Footnotes and references are included in the original document; they didn't transfer over in a copy and paste. Response to Proposed New Laws for Personal Vaporisers (Electronic Cigarettes), Tobacco Licensing, and Smoking Bans. A Regulatory Impact Statement. From: Dr Attila Danko, President, New Nicotine Alliance, Australia firstname.lastname@example.org PO Box 3 Chelsea Vic 3196 Tel: 0428 412 353 To: Tasmanian Government Dept. of Health and Human Services email@example.com The New Nicotine Alliance (AU) is a group formed by Australian consumers of reduced risk nicotine products (including electronic cigarettes) and health professionals which has strong links to the UK based group of the same name. We recieve no funding directly or indirectly from any e-cigarette, tobacco or pharmaceutical company. The choices for regulation presented in the Regulatory Impact Statement are flawed due to the presumption that personal vapourisers are only a threat to Public Health. Evidence that demonstrates personal vapourisers are a Public Health opportunity to substitute for smoking with a less harmful alternative is ignored. Proportional regulation to maximise the benefits and minimise the risks is not presented as an option. As we are limited to the 5 options outlined in the Regulatory Impact Statement the least worst option in the view of the NNA AU is option 3: Do Nothing. Most people who use Personal Vapourisers are smokers who use them to quit or reduce smoking. No personal vapouriser or e-cigarette sold in Australia comes from a tobacco company. Every sale and use of a personal vapouriser product in Australia therefore represents a loss to tobacco companies. The proposed legislation claims to be aimed at reducing smoking, but these laws perversely protect tobacco companies from competition and supports higher smoking rates in the community by making it harder to vape than to smoke. The RIS almost exclusively relies on World Health Organisation statements for it’s rationale for increased restrictions on personal vapourisers. Not only are there significant and authoritative evidence based critiques of the WHO’s position, the RIS ignores recent changes in the WHO position that are more positive towards personal vapourisers. For example, the latest WHO document presented at the FCTC/COP7 convention in November 2016 on personal vapouriser regulation contained this statement: “ If the great majority of tobacco smokers who are unable or unwilling to quit would switch without delay to using an alternative source of nicotine with lower health risks, and eventually stop using it, this would represent a significant contemporary public health achievement.” Presumption 1. Restricting and reducing e-cigarette use reduces smoking. From first principles, the idea that reducing the use of one product reduces the use of another product that serves the same need is extraordinary. It is as nonsensical as saying reducing the use of energy from solar and windfarms will reduce the use of fossil fuels. Extraordinary claims require extraordinary evidence, and the people fighting against e-cigarettes have not produced this evidence. Australia claims to be a world leader in tobacco control, however the latest evidence shows we are falling behind by our refusal to embrace harm reduction as part of the strategies to reduce smoking. Notably, Canada, where e-cigarette use has always been more common and less regulated than in Australia are now looking at further liberalisation and de-regulation. They just published figures on their daily smoking rates which are now at 9%, significantly lower than Australia’s last reported daily smoking rates of 13%. Every country which allows e-cigarette sale and use has a falling prevalence of smoking, and largely at a faster rate than Australia. It is as you would expect, like countries that embrace wind and solar power see falling rates of fossil fuel use. The idea that strong tobacco control requires strong action against e-cigarettes comes from an ideology that demonises all nicotine use outside a medical model. Policy needs to be based on evidence, not on ideology. We should not sacrifice the lives of smokers for the sake of ideology. Presumption 2. Reducing e-cigarette use reduces teenage smoking. There is a legitimate concern among people in Public Health that e-cigarette use could be a gateway to smoking in teenagers. However, in the UK, where Public Health and Tobacco Control is very positive and encouraging about e-cigarette use, rates of regular use of e-cigarettes by never smoking youth is extremely rare, at 0.3% or less. There is a lot of experimental use, but this is likely to be a diversion from experimenting with much more addictive and harmful cigarettes. There is much evidence for e-cigarettes being a gateway out of smoking, and very poor and limited evidence for it being a gateway in to smoking. Nevertheless, we are not opposed to e-cigarettes being regulated as adult only products. Presumption 3. E-cigarette use is toxic with significant second hand vapor risks. No scientist, even the most skeptical, credibly disputes the idea that electronic cigarettes are far less harmful than combustible cigarettes as explained in the most comprehensive scientific review on their toxicology so far. It has been long recognised that nicotine away from smoke is fairly benign and this is reflected in the rational widespread availability of pharmaceutical nicotine products in many stores and supermarkets which are available for purchase by anyone, even children. Clinical studies on e-cigarettes also confirm they are far safer than smoking. A recent study shows that quitting smoking via e-cigarettes leads to harm reversal, with clinical indicators of lung function significantly improving and effects on the heart not being detectable compared with the clear detrimental effects of cigarette smoking. Second hand vapor is a tiny fraction of direct vapor, and there is no credible evidence to suggest it is a risk for bystanders. Lumping e-cigarettes into smoke free legislation is not rational as there is no smoke. Fog machines create similar emissions to e-cigarette vapour but in larger amounts and yet there is no call to ban their use indoors. There is a Public Health benefit in allowing at least some indoor vaping to send a public health message that vaping is far safer than smoking and this is the policy adopted by Public Health in the UK. The UK also accepts that vapers should not be forced to the same areas as smokers, this is like forcing ex-alcoholics to have AA meetings in a pub, and increases the risk of relapse to smoking, as well as increasing exposure to second hand smoke. Presumption 4. Putting the same restrictions on sale and display of e-cigarettes will be beneficial in stopping never smokers from buying them, and therefore enhance tobacco control. This rests on the presumption that reducing e-cigarette use reduces smoking, which we have shown to be without evidence. This is the most damaging proposal in the proposed regulations, in that it unintentionally gives a competitive advantage to tobacco cigarettes and protects tobacco sales and tobacco company profits. It demonstrates a lack of knowledge of modern e-cigarettes and vapor products, what they are, and how they are used. Standard, deadly cigarettes are easy to use. It does not matter that their use cannot be demonstrated. However, it is crucial that when a smoker is wanting to switch to the use of vapourisers that they be instructed in their safe and effective use. Different models appeal to different people, and the effectiveness of them is largely that they provide an attractive and enjoyable substitute for smoking. This requires that the devices be able to be shown and demonstrated. Applying the same rules to vapourisers as apply to cigarettes mean that a customer must choose which device they want without the ability to use or have them demonstrated to them. Many are complex and people need instruction in their safe and effective use, how to adjust the voltage, airflow, how to refill and change coils, etc. In the frustration of not being allowed to have help from a vape shop, they will likely simply return to the familiar but deadly cigarette. Currently, the only stores that can continue to display some tobacco products are specialist tobacco retailers. Under the proposed regulations if they choose to sell e-cigarettes then this concession will be withdrawn. This makes no sense, and seems aimed at making sure that rules on the display and demonstration of vapouriser devices are harsher than the rules for tobacco. This provision gives a competitive advantage to smoked tobacco, and supports the deadly tobacco industry. Toxic combustible cigarettes are at present available everywhere. Only a very few dedicated vape shops exist in Tasmania due to the uncertain regulatory environment. Advanced generation electronic cigarettes, sold through dedicated vaping shops, are associated with very high verified smoking cessation rates of 40-66% Dedicated vaping shops therefore behave as de-facto ‘stop smoking’ centres with a financial interest in helping people transition completely and with success rates equal to or greater than standard smoking cessation clinics. They achieve this at no cost to the taxpayer, indeed they have a net positive economic impact by creating an industry and jobs. They appeal to people who would never access standard smoking cessation clinics and therefore are additive to cessation success in a population. Making the regulation more certain and relaxed around these products would encourage more dedicated vape shops to open and directly compete with toxic combustible tobacco products. We appeal for regulations that allow the display, demonstration and trial use within specialist vape shops, which may be made adult only venues to minimise any risks. In summary, we recommend proportionate regulation of electronic cigarettes in Tasmania. They should be lightly regulated to encourage accessibility, availability and use by adult smokers to help them reduce and cease smoking and to prevent relapse to smoking. It should be made easier to vape than to smoke; these proposals perpetuate the smoking epidemic by making it easier to smoke than to vape.