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Legislative Council - Fifty-Fifth Parliament, First Session (55-1)
2022-11-02 Daily Xml
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Bills

Controlled Substances (Nicotine) Amendment Bill

Introduction and First Reading

The Hon. S.L. GAME (16:07): Obtained leave and introduced a bill for an act to amend the Controlled Substances Act 1984. Read a first time.

Second Reading

The Hon. S.L. GAME (16:08): I move:

That this bill be now read a second time.

As unregulated youth vaping skyrockets, and access to the most successful nicotine replacement therapy remains severely restricted, it is clear that our state and federal governments' approach to vaping is not only flawed but costing lives. Concerns have been raised with me that the revenue from the tobacco tax is behind Australia's standalone nonsensical policy. Those suffering from the government's current approach are predominantly young people and those with socio-economic hardship.

Our youth are afflicted not only by the thriving black market of vape products, with unknown chemical make-up and misleading nicotine labelling, they are losing loved ones to smoking-related deaths. The government continues to make it much harder to buy regulated, safe vape products and cigarettes. It is criminal. Statistics show that families from areas of socio-economic hardship are more likely to have heavy smoking habits. Over a year a pack-a-day smoker can spend $15,000. The equivalent vaping habit costs closer to only $1,000. These families are encouraged to smoke deadly cigarettes due to easy access, instead of the much safer alternative of vapes.

Current vaping policy is wrong and negligent. Let me be clear: the vaping products I refer to as a smoking cessation tool only contain safe low doses of nicotine, solvents and flavouring. They are promoted throughout the Western world as successful smoking cessation tools. They are not the black market products of unknown ingredients which are widely accessible.

South Australia needs urgent reform to our controlled substances regulations for nicotine vaping. This is a public health matter, and it is time to put science before ideology. We are the only Western country with a prescription-only base model for nicotine vaping. I want regulated nicotine vapes to be able to be legally sold from licensed retail premises for adults, especially those wishing to quit smoking.

I want strict age identification required and loss of licence for those who sell to minors, as is consistent with smoking and alcohol regulations. The way to reduce the illicit market is to replace it with a legal regulated market. I want adults looking to quit smoking to have access to safer regulated vaping products when they go to a licensed retail outlet, and I want South Australians to stop losing loved ones to smoking-related deaths.

These are the reasons I have introduced a Controlled Substances (Nicotine) Amendment Bill 2022. I want to express my gratitude to two of Australia's leading experts on smoking cessation and tobacco harm reduction. Their guidance on this important public health issue continues to show industry leadership. I thank Dr Colin Mendelsohn, a clinician, academic and founding chairman of the Australian Tobacco Harm Reduction Association, and Dr Alex Wodak AM, current board director of the association and Emeritus Consultant Alcohol and Drug Service at St Vincent's Hospital.

After 12 months of Australia's failed prescription-based nicotine model, the results are in. Young Australians are vaping more than ever, with Quitline reporting for the first time that 13 year olds are becoming hooked on imported, unregulated nicotine vapes. At most, 12 per cent of vapers buy their devices legally, according to a recent Roy Morgan survey, and a mere 13 South Australian GPs are listed on the TGA's website as authorised prescribers. The black market is thriving, diverting up to $200 million in lost tax revenue from government coffers.

As members will observe, the Controlled Substances (Nicotine) Amendment Bill 2022 is succinct and straightforward. Its purpose is to exempt the sale of nicotine from the Controlled Substances Act 1984, which will allow for regulated levels of nicotine in vapes, regulated additives and ingredients in vapes, and regulated control of sales such as age restrictions and importing standards.

Growing scientific evidence from overseas continues to mount the case that vaping is a far safer alternative to deadly cigarette smoking. We know smoking prematurely kills one-half to two-thirds of continuing users. In Australia, restrictive and onerous regulations on nicotine vapes have resulted in a thriving black market. Imported unregulated devices are able to be purchased cash only from a corner shop or secured online and over social media with relative ease. By contrast, deadly, yet legal, cigarettes are available from virtually every service station, supermarket and corner shop in the country.

In order to access a nicotine vape in Australia, one must obtain a prescription from a general practitioner, with South Australia having just 13 authorised prescribers listed on the TGA website. Due to the current controlled substances regulations, these GPs are prohibited from advertising their willingness to prescribe nicotine vapes, yet another restrictive, high barrier for those smokers wishing to quit.

As stated, we are the only country in the Western world that requires prescriptions to possess, use or import nicotine e-liquids. Under the current regime that was enacted just over 12 months ago, nationally only 200 out of the 31,000 Australian GPs are publicly listed as nicotine prescribers, less than 1 per cent of all doctors. This is utterly ineffective. Without a prescription, possessing or importing nicotine liquid is a criminal offence punishable by fines of up to $222,000 and even jail terms. A 2022 survey states that only 12 per cent of vapers have obtained a prescription and only 2 per cent of vape purchases were from a pharmacy, which is the federal government's preferred method.

There is no quality control on the black market. Under the current prohibitionist model, nicotine vape consumers remain unaware of what is in their product and unprotected should anything go wrong. There are no incentives for manufacturers to comply with Australian standards and many of these devices are poor quality, imported from China and being sold under the counter for cash, including to children. Criminal organisations are becoming involved. It is easier for consumers to continue to buy deadly cigarettes than it is to navigate our state and federal governments' ridiculous process to obtain regulated vapes.

Modelling published as recently as October shows that relaxing these harsh restrictions could save the lives of 70,000 to 104,000 Australians by 2080. These figures were obtained from modelling based on the United States' more accessible nicotine vaping laws, and uses a mix of Australian and US data.

Another significant independent report, commissioned by the United Kingdom's Office for Health Improvement and Disparities, was released in late September 2022. It is the most comprehensive review to date on the topic. Researchers drew on more than 400 published studies from across the globe, including many that investigated signs of harm or levels of toxic substances in the body after smoking and vaping.

Overall the review confirms what previous studies have also shown: vaping is estimated to be at least 95 per cent less harmful than smoking over the short and medium term. Key findings of the report were:

using vaping products leads to a substantial reduction in toxicants compared to smoking;

vaping leads to lower exposure to many of the chemicals that cause cancer;

vaping reduces exposure to the toxicants that cause lung damage and is likely to slow down the development of respiratory diseases;

cardiovascular disease risk is expected to be much less than for smoking;

blood pressure is lower in people who vape than people who smoke;

switching from smoking to vaping is likely to be beneficial for oral and dental health; and

the risk and severity of nicotine dependency for vaping is lower than for cigarette smoking.

Again I ask: why are we roadblocking such an important public health measure?

Independent experts have made positive comments about the research review. Dr Sarah Jackson said:

The evidence is clear. If you're a smoker you can substantially reduce the risks to your health by switching completely to e-cigarettes and continuing to use them for as long as you need to avoid a relapse to smoking.

Professor Peter Hajek said, 'Smokers should be emphatically advised that switching to vaping removes almost all the risks of smoking.' Professor Shahab said:

Nicotine vaping is far less harmful than smoking tobacco. Encouraging smokers who are unable to stop smoking to switch to these reduced-harm products will benefit population health.

Compare this to a review funded by the Australian Department of Health, that sought to examine the 'contemporary evidence on the health outcomes of nicotine and non-nicotine e-cigarette use', and integrate this with 'systematic reviews on smoking uptake and cessation'. I am grateful to Doctors Mendelsohn and Wodak for their critique of this review, and share their well-considered and thoroughly-evidenced concerns. In their critical analysis of the review, Doctors Mendelsohn, Wodak and colleagues conclude that the review failed to achieve its aims for the following reasons:

it did not compare the relative risk of the harms of vaping to conventional cigarettes;

it did not consider the net public health impact of vaping;

it ignored evidence that vaping is effective in smoking cessation; and

it confused causation and correlation in interpreting the association between youth vaping and cigarette smoking.

What is currently forgotten in this debate is the sad reality that 21,000 Australians are dying every single year from smoking-related conditions. Despite what some vaping opponents say, there is a growing evidence base that points to vaping being the most successful smoking cessation aid.

The Australian government has a modest goal of reducing daily adult smoking to less than 10 per cent of the population by 2025 and less than 5 per cent by 2030, but the October 2022 modelling study suggests that this is fanciful. Indeed, under current vaping regulations the national smoking rate will only reach 7.5 per cent for males in 2080 and 5 per cent for females in 2064. Modelling of relaxed vaping laws, however, predicts that we will reach 5 per cent of Australian men in 2042 and 5 per cent of women in 2036. Imagine the positive impact on our health system with this reduction.

In New Zealand, which passed the Smoke-Free Environments and Regulated Products (Vaping) Amendment Act 2020, the government promoted that it was, 'putting New Zealand on track to saving thousands of lives and having a smoke-free generation sooner rather than later.' Their Ministry of Health actively encourages smokers to switch to vaping if other methods fail. In just 12 months following the bipartisan passing of this legislation, the adult smoking rate in New Zealand fell by an unprecedented 25 per cent.

In the United Kingdom vaping is a formal part of the Tobacco Control Plan and is supported by the Department of Health, the National Institute for Health and Care Excellence, the Royal College of Physicians, the Royal Society of Health and almost all public health, medical and health associations and charities. Currently 8.3 per cent of the English adult population vape, and smoking rates have been declining faster than in Australia as smokers switch to the safer alternative.

We are doing smokers who want to quit a huge disservice. Our regulatory model penalises them and prioritises big tobacco. Along with being a healthier alternative, vaping is much cheaper than smoking. We have the highest cigarette prices in the world, where a pack-a-day smoker who smokes 20 cigarettes a day of the leading brands spends $14,600 a year. Compare this with vaping, which averages around $1,150 per year.

We know that the greatest impacts of high tobacco prices and associated taxes are felt by lower socioeconomic people, for whom a larger portion of their income is lost to smoking. These are also the same groups of people who have the highest smoking rates and smoke more heavily. The same can be said for Aboriginal and Torres Strait Islander South Australians, where smoking rates have remained stubbornly high, sitting at 40.4 per cent as of 2018-19.

Vaping taxes must be kept to a minimum to ensure there is sound financial incentive for those wishing to shift to a lower risk product. Taxation on cigarettes ought to be higher than on vapes so that it is proportionate to the level of risk. In the United Kingdom, for example, the Royal College of Physicians recommends a tax on vaping of 5 per cent of that of tobacco taxes.

To be clear, neither myself nor vaping advocates are suggesting that vaping is completely safe and risk free. It is not recommended for non-smokers, and of course engaging in neither smoking nor vaping is the healthiest option. But the reality is that we are dealing with this compared with smoking deadly cigarettes that contain over 7,000 toxic chemicals. Vaping is the healthier alternative. The lifetime cancer risk from vaping has been estimated to be less than 0.5 per cent of that of smoking.

Vape users should not face high barriers, penalties and restrictions to obtain a product that is healthier, cheaper and has been shown empirically to be successful at smoking cessation. I am urging my colleagues here to re-evaluate their perception of nicotine vapes and to support this public health measure that will save the lives and livelihoods of South Australians. I commend this bill to the chamber.

Debate adjourned on motion of Hon. I.K. Hunter.

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