Issue 3 • 2022
© 2022 The Royal Australasian College of Physicians
Lack of vaping regulations leaves youth at risk
The use of e-cigarettes has become increasingly popular due to the lack of regulation and the clever marketing strategies being used to target our youth. We examine this growing problem and what can be done to contain it.
Banana crème, white chocolate mocha, blue raspberry candy, strawbana, mango pitaya pineapple. At first glance, it reads like a dessert menu or a candy store selection, but this is the marketing being employed to sell vape flavours and vape juice to an increasingly younger demographic.
This targeting, it seems, is having an effect. According to the Australian National Drug Strategy Household Survey 2019 between 2016 and 2019 the proportion of people who had used e-cigarettes rose from 8.8 per cent to 11.3 per cent. Nearly two in three current smokers and one in five non-smokers aged 18–24 reported having tried e-cigarettes. More concerning, though, were the results found in the adolescent community. According to the Alcohol and Drug Foundation, in Australia, around 14 per cent of 12 to 17-year-olds have tried an e-cigarette, with around 32 per cent of these students having used one in the past months. Students who had vaped most commonly reported getting the last e-cigarette they had used from friends (63 per cent), siblings (8 per cent) or parents (7 per cent). Around 12 per cent of students had also reported buying an e-cigarette themselves.1
At the time of writing this article, the Therapeutic Goods Administration (TGA) stated that nicotine vaping products are Schedule 4 (prescription only) medicines, with consumers requiring a prescription for all purchases of nicotine vaping products, including those from Australian pharmacies and overseas.
These restrictions, however, appear to have done little to stop the proliferation of vaping products, especially those products containing nicotine, into the wider community. To skirt laws around the importation and sale of nicotine products, packaging often does not list nicotine as an ingredient. This, along with a growing underground market for cheap, colourful, disposable vapes is making it increasingly easier for adolescents to be exposed to vaping as a cooler, more convenient alternative to smoking.
Professor Emily Banks, a public health physician and RACP Fellow, said, “Many people are not aware that the majority of people quitting smoking successfully do so unaided. Currently, the evidence that e-cigarettes are efficacious for smoking cessation is limited and they are not currently approved by the TGA for this purpose. However, given the extreme harm of smoking, smokers who switch completely and promptly to e-cigarettes may benefit, noting that we don’t know their long-term health impacts. This means that the current RACGP recommendations for clinicians is that they are an option for people seeking help who are unable to quit smoking using approved therapies.”
The problem has grown so prolific in some areas that “silent vape detectors” have been installed in some schools. Designed to sense the movement of students in the bathrooms and whether they appear to be vaping, these detectors are an aggressive response to this growing problem. If potential vaping is detected, students are locked in the toilet until a teacher comes to collect the vape. There are reports of some colleges using bathroom pass systems for students who need to use the toilets outside of regular breaks.
This solution, however, is not without its controversies and anecdotal reports have shown that this has had a negative impact on some students, especially those who are uncomfortable about requesting passes for fear of being suspected of vaping. It can also be an impediment to students moving between classes, queueing for toilets, or waiting for a bathroom key.
When smokers use e-cigarettes instead of conventional cigarettes there is evidence of improvement in individual health, probably mainly due to the reduction in smoking. However, the more spurious claims that e-cigarettes or vapes are less harmful than cigarettes are receiving much greater scrutiny. The testing of vapes, especially those purchased from overseas through online websites, has often revealed unspecified and uncontrolled amounts of substances known to be harmful, particularly when inhaled.
A 2021 study published in the Medical Journal of Australia on the chemical analysis of fresh and aged Australian e‐cigarette liquids states that this includes but is not limited to substances such as:
  • Menthol – which is found to enhance the addictive properties of nicotine and inhibit nicotine metabolism.
  • Ethyl maltol – where the effects of heating and inhaling it are largely unknown, but it increases free radical formation in e‐cigarette aerosols. Ethyl maltol also reacts with iron and copper (potentially present in e‐liquids as coil residue) to produce toxic hydroxypyranone complexes.
  • Trans‐Cinnamaldehyde – impairs innate immune cell function in the lung, suppresses bronchial airway epithelial cell ciliary motility and mitochondrial function, inhibits microsomal CYP2A6, impairs neutrophil, macrophage and natural killer cell function, and reduces oxidative burst when heated and inhaled.
  • Ethyl vanillin – reduces oxidative burst and inhibits in vitro free radical formation.
In a recent media release, the Royal Australasian College of Physicians said that the federal government should consider strengthening importation laws and their enforcement to reduce the growing black-market supply of vaping products to children and young people.
Anita Dessaix, Director, Cancer Prevention & Advocacy for the NSW Cancer Council, said, “the most urgent action needed at all levels of government is enforcement. More needs to be done immediately to effectively enforce regulations and protect adolescents, young Australians, and non-smokers from the harms of e-cigarettes.”
She goes on to suggest that the federal government needs to act to stop the unlawful importation of e-cigarettes at the border, and state and territory governments need to crack down hard on retailers who are openly and illegally selling nicotine e-cigarettes without a valid prescription. “We are at a tipping point where we can stop e-cigarettes from becoming a recreational consumer product. We do not want to repeat the historical mistake when tobacco products were allowed to become widespread consumer products that we have since spent decades trying to undo the damage from.”
References 1. Guerin N & White V, ASSAD 2017 Statistics & Trends: Australian Secondary Students’ Use of Tobacco, Alcohol, Over-the-counter Drugs, and Illicit Substances, Centre for Behavioural Research in Cancer, Cancer Council Victoria 2018.