You are here


Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Wednesday, 29 March 2023

Tags: Health, Tobacco

Dr WOODRUFF (Franklin) - Mr Deputy Speaker, I want to thank Ms Johnston for bringing this on. This is a very important issue and the Greens welcome being able to have more considered public conversation about this matter.

We are concerned where we have got to in Australia and the fact is that with the increase in vaping and the creation of the black market that has happened in Australia, which is different to many other countries' approach, we have effectively created a black market by so throttling the supply of vaping products to be prescription-only by a GP. Only 1 per cent of GPs in Australia are registered as prescribers for these smoking cessation products. That is a problem, so what has happened is that smokers who want to get off smoking - long-term, rusted-on smokers who have tried and tried - find it difficult to access a GP and extremely cumbersome so they buy them on the black market.

It has obviously spread out dramatically now into our whole community and there are reasonable concerns and questions about what is happening with young people and the uptake of vaping amongst them. However, we have a problem with looking at the evidence clearly and without going to an extreme attitude of all vapes are bad. The fact is that of the evidence presented, a lot of it is highly uncredible and there is a lot of cherry-picking, but worse than that, there is false information circulating about the reputed harms from some e-cigarettes. I do not have time to go into it now but I would really like the Government to create more opportunities for us to have a considered conversation about this very important issue.

There is not a lot of time to speak but I am speaking on the minister's amendment. I note, first, that the amendment does not really change anything. All it is doing in addition to what Ms Johnston has is to note that the federal ministers' meeting in February endorsed the National Tobacco Strategy and will establish an e-cigarette working group. Then it calls on the Government to continue doing what it is already doing, including to do what Ms Johnston has called for: to consider making it an offence to supply e-cigarette products regardless of what they contain, whether they contain nicotine outside the current TGA prescription avenues.

That is the problem; it is not changing anything. We cannot continue to put our heads in the sand on this. We have to recognise that internationally we are out of step with most other countries, including the United Kingdom and New Zealand. New Zealand has just brought in regulations to regulate the use of e-cigarettes so that they are only available to people over the age of 18. They are treating it like we treat tobacco.

Why would we have a product like tobacco on sale everywhere in Tasmania and have a standard where that is available - we know it causes a far greater number of deaths; it is a fact that two out of three people who smoke cigarettes will die from a smoking-related disease, but we do not have that evidence about e-cigarettes. I am not saying they may not cause harm. Clearly there are cases where they may cause harm. Clearly there are cases where people think they do not have nicotine and that is why they bought them, but they do. Clearly there are concerns with the unknown products in there.

However, there is no doubt at all that they are an effective smoking cessation aid because they are cool on the lungs. When you are drawing in, it is not hot combusted air. That is the biggest risk and one of the greatest reasons why there is strong evidence that amongst people who have been long-term smokers, randomised clinical controlled trials show that people who switch to e-cigarettes have short- to medium-term improvements in asthma, chronic obstructive pulmonary disease, blood pressure, mucociliary clearance, respiratory infections, lung function, respiratory systems, cardiovascular markers and gum disease. These are just some of the issues. It is a really complex matter.

Again I thank Ms Johnston for bringing it on. I really counsel us to continue with the restrictive process we have in place at the moment, which is what both of these things do. They say, 'Oh look at the situation, we've created a black-market supply, let us keep doing what we are doing'. It will not work, so we need to change what we are doing.

It is a complicated world. There are dangerous things and we use them every day. Alcohol is number one, top of the list; a very dangerous thing and we use it every day. I am not saying that we should not take really strong measures. I think we should but they should be considered. We should ask why Australia has taken a different approach to other jurisdictions. Why is the Cancer Council of Australia out of step with the Cancer Council of the UK? Why are the health foundations in Australia out of step with their sister organisations in the UK? Why are we out of step with the medical association in New Zealand?

I think it is because at the federal level we have been so successful in leading the charge against tobacco corporations. The Labor Party was to be strongly commended for world-first legislation around plain packaging on tobacco. That has got us into a particular space where anything with the word 'nicotine' on its package is such a demon that we have do everything we can to shut it down. I am in no way an apologist for what happens in the tobacco industry or any of the nefarious money-making activities to go into creating harm in people's lives. We need to regulate this. There is a very strong case for licensing and regulations. That is why I do not support the current approach, because it is continuing what we are already doing. It is obviously a problem.

We would strongly recommend that the Minister for Health talks to people in New Zealand about what they have done there. Is that the gold standard we should be heading to? It certainly has a lot of evidence behind it. We need to be looking at the data about the reduction in smoking among young people that has been recorded in the United States by the Centres for Disease Control, which collects this information. The National Youth Tobacco Surveys have shown among US high schoolers, the exact category that we are talking about, an overall long-term trend reduction in smoking from 22 per cent in 2004, down to, in their figures, 2 per cent at the moment.

In that long-term decline, in 2011 vapes started taking off among young people at high schools. In 2013 there was an increase in the use of vaping among young people at high schools. That went up to a high of 27 per cent. One in four or more of young people at high schools were vaping in the US four years ago. That is a similar pattern to what is happening here in Australia. Nonetheless, the decline in smoking continued.

The concerns about vaping being a gateway drug to cigarettes is not being demonstrated in the data that we have at the moment. It is showing that people who are risk takers are likely to go down the path of continuing to take risks. They are people we need to work with. We need to educate those people. We cannot educate in a prohibition mindset. We cannot have conversations when there is an attitude that this is a topic that we cannot talk about. That is exactly the problem when you have a society-wide ban on a product.

We know that the prescription-only model has failed, when less than 10 per cent of vapers have a nicotine prescription. It is obviously not working. I have circulated an amendment that I will speak to if there is time after we have dealt with the Government's amendment.

We do not support Ms Johnston's part (1) that says e-cigarettes are not safe. That is not the evidence of the National Health and Medical Research Council. Its words, and I have used them in the amendment, are that e-cigarettes can be harmful.

We do not support that list of things in part (2) that Ms Johnston has quoted. Unfortunately, that is false information. The evidence behind some of those claims has been proven to be false. I do not have time to go into it, but it is on the public record. We can talk about it later. It is true, and we accept the evidence, that e-cigarettes containing nicotine that can cause addiction.

We cannot agree with parts (3) and (4). Not because there is nothing in there that we might agree with, but there is such extreme generalisations in that information. Some of it is utterly false - that most e-cigarette use among smokers is not for smoking cessation. These are statements that have contested evidence behind them. I have two papers, one to the Australian Professional Society on Alcohol and other Drugs, in their journal Drug and Alcohol Review, and another one that was published in the AMJA in relation to the federal government's review on e-cigarettes, which was done by Emily Banks at the ANU.

Both of those are rebuttal papers and they contain some very important people who have high credibility in the drug and alcohol research area. Some of these statements, unfortunately, have been rebutted and the evidence has found to be untrue.

With part (5), we do not agree with the statement about the alarm about the rapid increase in use by young people. We would amend that to 'concern about the rapid increase in use by people under the age of 18'. We are talking about a vulnerable cohort of young people, we are talking about predatory marketing, and we are talking about the use of sponsorship to encourage the uptake of vapes among young people. That is our serious concern here.

Finally, we would make the very important point that e-cigarettes can be an effective smoking cessation tool for some people. We would also call upon the Government to regulate the sale of e-cigarettes in the same way as tobacco. We do not support the amendment that the Government has put because it is continuing the situation as it is. We hope to have time to move our amendment when we can.


Dr WOODRUFF (Franklin) - Mr Speaker, I will not take up time so that Ms Johnston can finish up but I have an amendment to the amended motion. I move -

That the amended motion be amended by -

(a) Omitting the words 'are not safe' from clause 1 and substituting with the words 'can be harmful'.

(b) Omitting clause 2 and substituting the following clause - 'acknowledges the evidence that e cigarettes containing nicotine can cause addiction'.

(c) Omitting clauses 3 and 4.

(d) Omitting the words 'alarm about the rapid increase in use by young people' from clause 5 and substituting the words 'concern about the rapid increase in use by people under the age of 18'.

(e) Omitting clause 7 and substituting the following clauses -

(7) Recognises e cigarettes can be an effective smoking cessation tool for some people.

(8) Calls on the Government to regulate the sale of e cigarettes in the same way as tobacco.

That effectively deals with the many concerns about the vulnerability of young people, recognising those under the age of 18 where there has been such a large increase in vaping demonstrated in Tasmania would not be able to legally purchase vaping products, and that the use of vapes for people over the age of 18 would be appropriately regulated and licensed in the manner in which we do so for tobacco and with the many conditions and caveats around that in relation to the place of purchase, the proof of identity, of age, and the training and the other requirements that a place of sale must adhere to.

There would be a conversation with the Government about the sort of approach taken by New Zealand where they have stipulated particular points of sale. Tobacconists need to have a higher level of licensing so that they can sell a whole range of flavours. Other places in New Zealand, such as a local tobacconist or the other places where you buy tobacco would only be able to sell a minimum number of flavoured vapes.

We all have our views about flavoured vapes. It is a concern when you hear 12- and 13-year-olds being marketed to bubble gum vapes. There is no doubt this is a very concerning space. We are moving for regulation as we do for tobacco. In that process the Government would undertake a thorough investigation of the evidence. There is good evidence that unless vapes are flavoured then people who are long term smokers are much more inclined to go back to smoking cigarettes, which are more harmful. This is a harm reduction measure. The world is not perfect and we do have and continue to expose ourselves to legal products which harm ourselves every single time. We go to the shops, we buy things that have demonstrated harm. We need to have governments that regulate for that, that educate for that. That is what we are calling for, the same practice with vaping products as for the other harmful products we can legally purchase.