What does the Royal Australian College of General Practitioners (RACGP) say about smoking cessation options?
RACGP provides a comprehensive guideline for doctors regarding smoking cessation. The relevant section can be accessed here. In essence, RACGP recommends as first-line the existing nicotine replacement therapies (patches/gum/inhalers), as well as pharmacotherapy (such as Champix or bupropion). There is also a strong role for counselling. Nicotine vaping is listed as a second-line smoking cessation method.The RACGP says vaping nicotine ‘may be a reasonable intervention’ in certain groups:
“For people who have tried to achieve smoking cessation with approved pharmacotherapies but failed, but who are still motivated to quit smoking and have brought up e-cigarette usage with their healthcare practitioner, nicotine containing e-cigarettes may be a reasonable intervention to recommend.”
How safe and effective is liquid nicotine for vaping?
There is mixed evidence on its effectiveness as an aid to quit smoking. There is no long-term evidence on the safety of nicotine vaping, or the potential long-term impacts of its use. Animal studies have shown that liquid nicotine is harmful to the foetus, although these results have not been replicated in human studies. Potential side effects of nicotine (whether in cigarettes or vaping) include high blood pressure, heart arrythymias and cardiovascular events. On the other hand, some studies suggest that liquid nicotine is up to 95% safer than tobacco, with almost none of the inhaled toxins and carcinogens of tobacco.
It is essential that liquid nicotine is obtained from a reliable supplier, with TGO-110 (Australian safety standard) accreditation. Store in a childproof, lockable cupboard. Liquid nicotine can be toxic and even fatal if ingested in high concentrations. Battery care is essential, to ensure leakage or explosions do not occur. Always follow the package directions for use.
Vaping in under 18s, with or without nicotine, is unsafe. There are many valid concerns that underage vaping may be an ‘on ramp’ to other tobacco or substance use. Further, the effect of nicotine on the developing brain is unknown.
Under no circumstances should ‘black market’ liquid nicotine be used. There have been serious cases of vaping associated lung injury (‘EVALI’) mostly from black market, unregulated nicotine juice. Toxic vitamin E acetate contamination was thought to be the main cause of the lung injury, but the true picture is still not known. Although no-one can say with 100% certainty that Australian TGO-110 standard nicotine is safe, the risk of lung injury is vastly reduced if safe, legal nicotine products are used instead of black market nicotine.
It is recommended that UNFLAVOURED nicotine is used for vaping. This is because of the risk of ‘Popcorn lung‘ (bronchiolitis obliterans): a serious and irreversible lung disease causing shortness of breath, coughing and wheezing. It is associated with diacetyl, a buttery-flavoured chemical originally used in popcorn. Although the majority of reputable vaping products do NOT knowingly have diacetyl, it is recommended that if you are purchasing a flavoured nicotine product that you ask the supplier about this.
What does the World Health Organization say about nicotine vaping?
The World Health Organization provides a balanced assessment of the role of nicotine vaping. Click here for the full report. Essentially, although the lack of long-term safety data is highlighted as a major issue, WHO does offer support for nicotine vaping in current smokers who are unable to stop smoking:
“If the great majority of tobacco smokers who are unable or unwilling to quit would switch without delay to using an alternative source of nicotine with lower health risks, and eventually stop using it, this would represent a significant contemporary public health achievement.”
“Electronic nicotine devices are unlikely to be harmless, (but) the magnitude of these risks is likely to be smaller than from tobacco smoke.”
— World Health Organization 2016, WHO Framework Convention on Tobacco Control
Do I need a nicotine script for vaping?
Yes, definitely! Since October 1st 2021, Australian law has changed. It is now illegal to import, possess or use a nicotine vaping product without a valid script. The fines are substantial, up to $220,000. Although it remains legal to buy cigarettes from the corner store, complete with carcinogens and all the poor health outcomes of smoking, a script for nicotine for vaping is required.