The Australian government’s plan to make pharmacies the gatekeepers of vaping will push more young people onto the black market, according to illicit trade experts, reports Financial Review.
Nicotine levels found in wastewater in December were among the highest since authorities started recording them in 2016, a trend that the health department attributes to the rise of vaping among young people.
An Australian Criminal Intelligence Commission report last week found that nicotine consumption had risen from August in capital cities to their second-highest level since 2016. The peak use of nicotine was in December 2022.
Federal Health Minister Mark Butler announced in May last year that the government would increase tobacco excise by 5 percent a year for three years to deter smoking.
“Studies have confirmed that the rise in vaping over the last decade has driven more young Australians to nicotine consumption,” a federal health department spokesman said, adding that the nicotine data also captured people using nicotine patches and gum to quit smoking.
Since July 1, vape sales in Australia require a doctor’s prescription, nicotine levels are regulated, and flavors are limited to tobacco, menthol and mint. Another requirement restricts products to plain packaging.
Several major pharmacy chains in Australia have stated that they will not stock vapes once their sale is prohibited outside of pharmacies and a prescription requirement for adults is lifted.
In communications with their stakeholders, TerryWhite Chemmart, Priceline Pharmacy, National Pharmacies in South Australia and 777 Group in West Australia all voiced strong disagreement with new laws allowing the sale of vapes without prescriptions.
In a statement, The Pharmacy Guild of Australia said Blooms and thousands of independent pharmacies had also opposed the government’s deal with the Greens to open access for adults from October.
Chemist Warehouse has told the ABC it is still looking at the implications of the decision and seeking more information on how it will work.
While those pharmacies have indicated they will not be moving to stock vapes, franchisors under the brands are technically able to make an independent decision to do so.
Many pharmacies under those brands already supply vapes nationwide or are licensed to do so. The key dispute raised by them is the “down scheduling” of vapes from requiring scripts to being available behind the counter for adults once they have had a conversation with their pharmacist.
Health Minister Mark Butler said earlier this week that pharmacies would not be forced to stock vapes and the government did not expect that all pharmacies would.
Australia will soften a proposed ban on vaping following opposition from the Greens party, leading the government to agree to revise a bill that would have limited vapes to those with a doctor’s prescription.
The agreement between the ruling center-left Labor Party and the Greens will lead to the passage of legislation later this week that restricts the sale of vapes to pharmacies and removes them from retail shelves. This move is aimed at curbing the rise in youth vaping.
However, the bill falls short of the government’s initial ambition to restrict sales only to those with a doctor’s prescription, which would have been a world first. The amended bill will take effect on July 1, reports Reuters.
Under the compromise deal, vapes will be moved “behind the counter” in October. Customers will need to have a conversation with the pharmacist before making a purchase, and those under 18 years old will need a prescription.
Health Minister Mark Butler said in a statement that the government “welcomed constructive engagement with the crossbench and secured the support of the Greens for our world-leading vaping laws.”
The Labor Party does not have a majority in the upper house and must negotiate with other parties and independent senators to pass legislation.
Contrary to popular perceptions, most smokers in Australia are educated, employed and in good mental health, according to a national study by the Australian National University (ANU).
Study senior author Emily Banks said the findings will help break down stigma surrounding people who smoke as well as ensure that support is better targeted to the people who need it.
“Smoking remains Australia’s leading cause of premature death and disability, so it’s vital that we better understand who smokes and the reasons why they do,” she said in a statement.
“People who smoke are often stigmatized and stereotyped as uneducated, unemployed and mentally ill.”
“We analyzed nationally representative data on smoking in Australia to get a better understanding of who smokes in our population,” said lead author, Jessica Aw, a medical student at ANU. “We found that around 2.5 million people smoke daily in Australia; around 60 percent of people who smoke are men, 65 percent live in major cities, and 92 percent are non-Indigenous.
“In addition, 69 percent have completed year 12, 69 percent of those of working age are in paid employment and 73 percent had good mental health.
“Although smoking is more common in people who are experiencing structural disadvantage—like people in more remote areas, Indigenous peoples, those with less education and those living in poverty—most people who smoke are educated, employed and in good mental health, similar to the total population of Australia.”
Police in the Australian state of Victoria have arrested five individuals believed to be connected to the Finks outlaw motorcycle gang and a series of arson attacks on tobacco stores in Victoria.
The arrests are a police response to the so-called tobacco wars, which have seen criminal gangs fight for control of the “significant source of income” generated by the sale of illicit tobacco.
Victoria police Det. Insp. Graham Banks acknowledged community concern about the attacks in recent weeks and said the force was “turning the corner” with new intelligence, according to media reports.
The arrests are related to the torching of four tobacco stores and a cafe between Christmas Day and Friday in Moe, Croydon, Altona, Altona North and Sunshine.
On each occasion, police allege the offenders broke into the stores before setting them ablaze.
Police report they found five vehicles believed to have been stolen when arresting the group, along with Molotov cocktails.
“We believe they were preparing to do further attacks, so this is a substantial series of arrests,” Banks said. “This certainly impacts a syndicate that is driving this.
“There is still a significant conflict between multiple different groups over control of a significant source of income. It will be an ongoing issue for several months, but we’re certainly turning the corner.”
After nearly a decade advocating for vaping as a tobacco harm reduction strategy in Australia, Colin Mendelsohn announced his retirement in Filter.
In his piece, Mendelsohn expressed distress at what he described as Australia’s “descent from its former status as a global leader in tobacco control to the current slow-moving train wreck.”
“Where vaping is seen by other Western democracies as a huge opportunity for public health, successive Australian governments have framed it as a threat,” he wrote. “The ensuing prohibitive regulations have neutralized the potential benefits and led to troubling and escalating unintended consequences.”
During his career, Mendelsohn endured heavy criticism from anti-vaping groups.
“My evidence-based advocacy and the efforts of others are undermined with smears, insults and harassment,” he wrote. “I have repeatedly faced false accusations of being funded by Big Tobacco, including in national print media and on national radio.”
Despite his disappointment over Australia’s tobacco-control policy choices and the personal attacks, Mendelsohn, remained optimistic that tobacco harm reduction would eventually prevail.
“As I retire, my hope, still, is for a balanced, evidence-based approach to vaping in Australia,” he wrote. “It won’t come soon. The latest regulatory crackdown will need to run its course and fail again before much-needed reforms are possible.
“Then we will need to move beyond the echo chamber of Australia’s tobacco control group-think, if we’re to recognize vaping not as a ‘public health menace’ but as a powerful ally in the fight against tobacco-related harm.”
Image: Australian Government Department of Health and Aged Care
Federal laws passed in Australia will require vapes and individual cigarettes to display warning labels beginning April 2024.
The labels will include “toxic addiction,” “poisons in ever puff,” “causes 16 cancers” and “What is this costing you?” according to the Daily Mail.
Proposed new packaging images show cancerous tumors in the mouth and throat and a surgeon removing a voice box. The changes also include incorporating inserts in cigarette packs promoting the benefits of quitting smoking and providing contact information for helpline support to quit.
According to Health Minister Mark Butler, the measures are necessary because consumers have become desensitized to the warnings and images currently printed on packs.
“The most concerning thing over the last 10 years is the advice that the government has received is that the smoking rates, which have been declining steadily for 50 years or so, have started to plateau,” said Butler. “We are not currently on track to achieve the targets that are set our in the National Tobacco Strategy.”
“I am so delighted the Parliament has passed a new generation of laws to take the fight back up to big tobacco and to save more American lives,” Butler said.
Products will have 12 months to comply with the new packaging requirements. Retailers will have an additional three months to update stock.
The import of nontherapeutic and disposable single-use vapes will also be banned.
“Today marks a new era as Australia returns to the forefront of the global fight against smoking,” Butler said. “We cannot stand by and allow another generation of people to be lured into addiction and suffer the enormous health, economic and social consequences.
“The laws that passed today will save lives.”
Current plain packaging laws state that cigarette and other tobacco product packaging must display extreme disease caused by smoking. Point of sale advertising is banned, and cigarettes for retail must be hidden from view at all times. Tobacco is also heavily taxed in Australia, and a pack is set to surpass $50 in 2026.
The sale of illegal tobacco and vapes has increased in the country, and smoking and nicotine-based vaping among 14-year-olds to 17-year-olds has increased 15-fold in the past five years. Illegal tobacco is commonly available and widely socially acceptable.
In August, a requirement for tobacco companies to print warnings on individual cigarettes took effect in Canada.
Potential new graphic health warnings as envisioned by Australia’s Department of Health and Aged Care
Australia will extend the requirement for manufacturers to print graphic health warnings on tobacco products to e-cigarettes, according to reports by CityNews and News. Manufacturers have until April 1, 2024, to roll out “repulsive” new health warnings on cigarette and vape packets. Retailers will be given a further three months to update their stock as new warning labels are gradually rolled out.
On Dec. 7, the country’s federal parliament passed a law with measures to discourage smoking and vaping. Among other provisions, the legislation updates the health warnings on cigarette packages, standardizes the design and appearance of cigarette filters and applies tobacco advertising restrictions to vapor products.
Earlier, Australia had announced a ban on single-use vapes that will take effect at the start of 2024. Starting in March, it will also be illegal to import or supply vapes that don’t comply with standards from the medical regulator. Doctors and nurses would still be able to prescribe therapeutic vapes as a tool to help smokers quit.
Health Minister Mark Butler said the new smoking laws would save lives.
“Tobacco has caused immeasurable harm and cost us countless lives in this country,” he told parliament. “We can’t stand by and allow another generation of people to be lured into addiction and suffer the enormous health, economic and social consequences.”
About 20 percent of Australian 18-year-olds to 24-year-olds vape while about one in seven 14-year-olds to 17-year-olds use the product.
Australia will ban imports of single-use e-cigarettes in January and all non-therapeutic vapes, including refillable devices, in March, reports Reuters. Importers of vapes for medical purposes will need a permit from the Office of Drug Control, according to Health Minister Mark Butler.
Additional legislation next year will apply the same restrictions to domestic manufacturers.
“These are the vapes that have pink unicorns on them, bubblegum flavoring, disguised in order for them to hide them in their pencil cases,” Butler was quoted as saying.
“This is not a therapeutic good to help hardened smokers kick the habit. This is a good that is deliberately targeted at kids to recruit them to nicotine addiction.”
Around one if five Australians aged 18 to 24 vape, according to government data.
To ensure continued access to vapes for smokers looking to quit, Doctors will be given expanded powers in January to prescribe therapeutic vapes when clinically appropriate.
Australia’s proposed crackdown on vaping is unlikely to achieve its objectives.
By Stefanie Rossel
As a vaper in Australia, you basically have two choices. The first option is to behave like a good citizen, go to your doctor, get a prescription and convince a pharmacist to sell it to you. The alternative is to be not so good and do what 92 percent of Australian vapers do—source your e-cigarettes on the black market. Vapes have been regulated Down Under since October 2021 but so poorly that Australian health professionals speaking at the Warsaw Global Forum on Nicotine in June apologized for the legislation.
Getting a prescription is more difficult than one might think, according to Carolyn Beaumont, an Australian general practitioner (GP) who advocates for the right of adult smokers to access vaping products. As Beaumont explained during her presentation, among the many barriers is the challenge to find a doctor who is not only familiar with vaping products but also believes in their potential as smoking cessation tools. But Australia is a huge country, where most of the population—and doctors—live along the Eastern Seaboard. In other regions, there are fewer physicians. Additionally, clinics may not be open daily, wait times are getting worse, and more GPs are charging privately. An estimated 20 percent of Australians have no regular GP; Beaumont said it could be even 35 percent.
Doctors often lack product knowledge and have an inadequate understanding of smoking, vaping and nicotine dependence. Tobacco harm reduction is not taught in Australia, according to Beaumont, and the medical guidelines are not supportive of vaping. Doctors also face an administrative barrier: They need to be registered as an authorized nicotine prescriber. However, the prevailing negative media narrative in Australia makes many GPs reluctant to register. In April 2023, the Australian Department of Health and Aged Care listed 1,963 authorized prescribers nationwide, which equals one in 20 practitioners.
Once vapers have secured a prescription, they need to find a pharmacy that sells vapes. But few establishments do so, and often, they have only limited stock. Vapes can also be ordered online and imported for personal use under the Therapeutic Goods Administration’s (TGA) personal importation scheme. With a valid prescription, Australians may legally import a three-month supply per order. “It remains illegal for other Australian retailers, such as tobacconists, vape shops and convenience stores, to sell you nicotine vaping products, even if you have a prescription,” the TGA stresses on its website.
At present, merely 8 percent of vapers have a prescription, and only 2 percent purchase from pharmacies, according to a Roy Morgain survey in February 2023.
Additional Restrictions
Colin Mendelsohn
Things are unlikely to get easier for smokers seeking less hazardous alternatives to combustible cigarettes. In May 2023, Health Minister Mark Butler announced a further crackdown on recreational vaping. He claimed that vaping had been advertised to the public as a therapeutic product meant to help smokers quit but instead spawned a new generation of nicotine users, particularly young people. At press time, details on the new rules were unavailable, but tobacco harm reduction advocates were bracing for restrictions on disposable vapes, flavor options and nicotine concentrations, along with a requirement to package vaping products in pharmaceutical-style packaging and an end to the personal importation scheme, with sales permitted only through authorized pharmacies.
Writing on his blog, professor Simon Chapman, a determined opponent of vaping, suggested that Butler might ban refillable vaporizers as well. The planned legislation will require federal authorities to seize products at the border and states to police retail sales, but so far, it has not allocated any funding to enforcement.
The proposed plan is de facto prohibition, according to Colin Mendelsohn, a former GP who has been helping smokers quit for more than 30 years. “It is a doubling down on a failed highly restrictive model that has been rejected by vapers and prescribing doctors and has created a thriving black market, which sells freely to underage users,” he says. “The history of prohibition and the war on drugs shows consistently that it does not reduce long-term illicit drug supply, and there is no reason to believe that this will be different. Bans are effective short-term political strategies but are bad public health policy. The Australian Border Force (ABF) does not have the resources or interest in intercepting vapes and is correctly more focused on dangerous illicit drugs, such as heroin, cocaine, ice, etc., or weapons.”
In an interview in May, ABF Chief Michael Outram warned that banning vapes at the border wouldn’t be enough to stamp out a rampant black market, as his organization managed to intercept barely 75 percent to 80 percent of illicit drugs making their way into Australia “on a good day.” Of the 8 million containers coming into the country each year, only 1 percent to 1.5 percent are scanned.
The proposed crackdown, cautions Mendelsohn, will likely have many unintended consequences. “Criminal networks will continue to find ways to import vapes,” he says. “This is a high-profit and low-risk crime, and it is accompanied by stand-over tactics, such as firebombing of retail outlets, gang wars and violence, and corruption of officials. The proceeds fund other, more serious criminal activities. There will be continuing sales to youth and more difficult legal access for adult smokers. Some vapers will relapse to smoking. It will be harder for current smokers to switch to vaping.”
According to Mendelsohn, the planned law will criminalize otherwise law-abiding citizens who simply want to improve their health, and cause the government to lose revenue from taxes, licensing and vape shops while shouldering increased cost of policing, enforcement, the justice system and prisons. “We will continue to see dodgy, mislabeled, unregulated products with high nicotine levels,” he says. “The harm from unregulated black market products was demonstrated during the EVALI [e-cigarette or vaping product use-associated lung injury] outbreak. There will also be higher prices, increased drug potency [and] stockpiling of nicotine e-liquids prior to the change. All legal, legitimate vape businesses will be closed. It’s a violation of the human right to access a safer alternative to smoking.”
Unsuccessful Measures
Low-income and otherwise disadvantaged people, among whom rates of smoking and smoking-related death and disease are significantly higher than in the rest of the population, will be disproportionately affected, according to Mendelsohn. “Australian research has shown that vaping may help to reduce health inequalities,” he says. “Smoking is a leading cause of financial stress in disadvantaged populations, especially at a time of sluggish wage growth, high interest rates and a high cost of living. Spending is diverted from food, clothing, etc., to smoking.”
Australia has the highest cigarette prices in the world, with a pack of 20 retailing at AUD40 ($25.60). Based on a consumption of 13 cigarettes a day, the average cost of smoking is AUD11,850 per year. Vaping, by comparison, costs AUD500 to AUD1,500 per year, depending on the device used.
“At the current high levels, further tax rises are no longer effective due to the law of diminishing returns,” says Mendelsohn. “Many addicted smokers are simply unable to quit no matter how high the price. Smoking rates in Australia have not declined over the last four years in spite of high prices, plain packaging and other tobacco control strategies.”
So where’s the consumer in all of this? Mendelsohn says that the lack of a consumer voice is a big problem. “We had a New Nicotine Alliance AU, which disbanded about five years ago. Recently, the Australian Smokefree Alternatives Consumer Association was formed but is still very quiet. Legalise Vaping is a part of the Australian Taxpayers Association and is the most active advocacy group. I believe they have had some indirect tobacco company funding in the past, but they are focused on legalizing and regulating vaping and the rights of adults to make their own choices. Overall, they do an excellent job with limited resources. All anti-vaping groups are subject to great scrutiny and are smeared and undermined by anti-vaping advocates if there is any potential opportunity.”
Ideology Instead of Science
Butler’s plan has attracted criticism from several institutions. On July 8, internal confidential e-mails sent by members of the Australian National Advisory Council on Alcohol and Other Drugs (ANACAD) expressed concerns about further restrictions, saying it would exacerbate the black market problem, criminalize more people and make smoking more attractive. On July 18, Mendelsohn and a group of more than 40 experts from Australia and New Zealand urged lawmakers to listen to the ANACAD ahead of Butler’s proposed vaping crackdown. At the time of this interview, they had not received a response to their letter.
Mendelsohn is not optimistic that Butler will change course. “Butler has committed himself to this crackdown, and there is no indication that he will soften his approach,” he says. “He is taking advice from a small group of ideologically driven tobacco control academics and health bureaucrats with extreme anti-vaping views.” According to Mendelsohn, Butler operates in a bubble and is ignoring the pro-vaping arguments. “He has refused to meet with Dr. Wodak [a fellow tobacco harm reduction proponent] and me, although we met with his adviser, who was clearly committed to a predetermined position,” says Mendelsohn. “He is under considerable pressure from Australian health charities, medical associations, public health organizations and state governments that are almost universally opposed to vaping. The media is also hostile to vaping. Any turnaround will be very difficult politically.”
Vaping policy in Australia, says Mendelsohn, is driven by ideology rather than science. “Australia’s peak health and medical research organization, the National Health and Medical Research Council (NHMRC), prepared an anti-vaping position paper on vaping. The NHMRC is very influential in guiding national health policy. The NHMRC document was critiqued in a peer-reviewed article in Addiction by leading Australian and international experts and found to be riddled with serious scientific flaws and misinformation. However, it remains unchanged.”
For sensible regulation of vaping, says Mendelsohn, Australia should look to its neighbor, New Zealand, which in August 2020 legalized and regulated vaping. “Over the next two years, there was an unprecedented 33 percent decline in the adult smoking rate among those aged 15 and over—from 13.7 percent to 9.2 percent. In Australia during the same period, the smoking rate increased by 4.5 percent. In that time, there have been no major smoke-free policy interventions, almost no mass media spend on quit campaigns and no tobacco tax increases in NZ.”
Lessons From Drug Policy
Alex Wodak
Alex Wodak, Mendelsohn’s ally in the battle for harm reduction-based legislation, is more confident that Australia will eventually change its stance on vaping. Wodak has dedicated his career to drug harm reduction and was instrumental in reforming drug law in Australia. Together with colleagues, he created the country’s first needle exchange program in 1986 and its first medically supervised injecting center in 1999. At this time, both were pre-legal.
He observes parallels with his country’s current crackdown on vaping. “The World Health Organization opposed drug harm reduction, including needle and syringe programs for a few years in the 1990s, apparently relenting to intense U.S. pressure,” says Wodak. “The default policy for communities, governments and the WHO for new drugs, new forms of drug administration and new forms of drug harm reduction is generally negative. It seems sensible to be initially cautious about changing situations regarding drugs, but we have a problem when the opposition to a new form of drug harm reduction is maintained long after the evidence of effectiveness and safety has become compelling, especially when the costs of delay are so substantial as they are with needle and syringe programs and tobacco harm reduction.
“The case in favor of vaping and other forms of tobacco harm reduction is now overwhelming. Smokers increasingly prefer to continue to use nicotine but prefer to consume it in safer ways. Many traded tobacco companies are transforming from combustible cigarettes to safer products, some faster than others, but they are changing. Investors pay higher prices for tobacco companies transforming more rapidly. Unfortunately, tobacco control, governments and the WHO are still resisting change, which now seems inevitable. This change is an enormous opportunity for public health, similar to the scale of the benefits from vaccination.”
Wodak remembers the time when harm reduction was refused in favor of an abstinence-only approach in drug policy circles. “The political debate lags behind the scientific debate,” he says. “There are many lessons from this experience. It is important to continue improving the quantity and quality of evidence. It eventually does make a difference. Being polite and respectful to harm reduction opponents matters. So does persistence. There are no shortcuts. Harm reduction involves consequentialism—that is, making an assessment of both the benefits and costs of a policy or intervention. Opposition to harm reduction often involves deontology—that is, following a set principle, such as aiming for a tobacco-free—or nicotine-free—outcome rather than a smoke-free outcome. The net effect of the policy or intervention is not a concern.”
Staying Power Needed
The current approach of the Australian government to vaping is unsustainable, Wodak emphasizes. “It is destined to collapse sooner or later,” he says. “Opponents of harm reduction are unable to justify why a far safer option is severely restricted while a deadly option remains readily available. Despite dominating politics, mainstream media and medical and health publications, 73 percent of Australians support vaping being regulated like cigarettes and alcohol while only 20 percent support prescription-only regulation of vaping.”
The new approach announced by Butler on May 1 requires legislation to be passed by the House of Representatives and the Senate. “This legislation will most likely be passed by the House of Representatives but is unlikely to be passed by the Senate,” says Wodak. “The black market currently meets 92 percent of the demand from a rapidly growing number of adult Australian vapers, now estimated to number 1.3 million. Although the government asserts it will strengthen law enforcement border efforts to reduce the number of illegal vapes entering Australia, now estimated at about 10 million per month, no additional funds have been provided for this purpose. Heroin was prohibited 70 years ago in Australia. However, in 2022, a survey of people who use drugs found that 87 percent said that obtaining heroin was ‘easy’ or ‘very easy.’ When demand for a good or service is strong and controls are easy to subvert, as is the case with vaping, other sources of supply almost invariably emerge.”
Wodak views the battle for vaping reform in Australia through the lens of drug harm reduction rather than from a perspective of tobacco control. “I have been involved in battles for drug law reform in Australia over about 40 years. We have won almost all of these battles, although it has often taken more time and effort than we would have preferred. I am very confident that tobacco harm reduction will prevail in Australia. Taking a bet against drug harm reduction is very brave as harm reduction almost always wins.”
Stefanie Rossel is Tobacco Reporter’s editorial contributor. An experienced trade journalist, she combines sharp reporting skills with in-depth knowledge of the tobacco and vapor industries. Prior to joining Tobacco Reporter, Stefanie was editor-in-chief at Tobacco Journal International, where she worked for a decade. Fluent in English, German and French, Stefanie covers tobacco news around the world. She is based in Germany.
