Last updated 21 October 2021
An electronic cigarette is a battery-operated device that simulates the act of smoking. It heats a nicotine liquid or ‘juice’ and converts it into a water vapour. It is the water vapour that smokers inhale and exhale, hence the term ‘vaping’.
These products are often described as electronic and alternative nicotine delivery systems, as well as personal vaporisers and vape pens.
Electronic cigarettes come in all shapes and sizes
Some look like cigarettes (‘first generation devices’), whilst others look like fountain pens and USB flash drives.
Some of the devices are disposable and others can be reused by recharging the battery and adding the liquid as needed.
Some electronic cigarettes are referred to as ‘tanks’ or ‘mods’, which means that they can be modified or transformed to suit the smoker’s needs (‘third generation devices’).
It is estimated that there are approximately 20,000 e-liquids and 250 unique flavour descriptions available, including cappuccino, berry and apple pie flavours.
Are they safe?
Due to the wide variation in products and the ability to customise your device, the World Health Organization (WHO) highlights that the scientific evidence regarding the short and long term health effects, (including the effects of secondhand vaping) remains inconclusive.
As these products are not regulated, the quality and safety of e-cigarettes is not known.
Although there have been reports that electronic cigarettes may be safer than smoking (due to the exposure of fewer toxic chemicals than traditional cigarettes), they could also be delivering:
- unreliable doses of nicotine
- toxic chemicals or cancer causing substances which can increase your risk of developing cancer, and other chronic conditions such as lung disease and injury, as well as heart disease
E-cigarettes have furthermore been reported to cause death and injury, including severe burns to the face and body due to explosions, and the devices catching on fire. The explosions are often occurring because of batteries being over-charged, using the incorrect charger for the device, and because the device had been over used.
A number of children being poisoned by the nicotine liquid have also been reported and these devices have also been shown to cause harm to the developing foetus.
Although some devices have claimed to be free from nicotine, research has found that some of the nicotine-free devices do actually contain nicotine in them. As nicotine is highly addictive, it can lead to young people who are experimenting with the devices to start using them on a regular basis.
Young people using electronic cigarettes are also twice as likely to swtich to smoking conventional cigarettes later in life.
Can they help people quit?
Although there is disagreement amongst tobacco control experts and clinicians as to whether these devices can help smokers quit, there is currently insufficient evidence to conclude that electronic cigarettes help people stop smoking.
Some of the experts believe they may keep smokers addicted, with research showing dual usage, that is, smokers using traditional and electronic cigarettes at the same time. Smokers may therefore not be using these products as a quit smoking aid…
There is also concern that electronic cigarettes may renormalise smoking and possibly recruit new smokers and in particular, adolescents.
In Australia, the Therapeutic Goods Administration has not approved any of these devices to support people with their quitting efforts.
What does WHO recommend?
Both smoking and the use of electronic cigarettes pose significant health risks. The safest option is to not use them and to quit smoking.
The World Health Organization recommends that Governments who have not banned them as yet, to consider regulating them under existing rules for tobacco products.
There is a call to ban their use indoors, as well as have restrictions on advertising and promotion.
This includes removing any claims of ‘health benefits’ and instead, adding health warnings, such as the potential of nicotine addiction. Other health warnings include the potential of respiratory, eyes, nose, and throat irritation, and the potential adverse effects on pregnancy (due to nicotine exposure).
WHO also encourages banning sales to minors as well as banning fruity and candy-flavoured products that may appeal to young people.
E-cigarettes in Australia
The sale or use of electronic cigarettes that contain nicotine in Australia is illegal.
The only exemption is if you have a doctor’s prescription that you are using the device to help you stop smoking. The Royal Australian College of General Practitioners (RACGP) however, encourages doctors to exercise caution as to whether to prescribe ‘nicotine for inhalation as a smoking cessation aide’…
Quit Victoria and the Heart Foundation do not encourage the use of nicotine vaping products (NVPs) for quitting smoking.
The latest information
Australia’s Therapeutic Goods Administration has now confirmed that access to e-cigarettes with nicotine in them, is by a doctor’s prescription only.
As highlighted in their latest media release, “From 1 October 2021, the law for consumers to import nicotine e-cigarettes and liquid nicotine will align with the law for them to buy such products domestically.
Consumers can continue to import nicotine e-cigarettes to assist with smoking cessation with a doctor’s prescription. Consumers will also be able to obtain nicotine e-cigarettes from local pharmacies and Australian based on-line pharmacies, with a prescription from an Authorised Prescriber or under the TGA Special Access Scheme. The requirement for a prescription will provide an opportunity for consumers to receive advice from their doctor on smoking cessation in the context of their overall health management.
Consumers who may be affected by these changes are encouraged to speak to their medical practitioner regarding potential options ahead of the 1 October 2021 implementation date.”
What should smokers do?
As there is not enough evidence at this stage that electronic cigarettes help people quit, and the fact that they may contain toxic chemicals, all smokers thinking about quitting are encouraged to use the quitting medications which have been extensively tested, and are considered safe.
The final decision to use e-cigarettes however, belongs to the individual smoker.
Smokers are encouraged to weigh up the risks and benefits, and make an informed decision as to whether this product is right for them.
If smokers have tried to quit smoking with the quitting medications and were unsuccessful, and if smokers are still motivated to quit, they are encouraged to speak to their local doctor as to whether the use of a nicotine vaping device is appropriate for them. The individual however, needs to be aware that the long term effects of vaping is unknown and that any use is only recommended for a short amount of time. Most importantly, dual usage (vaping and smoking) is to be avoided (RACGP, 2019).
Individuals are also encouraged to seek additional support by contacting the Quitline, and/or working with a smoking cessation specialist/Educator during the quitting process.
For some extra tips on quitting smoking, take a look at our blog post which shares some practical strategies to help smokers cope with cravings and withdrawal when quitting.
We hope you enjoyed this post and until next time, wish you all great health and wellbeing.
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Australian Government Department of Health (2020). About e-cigarettes. Retrieved from: https://www.health.gov.au/health-topics/smoking-and-tobacco/about-smoking-and-tobacco/about-e-cigarettes.
Australian Government Department of Health (2021). Nicotine vaping laws are changing. Retrieved from: https://www.tga.gov.au/blogs/tga-topics/nicotine-vaping-laws-are-changing.
Greenhalgh, EM, & Scollo, MM. InDepth 18B: Electronic cigarettes (e-cigarettes). In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2018. Retrieved from: http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes.
, et al (2019). Nearly 20 000 e-liquids and 250 unique flavour descriptions: an overview of the Dutch market based on information from manufacturers.
NHMRC. CEO Statement: Electronic cigarettes (2020). Retrieved from https://www.nhmrc.gov.au/about-us/resources/ceo-statement-electronic-cigarettes.
The Royal Australian College of General Practitioners (2019). Supporting smoking cessation: A guide for health professionals. 2nd edn. East Melbourne, Vic: RACGP. Available from: https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/supporting-smoking-cessation.
The Royal Australian College of General Practitioners (2021). Supporting smoking cessation. An update on pharmacotherapy for smoking cessation. Recommendation 15. Available from: https://www.quit.org.au/documents/418/QuitHeart_Position_Statement_smoking_cessation_FINAL_PNGDzNH.pdf
Quit Victoria and Heart Foundation (2021). Position statement: Smoking and vaping cessation. Retrieved from: https://www.quit.org.au/resources/policy-advocacy/position-statements/electronic-cigarettes/.
World Health Organization (2021). WHO report on the global tobacco epidemic 2021: addressing new and emerging products. Available from: https://www.who.int/publications/i/item/9789240032095.
World Health Organization (2021). Tobacco. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/tobacco.
World Health Organization (2020). E-cigarettes. Retrieved from: https://www.who.int/news-room/q-a-detail/e-cigarettes-how-risky-are-they.