Should vaping, snus and heat-not-burn tobacco devices be legalised? – Expert reaction

A new report from the New Zealand Initiative think tank argues that quitting cold turkey doesn’t work for all smokers and less harmful alternatives should be encouraged.

Rather than continuing to raise taxes on cigarettes, they recommend encouraging smokers to switch to harm-reduced alternatives like e-cigarettes and snus.

The SMC gathered expert reaction on the report.

ASPIRE 2025 co-directors and Professors of Public Health, Richard Edwards and Janet Hoek, University of Otago Wellington, comment:

“Ms Jerram’s report correctly notes that we require new measures to support smokers to quit smoking if we are to reach the Smokefree 2025 goal. However, she focuses solely on promoting greater availability of alternative tobacco products to combustible cigarettes. She dismisses evidence-based public health measures that have substantially reduced smoking prevalence in New Zealand and around the world, and that could continue to help prompt and support smoking cessation.

“She fails to address the need to reduce the continuing high rate of uptake of smoking among youth and young adults, which is sustaining the current epidemic of smoking-related disease. Instead, the NZ Initiative report recommends introducing products of uncertain effectiveness and toxicity with minimal regulation of advertising, availability and packaging. Such products are relatively expensive and have generally been promoted internationally as ‘premium products’.

“As a result, any effects on supporting quitting would likely have minimal impact on disadvantaged smokers, including many Māori and Pacific smokers, where the realisation of the Smokefree 2025 is most elusive.

“The dismissal of effective public health measures is perhaps unsurprising for a group funded in part by the three largest tobacco companies operating in New Zealand (British American Tobacco, Imperial Tobacco and Philip Morris). These are the companies already making or developing the ‘Heat not Burn’ products that the report promotes.

“We recommend that readers refer to an action plan developed following broad consultation with the New Zealand tobacco control sector. This sets out a multi-faceted strategy comprising an intensification of current approaches, including enhanced support for smokers wishing to quit; implementation of cutting-edge methods to reduce the affordability, availability, appeal and addictiveness of smoked tobacco products, and making nicotine-containing e-cigarettes and e-liquids widely available to smokers who wish to use them to help quit or as substitutes for smoking if they cannot or do not wish to quit.

“This comprehensive and evidence-based plan is far more likely to succeed than a limited approach that seems inspired more by the corporate interests of its backers than any real desire to achieve the Smokefree 2025 goal. It is difficult to view Ms Jerram’s report as anything other than ‘prugging’ – PR under the guise of research.”

No conflicts of interest to report.

Dr Penelope Truman, Senior Lecturer, School of Health Sciences, Massey University, comments:

“I welcome this policy input from the New Zealand Initiative.

“New Zealand has been at the forefront of tobacco control initiatives, with strong and largely successful policies in such matters as tobacco tax increases, restrictions on the places where people can smoke, restricting point of sale displays and, recently, introducing plain packaging.

“However, decreases in smoking rates in New Zealand have slowed, particularly for some groups (including Māori). Further, tax increases have reached the stage of encouraging illegal activity, such as the much-publicised dairy robberies. Smoking addiction is bearing especially heavily on those households with a low disposable income, and onlookers are increasingly questioning the ethics and efficacy of taking our ‘force them to quit’ approach to smoking cessation much further.

“Both the outgoing National Government and the incoming Labour government are interested in developing better legislation around harm-reduced products such as electronic cigarettes (e-cigarettes) and the newer heat-not-burn devices. The process of deciding whether, how, and in what form these products should be made available is underway, with full support from the Ministry of Health. We are at the start of a wave of new technology, which current legislation was not designed for, and which we will need to decide about.

“E-cigarettes are likely to be the first harm reduction products to be legalised. It is increasingly common to see people vaping, and it is an obvious anomaly that a far more dangerous nicotine source – tobacco – can legally be sold to anyone over 18, while the nicotine-containing e-liquids used in vaping cannot. Those smokers with a credit card and internet connection, meanwhile, can and do access e-liquids from overseas. The legal grounds for the ban are also somewhat shaky.

“The major worry, of course, is that vaping may become attractive to children and teenagers, become a gateway to nicotine addiction and, from there, encourage smoking. While it is obvious that youth are experimenting with vaping, I have never yet found anyone who can explain to me why, if e-cigarettes are a gateway to smoking, youth smoking is declining markedly everywhere that vaping is available.

“My reading of the data is that young people may experiment and may even take up vaping for a while (with or without nicotine) but that vaping diverts a significant proportion of those who might otherwise have taken up smoking from ever doing so. This may well be because nicotine by itself, in any form, is just not as addictive as smoking is.

“In the meantime, we have over 600,000 New Zealand smokers, who have not yet stopped smoking in spite of all the pressure to do so. The indications currently are that many might stop or reduce smoking if vaping were to become more readily available as a substitute, while very few non-smokers will take up vaping, beyond short-term experimentation.”

Conflict of interest statement: P. Truman is a Board member of End Smoking New Zealand, which advocates for tobacco harm reduction approaches, and a member of the Ministry of Health’s Electronic Cigarette Technical Expert Advisory Group. She makes these comments as an individual, and not as representing either organisation. She has no industry links.