A critical analysis of Australia's ban on the sale of electronic nicotine delivery systems

Australia does not allow adult smokers to buy or use electronic nicotine delivery systems (ENDS) that contain nicotine without a prescription. This paper critically evaluates the empirical and ethical justifications provided for the policy by Federal and State governments, public health advocates and health organisations. These are: (1) that ENDS should only be approved as products for smoking cessation when there is evidence from randomised controlled trials that they are effective; (2) that as a matter of precaution we should not allow the sale of ENDS to smokers as consumer products because we do not know what their long-term effects will be; and (3) that allowing ENDS to be sold as consumer goods will enable the tobacco industry to market ENDS to young people which will also lead to an increase in youth smoking. We show that the arguments and evidence offered in support of all these claims is very weak. We also argue that even if the evidence were stronger, it would not justify denying adult smokers the right to use ENDS either to quit smoking or as a long-term alternative to smoking cigarettes. We outline ENDS policies that would more ethically address the public health concerns that motivated the current policy by allowing adult smokers to access ENDS for smoking cessation or tobacco harm reduction under tight regulations that discourage commercial promotion and adolescent use.