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Select Committee on Tobacco Harm Reduction The Senate Select Committee on Tobacco Harm Reduction Report December 2020 © Commonwealth of Australia 2020 ISBN 978-1-76093-170-4 This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License. The details of this licence are available on the Creative Commons website: https://creativecommons.org/licenses/by-nc-nd/4.0/. Printed by the Senate Printing Unit, Parliament House, Canberra. Contents Committee membership ...................................................................................................................... Committee report by the majority ................................................................................................. 1 Chapter 1—Introduction .................................................................................................................... 2 Conduct of the inquiry ........................................................................................................................ 3 World Health Organisation Guidelines ............................................................................................ 4 What are electronic cigarettes? ........................................................................................................... 5 Previous inquiries ................................................................................................................................ 7 Acknowledgements ............................................................................................................................ 7 References to Hansard ......................................................................................................................... 7 Structure of the report ......................................................................................................................... 7 Chapter 2—The Australian context ................................................................................................. 9 Introduction .......................................................................................................................................... 9 Tobacco smoking in Australia ............................................................................................................ 9 Use of e-cigarettes .............................................................................................................................. 10 The Australian Government's position on e-cigarettes ................................................................ 11 Regulation as a therapeutic good .................................................................................................... 13 Access to unapproved therapeutic goods ........................................................................... 15 Pathway for approval ............................................................................................................. 16 Relevant decisions of the Therapeutic Goods Administration ........................................ 17 Proposal to prohibit the importation of e-cigarettes containing nicotine ....................... 19 Chapter 3—Jurisdictional comparison .......................................................................................... 21 Overview ............................................................................................................................................. 21 World Health Organization .............................................................................................................. 21 Regulatory responses to e-cigarettes in other jurisdictions ......................................................... 22 New Zealand ........................................................................................................................... 24 The United States .................................................................................................................... 26 The European Union .............................................................................................................. 28 The United Kingdom……………………………………………………………………….. 28 iii Chapter 4—Issues .............................................................................................................................. 31 Harm reduction .................................................................................................................................. 32 Personal experience of e-cigarette use ................................................................................. 34 The health impacts of e-cigarettes ........................................................................................ 36 Negative impacts ................................................................................................................................ 43 Uptake by youth and non-smokers and the 'gateway effect' ........................................... 43 Nicotine toxicity ...................................................................................................................... 47 Dual use .................................................................................................................................... 50 E-cigarettes and smoking cessation ................................................................................................. 52 The evidence on smoking cessation ..................................................................................... 55 Impact of e-cigarettes on smoking prevalence ................................................................... 58 The role of the tobacco industry ...................................................................................................... 59 Chapter 5—Regulatory approaches ............................................................................................... 63 Evidence received on the prescription-based model .................................................................... 63 Regulation as a consumer good ....................................................................................................... 71 Restrictions .......................................................................................................................................... 75 Restrictions on sale and distribution .................................................................................... 75 Restrictions on promotion and advertising ........................................................................ 77 Product quality and safety..................................................................................................... 79 Restrictions on the use of flavours and other ingredients ................................................ 80 Chapter 6—Committee view ........................................................................................................... 83 Renewed efforts to reduce smoking prevalence ................................................................ 86 Senator the Hon Sarah Henderson's additional comments ...................................................... 91 Senator Griff's additional comments ............................................................................................ 97 Australian Greens' additional comments ................................................................................... 105 Chair's report.................................................................................................................................... 113 Chair's foreword .............................................................................................................................. 115 Chapter 1 - Introduction ................................................................................................................ 117 Chapter 2 - The Australian context .............................................................................................. 123 Chapter 3 - Jurisdictional comparison ........................................................................................ 135 Chapter 4 - Personal accounts ....................................................................................................... 143 Chapter 5 - Issues ............................................................................................................................ 179 iv Chapter 6 - Regulatory approaches .............................................................................................. 203 Chapter 7 - Chair's view ................................................................................................................. 225 Appendix 1—Submissions, answers to questions on notice and additional documents . 235 Appendix 2—Public hearings ....................................................................................................... 263 v Committee membership Chair Senator Hollie Hughes LP, NSW Deputy Chair Senator Tony Sheldon ALP, NSW Members Senator the Hon Matthew Canavan NATS, QLD Senator the Hon Sarah Henderson LP, VIC Senator Anne Urquhart ALP, TAS Senator Stirling Griff CA, SA Participating members Senator Rachel Siewert AG, WA Department of the Senate Ph: 02 6277 3555 PO Box 6100 Fax: 02 6277 5719 Parliament House E-mail: [email protected] Canberra ACT 2600 Web: www.aph.gov.au/select_tobaccoharmreduction vi Committee Report by the Majority 1 2 Chapter 1 Introduction 1.1 On 6 October 2020, the Senate established the Select Committee on Tobacco Harm Reduction (the committee) to inquire into
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