Australian Tobacco Control Expert Colin: Government Has Relaxed Tobacco Control Measures, Prescripti

Australian tobacco control expert Dr. Colin Mendelsohn shared his views on the current state of e-cigarettes in Australia and the future development of harm reduction products in an interview with Two Supremes.

[Two Supremes from Seoul, South Korea] On September 21, at the 2023 Global Tobacco and Nicotine Forum (GTNF), Australian tobacco control expert Dr. Colin Mendelsohn discussed the current state of e-cigarettes in Australia and shared his insights on the future development of harm reduction products globally. Dr. Mendelsohn stated that Australia's prescription e-cigarette model has proven to be a failure.

Australian tobacco control expert Dr. Colin Mendelsohn | Image source: GTNF  

Australia's tobacco control measures have fallen behind 

Dr. Mendelsohn is the founding chair of the Australian Tobacco Harm Reduction Association, a health promotion charity established by doctors to raise awareness of the reduced risks of combustible tobacco alternatives. He has over 40 years of experience in tobacco treatment and harm reduction, having served as an associate professor at the University of New South Wales' School of Public Health and Community Medicine. Dr. Mendelsohn is also a member of the expert advisory group for the National Smoking Cessation Guidelines of the Royal Australian College of General Practitioners. He actively engages in teaching, writing, research, and advocacy to reduce tobacco harm.

Dr. Mendelsohn stated that while Australia has historically been a global leader in tobacco control, the country has recently fallen far behind in the anti-smoking fight.

“In the past, we adopted plain packaging, high tobacco taxes, bans on tobacco advertising, smoke-free policies, and large-scale media campaigns early on. However, over the past decade, we seem to have shifted our focus away from these measures, resulting in stagnation in our smoking rates for four to five years.” 

Australia appears to be increasingly reliant on increasing tobacco taxes. According to Dr. Mendelsohn's observations, tobacco taxes in Australia have increased fivefold over the past fifteen years, leading to a massive illegal tobacco market and placing a significant economic burden on smokers.

Australia has the highest cigarette prices in the world. This practice has inadvertently fueled the growth of the illegal tobacco product black market, which currently accounts for 20-25% of the total tobacco supply. Models show that Australia will fall far short of its goal to reduce adult smoking rates to 10% by 2030.

He believes that Australia's tobacco control has failed to provide the strategies needed to curb the tobacco epidemic. He emphasized:

“However, many smokers in Australia are unable to quit, and they could benefit from harm reduction options that are not yet promoted, difficult to access, or obtained illegally.” 

The prescription e-cigarette model is a failed approach 

Since October 1, 2021, Australia has implemented a prescription system to regulate e-cigarettes, which Dr. Mendelsohn considers a significant failure.

He highlighted the challenges faced by this system, where smokers need to find doctors willing to prescribe, but very few doctors are willing to do so; then they need to find pharmacists willing to fill prescriptions, but very few pharmacists are willing to do so. Less than 10% of e-cigarette users actually have prescriptions, so the vast majority of e-cigarette users (1.3 million people) obtain these products through the black market.

“We have a thriving black market selling unregulated, low-quality e-cigarette products to adults and youth. Therefore, we have a significant issue with youth vaping, which is policy-driven. The black market has seen tremendous growth and is run by criminal gangs.” 

Despite the evident flaws in the prescription model, Dr. Mendelsohn expressed regret over the Australian Health Minister's decision to strengthen this approach and double down on a failed system. He praised the regulatory approaches to e-cigarettes in New Zealand and the UK.

“With government support and encouragement, I believe it has had a significant impact on our smoking rates.” 

“They will have to change policies” 

Dr. Mendelsohn also discussed his views on harm reduction products with Two Supremes. He stated that there is now very good evidence that high-quality harm reduction products will save lives, but many regulations are driven by fear and misinformation. 

“We should provide smokers with a variety of safer alternatives, including e-cigarette products, heated tobacco, snuff, and nicotine pouches, as different products work for different people. Addressing youth usage and environmental issues is crucial, especially with disposable products.” 

He noted that this presents a huge opportunity for public health, “If we do it right, we will save millions of lives.” 

Finally, Dr. Mendelsohn emphasized that the prescription model has received full support from all parties in Australia, public health groups, health charities, medical associations, and health departments.

He expressed concern that these stakeholders may need more evidence of failure before considering reasonable policy changes, while lives are being lost in the meantime, which he believes is a preventable tragedy.