Opinion: I don’t vape or smoke, and I don’t have teenage children, but I have a family member who was a youth smoker and now vapes, and who I would ideally prefer to quit. But I am still happier they are vaping rather than smoking. I have tried both, and it was my good fortune to be addicted to neither. As a cancer specialist, I feel much more worried about the consequences of my youthful forays into smoking than vaping.
A decade and a half ago, we had big hopes for pharmacotherapy to help people quit smoking. Nicotine replacement therapy (NRT) with patches and gum promised a simple and safe replacement for cigarettes for people wanting to quit. But these hopes were only partially fulfilled, as it proved only 7 percent effective. Neither were the drugs bupropion, nortriptyline and varenicline (Champix) any better.
The problem with NRT is its pharmacology – the way it works. It cannot deliver the same rapid spike in arterial blood nicotine levels as a cigarette. With the arrival of e-cigarettes, at last there was a way of getting nicotine that approached the subjective experience of smoking tobacco.
Vaping is manifestly safer than smoking, because the temperature to make a vaping aerosol does not go above 240C. In contrast, the heated tip of a cigarette burns tobacco at up to 900C, leading to far more toxic chemistry. That is why smoking ultimately kills at least half of the people who don’t quit.
Nicotine addiction can arrive as a rude intrusion from the outside world. It is hard to offer reassurance, except to say there are worse things to be addicted to, and it is possible to quit nicotine. By far the better thing is to not start in the first place.
People who vape are in a sense volunteers, in a decades-long social experiment that will tell us the level of harm caused by vaping. But we also know for sure how incredibly harmful smoking is right now; in any sane world, smoking would have ended long ago.
Smoking has proved extraordinarily hard to dislodge, but we are finally on track to succeed with Smokefree 2025 Aotearoa. I do not believe vaping is necessarily as hard to control as tobacco. Because vaping is a fully manufactured product, it is more open to control of production, composition, and presentation.
It is inaccurate to refer to the vaping industry as the tobacco industry – they are two different products. If there were a kiwifruit orchard that was bought out by a forestry company, we would still call it horticulture and not forestry. A shift of investment from combustible tobacco towards vaping is an improvement because vaping is less harmful to health than smoking. None of this means the industry that supplies combustible tobacco, including its financiers, should not be held to account for their historical and ongoing injury to people’s health, and their subversion of democratic processes.
But how to confront the reality that vapes increasingly find their way into the hands of young people, who now risk not only addiction but also harm to their physical health, in the event concerns about cardiorespiratory disease are borne out?
According to the ASH Year 10 survey, prevalence of daily vaping at 14 and 15 increased from 2 percent in 2018 to 10.1 percent in 2022. For Māori girls it increased from 5 percent to 25 percent. For many young people and their families, the loss of control that comes with addiction is frightening. Nicotine addiction can arrive as a rude intrusion from the outside world. It is hard to offer reassurance, except to say there are worse things to be addicted to, and it is possible to quit nicotine. By far the better thing is to not start in the first place.
We must also ask what is driving the rise in numbers of young people vaping. Although sales and marketing has had a big part, it is not the whole story. Why are young people primed to turn to vaping as a consolation in life? Economic prospects for many young people are not good. They see a worsening situation, and mostly can’t expect to own their own house. They are excluded from voting. They have grown up in the face of denial and inaction on climate change. Many must endure additional layers of prejudice, and Rangatahi Māori also carry the experience of colonisation. Shutting down vaping will not remedy any of these things. Justice for Rangatahi is the remedy for youth vaping, not sweeping it under the carpet.
Of course, justice is not here today, so those of us who advocate for vaping to help smokers stop, must also strike a balance with youth vaping. In New Zealand we have been through our own legislative and consultative process, leading to the Smokefree Environments and Regulated Products (Vaping) Amendment Act 2020. Section 3A makes clear its purpose is not only “discouraging non-smokers, especially children and young people, from taking up vaping” but also to “support smokers to switch to regulated products that are significantly less harmful than smoking”. New Zealand’s law is a good one and should not be hastily rewritten.
These are reasons why I argue we should not follow Australia’s lead on laws restricting vaping. A vape clampdown is not going to remedy the much bigger problems faced by young people. The Australian position on vaping is too extreme and, frankly, punitive towards people who smoke.
These are the personal views of Dr George Laking