Abstract
Mendelsohn and Hall (this issue) disagree with our call for an urgent review of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) position statement on e-cigarettes (2018). Within the position statement, the RANZCP recommends:
Exemption of nicotine-containing e-cigarettes and vaporisers from the restrictions imposed under the Poisons Standard so that they may be subject to stringent and suitable regulations as consumer products; Lower rates of taxation for e-cigarettes and vaporisers compared to smokable tobacco products to ensure affordability for low-income smokers and to provide a financial incentive to switch; and further research into the following: ○ The long-term health effects of vaping; ○ The effectiveness of e-cigarettes and vaporisers as a cessation tool; and ○ Monitoring demographic patterns of use including rates of initiation by young people.
We agree with Mendelsohn and Hall (2022) that e-cigarettes are less harmful than combustible cigarettes and are likely to be more effective than other methods in assisting current smokers to quit. Our views strongly diverge, however, on the evidence of effectiveness of e-cigarettes for people with serious mental illness and on the unintended harms to young people.
The evidence for e-cigarettes in assisting cessation of combustible cigarette smoking in people with serious mental illness is very weak (McKeon and Scott, 2022). We identified six studies of 240 participants with severe mental illness, of which three had combustible cigarette cessation rates of <10%, very similar to those achieved by conventional therapies. While the RANZCP position statement is driven by the disproportionate prevalence of tobacco smoking by people with mental illness, the current evidence-base does not support e-cigarettes as an effective intervention for this population.
By contrast, the evidence of unintended harm to young people from e-cigarettes in our opinion is now indisputable. Child and adolescent psychiatrists are now treating children under the age of 15 for nicotine dependence (JS personal clinical experience) arising directly from use of e-cigarettes. It may take many years to robustly establish a causal relationship between vaping and later combustible cigarette use. However, we identified five systematic reviews demonstrating a robust and consistent temporal relationship with vaping in never smokers preceding an increased risk of cigarette smoking (McKeon and Scott, 2022). It is imperitive that the RANZCP considers the impact of their recommendations on wider population harm in their position statements, as well as the risks and benefits to those living with mental illness.
Public health campaigns to reduce tobacco smoking have been remarkably successful in Australia. Public messaging, banning advertising, quit campaigns with access to interventions, reducing affordability through taxation, and preventing illegal tobacco trade have improved health and averted harm for so many individuals. The RANZCP should be calling for similar public health interventions to prevent young people using e-cigarettes rather than adopting a position statement that inadvertently increases access to nicotine-containing e-cigarette products. The RANZCP should immediately retract their e-cigarette position statement and focus on evidence-based interventions to support those with mental illness to quit cigarette smoking.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
