“Hello, I am a politician and a criminal.” The room laughed a little nervously and no doubt some in the room were muttering under their breath well aren’t they all? It was the opening of the 9th Global Forum on Nicotine and I was sharing the stage with doctors, litigation lawyers, consumer advocates and academics.
The conference was in Warsaw, Poland and comprised of doctors, scientists, academics, social workers and of course consumers – 600 in all from 70 countries. Many of them, including most of the panel, were discreetly vaping. There was minimal vape mist in the air but the soft bubbling sound of vapourisers was constant. They were passionate about their right to use nicotine and the right of their patients and clients via a less dangerous route. They were also angry. Angry that governments were restricting access and restricting the products that could be sold. For many this was life and death.
The Global Nicotine Forum is in its ninth year and as the popularity of non-combustible nicotine devices has grown, so has the conference. But there was still a real grassroots activist feel about it. It reminded me of the first HIV/AIDS conferences I attended in the 1990s; activists, doctors, scientists, advocacy groups all coming together to discuss policy, science and how to affect change. The conference was about, health, social justice, human rights and most importantly harm reduction. But in amongst the posters from NGOs there were companies promoting their products. And some of them were tobacco companies. That’s right, those evil companies that are the reason so many of the people there were now using vaporisers and heat not burn products.
Many talked about being accused of being in the pocket of big tobacco. But these were the warriors against big tobacco – Professor David Sweanor, Dr Dave Abrams, Professor Clive Bates and our own Dr Alex Wodak.
(Just to be clear what we are talking about is devices that heat either tobacco or fluids often containing nicotine but do not create smoke or tar. They create a vapour or an aerosol. They are used by millions of people around the world, but here in Australia the use of nicotine is prohibited in this form.)
It was unusual to be at an international harm reduction conference where Australia was at the bottom of the class – we were reporting that every state health department and every state health minister said that products like heat not burn tobacco, snus and vapourisers were too dangerous to allow smokers to use. The result was that our policy was just say no or continue feeding your nicotine dependence via the very dangerous form of combustible tobacco.
Everywhere I walked around the hotel and in the city of Warsaw people were vaping. I don’t know what the stats are for Poland but in the US and UK five per cent of adults use a nicotine device that is not a cigarette. In Germany, they estimate four million people vape. For every four smokers there is one vaper.
In Sweden almost no one smokes, but 17 per cent of the population use snus, a nicotine product that you place in your mouth between your gums and lips.
I listened to scientists and consumers talk about the health successes that have been achieved. Explain the role of nicotine, explain the difference between consuming nicotine without burning and without consuming the hundreds of other carcinogenic substances found in cigarettes.
But it was the people from the African countries where smoking rates are still increasing and presentations from health workers working with vulnerable communities in countries like the UK and New Zealand that was compelling.
I learned that our body is filled with nicotinic acetylcholine receptors. I learned why we smoke. I learned that nicotine has effects on every part of the body and that long term nicotine use, while not harmless, is much, much less harmful than cigarette smoking. That in Japan it is estimated that the country loses 4.3 trillion Yen due to smoking but receives 2.8 billion Yen in tax. The costs include loss of labour force due to smoking related disease, cleaning expenses, medical costs of smokers and fire safety expenses. And since the introduction in 2014 of heat not burn tobacco products, smoking rates have literally plummeted. In less than three years Japan had seen a 21 per cent reduction in tobacco sales.
Japan now has about the same smoking rates as Australia. But while their rates plummeted in the last few years ours have plateaued at around 15 per cent despite plain packaging, incredibly strict tobacco control policies and the most expensive cigarettes in the world. Still 19,000 Australians die due to smoking.
Australia is the only western democracy that bans the sale and use of nicotine liquid by adults. Everywhere else allows it and strictly regulates it.
1.2 per cent of Australians vaped in 2016 although these figure may not be accurate as there are very few researchers or governments asking the question.
Conference goers were just shaking their heads in pity as Dr Wodak explained that every health department and health minister in Australia rejected the use of non-combustible nicotine devices, except if a doctor has provided a prescription. That our federal health minister has stated that vapourisers would not be available under his watch.
Compare that with just about every other country where governments are getting behind vaping.
The UK government’s quit smoking campaign Stoptober is encouraging adults to switch to vaping or other forms of nicotine that doesn’t require the inhalation of tar and hundreds of other carcinogenic chemicals.
And of course New Zealand is doing this better than most and definitely better than Australia.
Smoking in vulnerable, marginalised or stigmatised groups is far higher. Professor Lynne Dawkins from the US reported that smoking rates amongst adults with severe mental illness is two to four times higher. The same goes for people who are using illicit substances or are homeless.
Many of these groups are not offered smoking cessation advice information or products. It is considered that they have so many issues that smoking is the least of them. Of course often it is smoking that will kill them.
Indigenous populations around the world have much higher smoking rates. In Australia smoking rates amongst the aboriginal community is almost triple of the rest of the population yet we refuse to look at new ways to help people stop smoking.
Of course New Zealand has taken a different approach. They have run targeted switch to vaping campaigns amongst the general population and specifically the Maori population with a special focus on the women.
To paraphrase anti-tobacco campaigner Professor Dave Abrams, people should have the right to make decisions. If you cared about people you would not stop them accessing nicotine through products other than tobacco. This is about human rights and social justice.
In Australia, we don’t talk about tobacco harm reduction but we must.