The first Australian clinical trial of e-cigarettes as quit-smoking tools will kick off this year with support for the devices building, but the government and some public health experts remain wary.
E-cigarettes are battery-powered electronic tubes that simulate the effects of smoking by evaporating a liquid solution into nicotine vapour. Some of the cheaper ones mimic the look of traditional cigarettes – complete with glowing tip – but they produce only vapour, no smoke or ash.
While none have been approved for sale as a therapeutic good, the devices are legally available in Australia. However, the nicotine solution is not available because nicotine is classified as a scheduled poison, so users are forced to order them online from unregulated overseas stores.
Australian e-cig community AussieVapers.com has 4000 members who swear by the gadgets, with one devotee telling Fairfax “e-cigs are the greatest innovation in health since the invention of penicillin”.
Several members of AussieVapers said they had been unable to quit cigarettes for up to 40 years but were smoke-free within a month of switching to a vaporiser.
Daniel Lucas, 42, from Rydalmere in Sydney, has been using e-cigarettes for just over a year, after smoking full-time since he was 15. He said he previously tried Champix, sprays, gum and patches and nothing worked.
“I don't wake up in the middle of the night coughing or waking the rest of the house. Don't get asthma any more like I use to. No more smoker's cough in the morning,” he said.
“My smell has come back and my taste for food. I don't burn my car seat covers or clothes any more, I don't smell like an ashtray.”
Damian O'Neill, 46, from San Remo in Victoria, said he smoked cigarettes for 33 years but hadn't had one since he started using a vaporiser. He said it “changed my life completely” and increased his self-esteem.
“To be honest the main thing is the feeling of the vapour going down the back of your throat, I think that's the thing that can't be replicated with patches or sprays.”
But unlike in Britain where authorities are assessing the use of e-cigarettes as medicine and have included them in official draft quit smoking guidelines, the Australian federal department of health said it did not support them because they had not been evaluated by the Therapeutic Goods Administration.
However, the department said it had "commissioned a regulatory impact statement on options for further regulation of electronic nicotine delivery systems (including electronic cigarettes) and smokeless tobacco products", and work on this project was ongoing.
Steve Hambleton of the Australian Medical Association said he was concerned there was not enough evidence of the benefits of e-cigarettes, there was little regulation and, particularly for kids, “it may be an entry into smoking not necessarily an exit from smoking”.
Simon Chapman, professor of public health at the University of Sydney said e-cigarettes which mimic the “smoking performance” of cigarettes may reinforce or “re-birth” the attraction of smoking.
There have been mixed reports of the health implications. In 2009 the US Food and Drug Administration said it tested 19 varieties of e-cigarettes and found several that contained cancer-causing ingredients.
The FDA report was criticised in an April 2012 article in the journal Addiction, which found the harms of e-cigarettes had been overstated relative to their potential benefits. These included enhanced quitting motivation, lower cravings and lower toxin exposure to non-smokers.
In August last year, Athens-based Onassis Cardiac Surgery Centre said in a study presented at the European Society of Cardiology that e-cigarettes prompted no adverse effects on cardiac function.
After examining the heart activity of 20 young daily smokers after one ordinary cigarette and comparing this against 22 people who smoked an e-cigarette for 7 minutes, the study found that while tobacco smokers showed “significant” disruptions of functions such as heartbeats or blood pressure, the effect of the e-cigarettes was minimal.
“Substituting tobacco with electronic cigarettes may be beneficial to health,” researcher Konstantinos Farsalinos said.
A six-month study of smokers not intending to quit, published in the journal BMC Public Health in 2011, found e-cigarettes led to a substantial decrease in cigarette consumption without causing significant side effects. Over half of the 40 pilot study participants either quit or more than halved their cigarette consumption.
Coral Gartner, research fellow with the University of Queensland's Centre for Clinical Research, will soon begin a federal government-funded trial with 1600 smokers to test the efficacy of e-cigarettes as long-term substitutes for cigarettes.
She believes that instead of being banned e-cigarettes should be regulated with the same restrictions as conventional cigarettes, as the quality and safety of devices was highly variable.
“If a large enough proportion of the smoking population find them to be an acceptable substitute, it might be possible to encourage smokers to move to e-cigarettes with the longer-term aim of phasing out conventional cigarettes, which are the most harmful nicotine product and kill half of all long-term users,” she said.
A paper on e-cigarettes published in May last year in the International Journal of Drug Policy found that the e-cigarettes had received such a hostile reaction from public health advocates because they “expose the artificial boundaries placed upon 'good' and 'bad' nicotine”. They “challenge the equation between addiction and harm” because they deliver the pleasures of smoking without the harms of combustible tobacco.