco Harm Reduction – RIS October 2020 Page 4