Hard News by Russell Brown

25

E-cigarettes and the path of least harm

The government's announcement that e-cigarettes and the vaping liquid to go with them will be legalised and regulated is welcome. But it doesn't change as much as it might at first appear. And some of the changes it does make may not be the right ones.

A "nicotine e-cigarette", which is the phrase Minister Nicky Wagner has used, is exactly the same thing as a non-nicotine e-cigarette – and those have never been illegal. And even nicotine e-liquid has been on display and for sale in places like Karangahape Road for years. One of Shosha's Vapor World "concept stores" opened recently in the local laundromat here in Point Chevalier. No one has been prosecuted.

The decision not to apply an excise tax is welcome. Vaping isn't entirely harmless, but the evidence that is it vastly less harmful than smoking tobacco is now compelling. Harm-reduction principles dictate that it is a poor idea to penalise a much less harmful option.

But I'm less convinced by the decision to allow the sale of e-cigs and consumables from any retail premises. There's actually a humdrum reason for them to be available only from specialist premises and that's that keeping a vape in good order is a bit of a hobby. This is not perfect technology: batteries fail, coils get dirty and vapes leak. 

If your intention is to get people to switch from smoking, then it's important that the alternative actually works for them. Any current vape seller will tell you that customers returning to complain that their gear isn't working is quite a burden. A dairy owner's not going to be interested in offering the necessary advice.

A study published in the British Medical Journal last year found that e-cig use was reducing smoking prevelance in Britain. New data this month showed British smoking rates lower than ever – but also found that there are three times as many former e-cig users as current. Some of those will be people who've given up nicotine altogether, but responses suggest that most people try vaping as an alternative to smoking. You want it to stick for them.

There's also the issue that a vape used wrongly (eg, when near-empty, so the glycerol burns rather than vaporises) is more harmful than one used properly.

But there are other reasons. I get that there's more chance of a smoker switching if the alternative is widely availabe and visible, but it's still selling – and displaying – drugs in dairies. In Britain last year, four in 10 retailers were found to be selling e-cigarette products  to under 18 year-olds. (And yes, it is true that many young people are more interested in vapour than in nicotine and some prefer zero-nicotine liquids. They just like doing tricks with vapour.)

Yet the decision to allow display of e-cigarette products, rather than hide them like cigarettes is a sensible and practical one. You only need to step into a Shosha store to get an idea of the range of devices and consumables already on display. There's a reason for that. You can't buy a device without seeing and ideally touching it. And the differentiation of consumables – perhaps half a dozen brands, each with as many as 30 flavours and six concentrations (from zero to 24mg nicotine) – would make a display ban difficult.

But, as Professor Marewa Glover notes in the Science Media Centre's expert opinion roundup, the blanket decision to ban vaping wherever smoking is banned isn't entirely logical: it "sends a mixed message that vaping must be similarly dangerous which it is not." Wellington and Christchurch council housing tenancies are smokefree; so we'd be selling e-cigs in dairies to encourage smokers to quit – but not allowing those tenants the very real incentive of being able to use indoors?

One dimension of the debate that isn't getting a lot of air at the moment is that vaporising is potentially about more than cigarette replacement. If inhaling vapour is less harmful than inhaling burning tobacco smoke, then the same applies to cannabis smoke. The respective devices already sit next to each other on the shelves of vape stores.

It seems likely that for medical use at least, weed vaping will eventually be permitted in New Zealand. And perhaps sooner than you think: the Ministry of Health is looking at products from the Dutch-Canadian company Bedrocan, which offers both concentrated and whole-flower products, along with recommended vaporisers.

And there's more. Dr Paul Quigley at Wellington Hospital last year told me his team was seeing some meth and opiate users vaporising their drugs after dissolving them in e-liquid. It was, he thought, a reasonable form of harm reduction, esecially for the opiate users.

That could be where we get to in the long term: vaping as means of delivery for other drugs. And that would take us to the core question of all this: leaving all else aside, which path leads to the least harm?

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