From 1 October, Australians who use e-cigarettes and other vaping products containing nicotine will need a prescription to buy from a local pharmacy or order them from overseas.
But there is another evidence-based way to help more smokers quit that Australia has yet to act on: reducing the nicotine in cigarettes to non-addictive levels. And e-cigarettes can play an important role in this policy.
If you know someone who’s ever tried and failed to quit smoking, that’s probably the reason nicotine addiction hit them so hard. While nicotine itself is not a significant direct cause of health damage from smoking, it does make tobacco products highly addictive. In 1963, lawyers for the tobacco industry wrote:
it is us […] In the business of selling the addictive drug nicotine.
So what are other countries doing to reduce nicotine addiction? What role can alternative nicotine products, including e-cigarettes, play, and how can nicotine in cigarettes be reduced if not managed well? And how likely is a new very low nicotine standard for cigarettes to end Australians’ smoking addiction?
Read more: From October, rape will be impossible for most Australians, but mainly because of Canberra’s little-known ‘homework police’.
How other countries are dealing with the global killer
Most people know someone who has died from smoking or developed serious health problems.
Even today, smoking remains the leading cause of early death in Australia, killing more than 20,000 Australians each year. This causes a loss of $ 136.9 billion annually to the Australian economy.
That’s why many countries, including Australia, are setting the goal of reducing smoking to very low levels. But new approaches are needed to achieve this goal.
The proposal to reduce nicotine levels in cigarettes to non-addictive levels was first proposed by the US Food and Drug Administration in 1994. Although it was not implemented at the time, there has been renewed interest in the policy.
New Zealand recently proposed a nicotine reduction strategy as an alternative to its Smokefree Aotearoa 2025 Action Plan.
US President Joe Biden’s administration is also considering a US Food and Drug Administration proposal to reduce nicotine levels to “give addicted users the option and ability to quit more easily”.
The World Health Organization supports a global nicotine reduction strategy and provides recommendations for implementing it.
The good news is that it is possible to reduce the level of nicotine in cigarettes, and such cigarettes have already been tested in clinical trials.
Results showed that people smoke fewer cigarettes when given where nicotine levels are reduced by 95% or more compared to regular cigarettes. They are also more likely to quit smoking. This is because people who smoke regularly find cigarettes with very low levels of nicotine less enjoyable and beneficial.
While it is not ethical to conduct similar studies with youth who do not already smoke, reducing nicotine levels is also expected to reduce the number of adolescents who become addicted to smoking, promising results from animal studies. See you.
How can alternative nicotine products help?
Allowing only cigarettes with very low nicotine content to be sold would require increased smoking cessation services and support, such as nicotine replacement therapy (including patches and gum), prescription medications, and treats from healthcare professionals. related support.
A nicotine reduction policy for tobacco products has been made more feasible by Australian government changes to how smokers can use e-cigarettes containing nicotine from 1 October 2021.
Although not harmless, e-cigarettes are likely to be significantly less harmful than smoked tobacco products. They may provide an alternative source of nicotine for people who are nicotine dependent, and have been shown to increase quitting compared to nicotine replacement therapy.
Read more: E-cigarettes: misconceptions about their dangers are keeping people from quitting smoking
Ensuring access to low-risk forms of nicotine is central to policies being considered by both New Zealand and the United States.
But nicotine reduction policy has potentially unintended consequences. Many people have misconceptions about nicotine and there is a risk that people may assume that low-nicotine cigarettes are less harmful than regular cigarettes. This can reduce the motivation to quit smoking.
So we will also need a health education campaign that encourages people to quit smoking tobacco, and warns of the harms of continued smoking, regardless of nicotine content.
Another risk is the growth in the illegal tobacco market, which will need to be monitored with greater enforcement efforts.
Policymakers may also be concerned about the growing legal challenges facing the tobacco industry. However, Australia’s successful defense of tobacco plain packaging laws shows that such industry challenges can be overcome.
Making it Easier to Quit—and Stop Kids from Getting Addicted Ever
Michael Russell, the founder of the medical approach to helping people quit smoking, famously said that if nicotine is removed from cigarettes, people will be “slightly more inclined to smoke a cigarette than to blow a bubble or a light fluff.” “.
Modeling suggests that mandating very low nicotine levels for cigarettes would give New Zealand a “realistic chance” of reaching its goal of smoking less than 5% of the population. It is estimated that 24 million deaths in the United States could have been prevented if the nicotine in cigarettes had been reduced decades ago.
If we make tobacco smoking less addictive, we can prevent a new generation from becoming addicted to smoking and help those who currently smoke quit. And that’s a good thing, given the high cost of cigarettes and their contribution to health inequalities in Australia.
Australia led the world in tobacco policy by introducing tobacco plain packaging laws. Taking the lead in new tobacco control policies, such as reducing addiction to tobacco products, can help us achieve a smoke-free Australia.
But does Australia have the key ingredient – the political will – to accomplish the task?