Australia is facing a potential increase to liquid nicotine restrictions, but will this actually reduce harm? Some liquid nicotine users don’t think so.
Fraser is adamant about what’ll happen if he can’t access liquid nicotine: smoking is the last option. “I would figure out a way to get either the nicotine salt, or whatever, to add to liquid, or just go to a place and buy it,” he laments.
“I would still rather go through that than smoke.”
It’s been a stressful three weeks for Fraser. On June 19, the Federal Government announced its intention to further restrict liquid nicotine — which Fraser uses for vaping. Currently, it’s illegal to buy or sell liquid nicotine in Australia, but a loophole exists, via the Therapeutic Goods Administration’s (TGA) Personal Importation Scheme, which allows anyone to import prescribed, but unregulated, medicine from overseas.
Despite never being prescribed, Fraser’s been importing liquid nicotine for the past four years, a measure that’s allowed the 27-year-old to break a six-year smoking habit.
“The goal was to not ever smoke a cigarette,” he explains.
Under the proposed plan — initially set for July 1, now delayed to January 1, 2021 — only a health practitioner or pharmacist can import liquid nicotine on behalf of a patient, strictly as a last measure for smoking cessation.
A decision hitched upon the emerging concerns of e-cigarettes, like how they’ve become increasingly popular with young people in the US and Canada, and how some research suggests e-cigarettes couldincrease smoking rates.
For users, the announcement was met with both rage and panic, Fraser himself purchasing $500 of liquid nicotine in preparation, a supply that’ll last him at least six months.
The delay is a small relief for users like Fraser, but this proposal is just another instance in the much-larger, and heavily politicised, e-cigarette debate. A polarising topic, where one side lauds e-cigarettes as a public health miracle that’ll end smoking, while the other forewarns the unknown, and potential health risks.
But while both sides argue tendentiously about proof and emerging research, the popularity of e-cigarettes in Australia is certain, with estimates suggesting there are at least 97 000 daily users nationwide. People who, for whatever reason, have embraced liquid nicotine and whose access comes from bending the law.
One criticism of these proposed restrictions is they could produce unintended consequences, such as the spawning of black markets or migration to tobacco. Rachel, a 24-year-old from Sydney, told The Feed that she’d rather just buy tobacco, despite transitioning to an e-cigarette eight-months-ago over health concerns, than have to hassle with sourcing liquid nicotine.
“We’ll see increased harms, and I have no doubt about that,” says Dr Alex Wodak, an addiction medicine specialist currently on the Australian Tobacco Harm Reduction Association’s Board of Directors.
But considering the known harms and high cost of tobacco, the emergence of illicitly-created liquid nicotine — a product that’s remained largely neutered by importing — may be the natural response to these restrictions. A scenario that’s concerning, healthwise.
Last year, the US saw a sudden boom of vaping-related lung disease, with over 2800 cases and 68 confirmed deaths as of February 2020, according to the Center for Disease Control and Prevention.
But the majority of these cases, according to studies, weren’t found to be the result of liquid nicotine use, but exposure to vitamin E acetate — an oil used to cut liquid THC. One study from February this year tested the lung fluid of 51 vaping-related lung disease cases. 48 tested positive for vitamin E acetate.
Tainted liquids are one of the infinite potential outcomes that come with a black market. A point not lost on the vaping community, further fueling the frustration towards these restrictions. Even with the risk, for many users, illicit liquid nicotine is the lesser evil, and a more tangible option than quitting nicotine — a difficult habit to break, even with medication.
“At the moment, I have the choice to avoid low-quality juice,” says Drew, a 31-year-old from Sydney. “This ban means I wouldn't have that choice. And low-quality juice is still a better alternative [than] carcinogenic cancer sticks.”
“If I could actually get a prescription and buy it from a pharmacy: no problem for me,” explains Nicole, a 51-year-old from the ACT. “If not, I'd be perfectly happy to go black market. Risks and all.”
“I’ve stocked up on legal nicotine, so I would be set for at least a year,” says 31-year-old Sam Parsons, a vaping influencer also known as the Vaping Bogan. “After that? I wouldn’t stop vaping nicotine, that’s for sure.”
“You see, I’m transgender. I need [hormone replacement therapy] to be me.” explains Pippa. “If I smoke, my doctor will not, and can’t, prescribe me HRT.”
It’s important to note that liquid nicotine will still be accessible under these proposed changes. If a GP or pharmacist felt liquid nicotine was necessary, they could submit a request to the TGA.
According to a TGA spokesperson, the average length of time for an urgent response to a Special Access Scheme Category B submission, the same form used to request liquid nicotine, has been two to three days over the last 12 months. But that response may not be an approval.
“[It can take] like five working days to get approved, but it’s pretty common to get rejected,” explains a pharmacist who spoke to The Feed anonymously about the Special Access Scheme. “Or, you just don’t hear back for weeks.”
The federal government has expressed their intention to streamline this process, but this also relies on health practitioners actually prescribing liquid nicotine which, considering its illegality and the potential harms that orbit its use, isn’t commonplace.
“[My doctor] told me that under no circumstances would he write me a prescription [for liquid nicotine], and that I shouldn't be using nicotine in my vape,” says Graeme, a 51-year-old from New South Wales, who’s been using liquid nicotine for two years.
It’s a point that illuminates what few options exist for users beyond a black market, tobacco itself, or quitting altogether. A choice that for users like Fraser, is obvious.
“It’s kind of, the option of what would definitely kill me, and what might kill me,” Fraser summarises. “And I would take the ‘what might kill me option’ any day of the week.”
If this story raised issues for you, help is available. Contact Quitline on 13 7848 www.quitlinesa.org.au