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Economics References Committee
09/03/2016
Personal choice and community impacts

DANKO, Dr Attila Lajos, President, New Nicotine Alliance Australia

DARVILL, Ms Donna, Secretary, New Nicotine Alliance Australia

GORDON, Ms Angela, Private capacity

STONE, Ms Jennifer Lynne, Private capacity

WODAK, Dr Alex, AM, President, Australian Drug Law Reform Foundation

WOLTERS, Mrs Judith, Private capacity

Evidence from Ms Stone and Ms Gordon was taken via teleconference—

Subcommittee met at 09:35

CHAIR ( Senator Leyonhjelm ): I declare open this public hearing of the Senate Economics References Committee. The committee is hearing evidence on the committee's inquiring into personal choice and community impacts. The committee has appointed a subcommittee for the purpose of the inquiry hearings. The Senate referred this inquiry to the committee on 25 June 2015, for report by 13 June 2016.

I welcome you all here today. The committee has received 467 submissions to date, which are available on the committee's website. This is a public hearing and a Hansard transcript of the proceedings is being made. Before the committee starts taking evidence, I remind all witnesses that in giving evidence to the committee they are protected by parliamentary privilege. It is unlawful for anyone to threaten or disadvantage a witness on account of evidence given to a committee, and such action may be treated by the Senate as a contempt. It is also a contempt to give false or misleading evidence to a committee. If a witness objects to answering a question, the witness should state the grounds upon which the objection is taken, and the committee will determine whether it will insist on an answer, having regard to the ground which is claimed. If the committee determines to insist on an answer, a witness may request that the answer be given in camera. Such a request may of course also be made at any other time.

On behalf of the committee, I would like to thank all those who have made submissions and sent representatives here today for their cooperation in this inquiry. I welcome the witnesses. Do you have any comments to make on the capacity in which you appear?

Ms Gordon : I am a registered nurse and I am also a user of electronic cigarettes.

Mrs Wolters : I am an associate of the New Nicotine Alliance Australia, but I made a submission as a private individual and I am an ex-smoker, thanks to vaping.

Ms Darvill : I am a founding board member, along with Dr Danko, of the New Nicotine Alliance. I am an ex-smoker, current vaper.

Dr Danko : As well as being President of the New Nicotine Alliance, I am also a general practitioner in Ballarat.

Dr Wodak : As well as being President of the Australian Drug Law Reform Foundation, I am appearing this morning as a supporter of the New Nicotine Alliance.

Ms Stone : I am a support worker in homelessness and I am an e-cigarette user, appearing as a private individual.

CHAIR: Thank you for appearing today. I will now ask each of you to make a brief opening statement before we proceed to questions, if you wish to.

Dr Danko : The New Nicotine Alliance Australia is a group of consumers of reduced risk nicotine products such as electronic cigarettes. We receive no funding from any tobacco, e-cigarette or pharmaceutical companies. We stand here today as a group of people representing many thousands of Australians who have only managed to give up smoking by breaking the law. I myself smoked daily from the age of 11 and was unable to give up smoking any other way except by using nicotine electronic cigarettes. I am a criminal, because Australia treats the nicotine I use in my e-cigarettes under schedule 7 poisons laws as a dangerous poison with hefty penalties for possession.

What do you do when you are trapped so tightly in smoking, when you look at your children and wonder if you will be around to see them grow up? I hated smoking, but I loved it so much at the same time. Like many other hardened smokers, I would more easily give up food than smoking. It was only when I found something that gave me the same enjoyment, the same satisfaction I had from smoking—without the smoke—that I could replace one behaviour with another. Now I feel better than I have ever felt in my life. I am able to run and not get puffed out, I have lost my smoker's cough and I know from studying the scientific evidence that I should now enjoy roughly the same life expectancy as if I had quit cold turkey—because any risk from vaping is minimal.

I stand here at considerable personal risk. I risk my professional career and I risk legal consequences to stand against the tobacco controlled establishment that tells me that I am not allowed to give up smoking—because I can only give up smoking 'the wrong way'. But I can no longer be silent. This goes far beyond the nanny state. This is a monstrous state that would keep people smoking who might have given up if they could only access a far safer option.

Judith here, one of our associates, told me about how sick she was before she took up vaping. She described symptoms consistent with end-stage chronic obstructive airways disease, which has a very high mortality rate. She was out of breath after even very short walks and would cough all night, unable to breathe and feeling like she was drowning. She was literally smoking herself to death, and no matter what she tried she could not stop—until she switched to e-cigarettes. Since then her health has improved dramatically. It is likely—I say this as a GP who has looked after patients like this before—that she would not be here today if she had not broken the law and switched to e-cigarettes. It is likely that she would have been dead. Look at Judith now; look how full of life she is. When you consider what attitude we should take towards e-cigarettes and nicotine, think about her and the many Judiths around the country.

Professor Ron Borland of the Australian Cancer Council recently shared with me the latest data on how many people regularly use e-cigarettes in Australia. This was presented at the SNRT world conference on tobacco in Chicago. As of late 2014, it is close to 15 per cent of smokers and recent ex-smokers. It was seven per cent when it was last measured in 2013, so it is exploding despite our draconian laws. This equates to almost half a million people, which is also half a million voters.

Schedule 7 poisons law specifically exempts tobacco, but there is no exemption for nicotine e-cigarettes. Given that not one e-cigarette sold in Australia comes from a tobacco company, this amounts to enshrined protection of big tobacco in law. But how are you going to enforce this law when it is so massively broken, this monstrous law that protects the cigarette market and keeps people smoking? A law that cannot be enforced makes a mockery of the law and leads potentially to embarrassment of the government, especially if it may be faced in the future with a civil disobedience movement with massive media attention. A simple stroke of the pen to legalise low-strength nicotine liquids to even the playing field could change all of this. It costs nothing. In fact, as small vaping shops spring up around the country to take business away from cigarettes—vape shops that act as quit-smoking centres everywhere—you will get more jobs, more taxes and a healthier population with lower healthcare costs.

Our vision is to allow the rapid pace of e-cigarette innovation to continue with only light-touch regulation. All of these small companies are fighting right now to make better and better substitutes for smoking. If we do not stop them with the heavy hand of overregulation, if we allow them to make more and more enjoyable and satisfying substitutes for smoking, eventually there may be no point to smoking anymore. Smoking could simply become obsolete.

Mrs Wolters : Dr Danko has said a lot of what I would have said so I can cut out a lot. It has been an incredible education for me over the last two years reading about vaping and associated research and topics. I have noticed that, over time, the war on smoking has become a war on tobacco companies, smokers, nicotine, and now it is nicotine. If I use nicotine it hurts no-one else, so it can hardly be called a harmful addiction to have. I do not rob banks or anything else, so it is a personal problem of mine and I should be left alone to get on with it. That is one thing that really worries me.

The government could be poised to make a mistake they made in 1991 when they banned Swedish snus for sale in Australia. I only found out about smokeless tobacco products after I had started vaping and researching that. If I had had access to Swedish snus, which is considered to be even safer than vaping, 24 years ago, I may have even stopped smoking that long ago. But the precautionary approach won, so there are a lot of people smoking now. Apparently in the late eighties it was actually banned and a lot of people that were using it went back to smoking, so the government relented and allowed import, but I am not sure about that ban, 100 per cent.

What I find most offensive though is the lack of empathy for people in poverty. Some of the figures from a report in 2013 called Smoking and disadvantage published by the Australian National Preventive Health Agency were 15.1 per cent average across the general population. For people experiencing unemployment it went up to 27.6 per cent; people with a mental illness it doubled; sole parents it went up to 36.9 percent, more than double; Aboriginal and Torres Strait Islanders, 47.7 per cent; people living with psychosis, 66 per cent, prisoners, 74 per cent; people experiencing homelessness, 77 per cent; young people in custody, 79 per cent; and people with substance use disorders, 85 per cent.

So, when tobacco taxation increases, every one of them is driving these vulnerable groups in society further into poverty to a place where they are even less likely to be able to give up smoking. I know what it is like when your bill comes and you think, 'How am I going to pay this. I'd better have a cigarette. Where's my cigarettes?' You do not think, 'I'd better stop smoking now so I can pay this bill.' That is not the way human beings work. I find it morally offensive and viscerally offensive that these groups are being driven further into poverty. I find it very offensive.

Apart from that, the wonderful thing about vaping is that I had three attempts on Champix—I had tried everything else—and I managed to give up three months on the last attempt and then, as soon as I was stressed, I went back to smoking. I stopped smoking 18 months ago last Monday and, if I get stressed, I do not have to have a cigarette, I just vape and it is enough. Those Champix attempts would have cost the taxpayer at least $1,000. It costs the taxpayer nothing for me to permanently stop smoking now.

Ms Stone : I do not have an opening statement. I am just here giving evidence because I smoked for 30 years. I had decided that I was not going to attempt to quit any more. I had weighed up the negatives with the positives and decided that I was going to take the risk and enjoy the quality of life I had been enjoying until I did not. E-cigarettes came along accidentally; I was introduced to them by a friend. I did not believe they would help me give up smoking, but that is what happened. Just naturally, I enjoyed using e-cigarettes more.

I am here because I am breaking the law by not smoking and using e-cigarettes as a safer alternative. I have been vaping for three years and I have learnt a lot about the regulations and I have heard the tone in the media directed by, I think, largely tobacco control bodies putting a negative light on e-cigarettes and scaring people off them. Because I work in homelessness, the figures that Judith gave seem underestimated to me. I would say 95 per cent of the people that I work with are smokers. As I said in my submission, it makes me really frustrated and very sad that I cannot support them in enjoying better health and saving money for actually surviving—instead of spending it on smoking—by switching to a safer alternative. It is illegal for them to do that. That is why I am here.

CHAIR: Thank you.

Ms Gordon : I have prepared a statement. I am a 54-year-old registered nurse. I smoked for 35 years and made over a dozen attempts to quit in that time, all of which failed, and I eventually quit trying to quit. I picked up an electronic cigarette nearly four years ago and have not smoked a cigarette since. It was incredibly easy. My health has improved dramatically and my doctor now considers me an ex-smoker. Unfortunately my government considers me a criminal because the nicotine I use in my devices was reclassified as a schedule 7 poison in 2008 when electronic cigarettes first began to surface in Australia.

I can import it from overseas, but I am breaking the law as soon as I take possession of it. To make matters worse, I recently converted my next-door neighbour to vaping—a woman in her late 60s with early-stage emphysema. She quit smoking completely within two weeks once I set her up with good equipment and liquid. Unfortunately, she does not have the internet and cannot source her own nicotine from international sellers online, so I sell her some of my own at cost price. This makes me a trafficker of a prohibited substance; a black marketeer. My crime is that I gave up smoking the wrong way and am assisting others to commit the same felony.

Prohibition of the sale of liquid nicotine in Australia was based on fears that electronic cigarettes might re-normalise smoking and act as gateway products to tobacco, leading to higher smoking rates. These were purely theoretical concepts which have since been thoroughly debunked. All the evidence shows that electronic cigarettes act only as a gateway out of smoking, not the other way around. Over three million Australian smokers have been denied legal access to an alternative to smoking which is widely accepted now as being at least 95 per cent safer. This catastrophe happened because we have a government which is willing to enact legislation based on nothing more than unfounded fears and suspicion.

I have made a choice to continue using recreational nicotine but not to smoke. I have made that decision based on a well-informed understanding that nicotine without the smoke, the tar and the hundreds of other chemicals in cigarettes is no more dangerous than caffeine. I enjoy vaping just as I enjoy drinking coffee. In Australia, the only form of recreational nicotine that I can legally purchase is the most dangerous form: smoking tobacco. Nasal snuff and Swedish snus have also been banned for sale here despite decades of evidence showing them to be virtually harmless. This is not responsible legislation; this is an outrage.

The only rational response for someone like me is noncompliance and a life of crime, apparently. At least it will be a longer and healthier life than if I obey the law and go back to smoking. If I complied with nanny state regulations, I would take my neighbour a carton of cigarettes instead of an illegal bottle of nicotine juice and assist her to advance her emphysema. Obviously this would be unconscionable. We have no choice but to protect ourselves from those in government who think it is their job to protect us from ourselves. They have no idea of the harm they are doing by eliminating all the competition to big tobacco companies. How can there possibly be a wrong way to give up smoking?

CHAIR: Thank you very much. Senator Ketter.

Senator KETTER: Could I get a rough guide on the cost of the delivery systems for e-cigarettes—the hardware and the software, as I think you described it, Dr Danko?

Ms Darvill : A disposable cigalike is probably around the $4 mark. But no-one uses them here because they are illegal because they contain nicotine. For a small e-cigarette—let's say a first-generation one that most people started using—you are probably looking at about $30. For one with a bigger capacity battery, you are probably looking at somewhere around $50 or $60. And they can go all the way up to $300 for something that is fancy or handmade—that is the hardware. Generally speaking, you would probably get about six months life out of one device; but everyone needs at least two because, while one is on charge, you need another one. Then you have got the peripherals such as coils—the disposable parts that keep them going. They probably work out at about $2 each and they would last about two weeks. And then there is the e-liquid. Most vapers would vape somewhere between three millilitres a day and six millilitres a day—some could be one millilitre and some could be 10. If you DIY, as I do, you are probably looking at about 10c a millilitre. That is buying in bulk—I have a big bottle in my freezer—but generally you are looking at between 50c and $1 a millilitre, and that is with or without nicotine.

Senator KETTER: And you say you would use six millilitres a day.

Ms Darvill : On average, it is between three millilitres and six millilitres a day. I vape five millilitres per day.

Dr Danko : It is a significant cost saving compared to smoking. It is often a tenth of the cost, or less, for ongoing e-liquid, which is the main consumable.

Ms Darvill : If I was smoking now, I would be spending more than $30 a day on cigarettes. But I spend probably $1 a day on consumables and might need to reinvest once every six months.

Senator KETTER: E-liquid is currently available on prescription?

Dr Danko : There is a loophole. You can have three months supply of nicotine e-liquid if there is a prescription from a doctor for the purposes of smoking cessation. But, even under that scheme, we are not using it for cessation; we are using it for ongoing recreational use—and the law does not state that that is allowed. Secondly, even when someone tries to get a prescription from a doctor—we have had people who have approached 15 or 20 doctors—

Ms Darvill : One guy did 48 doctors.

Dr Danko : And not one doctor was willing to do that prescription because it is an irregular thing. It is a loophole that a few people know about but it is not very widespread knowledge. As a GP, I know that most doctors feel very uncomfortable about prescribing something irregular.

Senator KETTER: Even if it is for the purpose of getting people away from smoking?

Dr Danko : Yes, because they are taking responsibility for something that someone has sourced overseas which is of uncertain quality and all that sort of thing. They are taking that responsibility when they do a prescription, and doctors are very hesitant to expose themselves to any legal risk or do something that is not what everybody else does.

Dr Wodak : Could I just add two points to what my friends and colleagues have already said and that is that I am sure we all know that smoking is not equally spread throughout the community. It is very much concentrated in economically and socially disadvantaged groups, so the savings that Dr Danko has talked about are critical to people who have very low incomes and wealth. These are people for whom smoking contributes disproportionately to inequalities in health. The fact that they can still get their nicotine but at lower economic cost to them is very significant in health policy terms.

We have only talked about the economic savings to the individual smokers, or vapers, we have not talked about the economic savings to the community. But, of course, if people are using a device to ingest nicotine that is a fraction of the risk that tobacco cigarettes are, then there is also significant economic savings to the Treasury and to the taxpayers. All up, e-cigarettes are a significant economic boon to former smokers as they are to taxpayers and the Treasury.

Senator KETTER: Whilst I certainly take the point that ingesting the e-liquid in a vapour form seems to be safer than smoking cigarettes and tobacco, I could not see anything in here that indicates that vaping and ingesting this liquid into your lungs is necessarily completely without some drawbacks, medically speaking. Are there any studies that go to that issue?

Dr Danko : Yes, I would agree with you that we do not have long-term studies on the potential effects of e-cigarette vapour on the lungs. What we can say though is that, if you examine the toxicology of the substances which are released, many of the substances are completely absent compared to cigarettes and most of the rest are in quantities nine to about 450 times less, roughly one per cent of the emissions. When you are talking about a 100-fold decrease,—when you separate out all the components and look at well studied occupational health and safety laws and occupational health and safety studies—pretty much all of them are below the exposure limits for those. It seems to me a scientifically untenable proposition to say that they could be anywhere near as harmful as smoking, and we always have to compare it to the reference product, which is smoked cigarettes.

Ms Darvill : May I read a short paragraph out of the recently published National Centre for Smoking Cessation and Training report? I will table that. It is a very short paragraph which answers the question there.

CHAIR: Yes.

Ms Darvill : It was only released last week so you have not got it yet. It says:

Is nicotine dangerous?

Nicotine does not cause smoking related disease, such as cancers and heart disease. These are caused by other chemicals found in tobacco smoke. Nicotine is addictive however and it is why people continue to smoke despite knowing about the harmful effects of tobacco. Nicotine in e-cigarettes poses little danger to adult users. In order to prevent accidental poisoning of children, e-cigarettes and liquids should be stored away safely (just as you would with household cleaning products and medicines, including NRT products).

This report goes from the national body to the smoking cessation services within the UK with all of the background information and work as far as the science goes, so I am happy to table that if that is okay.

CHAIR: Is that separate from this?

Ms Darvill : That is the one. You have just received that today.

CHAIR: That is accepted. Thank you.

Ms Darvill : Good, thank you.

Senator KETTER: Can you tell us who the National Centre for Smoking Cessation Training is?

Ms Darvill : They would be the equivalent of the association that Colin Mendelsohn works for.

CHAIR: The UK?

Ms Darvill : It is the UK version of the advisory group that advises stop-smoking services. It would be like our peak body that advises quit services—Quit Smoking NSW, smoking cessation specialists and so on.

CHAIR: I have quite a lot of questions, so this will go for a while. A couple of you mentioned 'quitting smoking the wrong way'. What is the wrong way? What are you referring to?

Ms Stone : The illegal way, using vaping.

CHAIR: Why is that wrong?

Ms Stone : Because it is illegal to possess the liquid nicotine you use in those devices.

CHAIR: Is there a right way to quit?

Ms Stone : Using nicotine replacement therapy or prescribed drugs like Champix—any way the government has sanctioned is the right way.

CHAIR: Just quitting cold turkey or nicotine gum is the right way? Champix is the right way? What else is there?

Ms Stone : There are all the over-the-counter nicotine replacement products like nicotine gum and lozenges—there are inhalers and stuff you can buy in the supermarket.

Mrs Wolters : There is a pharmaceutical called Zyban as well. I cannot recall the chemical name.

CHAIR: So they are all the right ways and vaping is the wrong way.

Ms Gordon : The nicotine in chewing gum, inhalers, lozenges and whatever—nicotine patches—is exactly the same nicotine we are using in producing electronic cigarettes. In those forms it is available in supermarkets and kids as young as 12 can buy it. Suddenly, when we use it in electronic cigarettes, it is the work of the devil. You cannot have it both ways. Either it is a harmless chemical in these amounts or it is really dangerous. We need to sort that out.

CHAIR: What is the origin of the ban on the nicotine you use in your e-cigarettes.

Ms Gordon : It happened in 2008. It was due to fears that electronic cigarettes were a gateway product to smoking. These were unfounded fears.

Mrs Wolters : States vary too. When I imported my first nicotine at the end of March 2014, there was a page on the internet that said it was legal to import 24-milligrams of nicotine liquid into Australia—and suddenly that disappeared and suddenly I was importing something that was not legal, when originally I had been importing something legal.

Ms Stone : The other reason is that it is not approved by the Therapeutic Goods Administration. It is not in a pharmaceutical product that has been approved. The process of approval through the TGA is extremely expensive. E-cigarettes are part of a consumer driven industry; they are not a big pharmaceutical product. It is prohibitively expensive for small companies to have their product approved by the TGA.

CHAIR: Are all the other nicotine products approved by the TGA?

Ms Stone : Yes.

CHAIR: Even the ones that are sold in the supermarket?

Ms Stone : Yes.

CHAIR: Have any of the Nicotine Alliance members—or indeed anybody that you know of—been prosecuted for importing nicotine?

Dr Denko : As far as I know, there has only been one prosecution for possession.

CHAIR: Possession—not for importing?

Dr Danko : Yes, I believe that was the case. There has been one prosecution for possession and that was someone who was running a vape shop and running a petition to try to change the laws in Queensland. The police came around to his shop because he was selling vaping equipment and liquids. I think the assumption was that they were trying to get him for selling and they could not do that, so they decided to charge him for possession.

CHAIR: What is your understanding of how common vaping is in Australia?

Dr Danko : As I said, from the latest figures in 2014, it is roughly or close to 15 per cent of the smoking and recent ex-smoking population. It is amongst those people. It is increasingly common and it is increasing all the time. It is now more than a year after that data was collected, so I am sure the number is bigger than that. It is becoming more and more common. A lot of people know other people who do it. The law to try and stamp it out has clearly been useless in its aims.

Ms Stone : Although it is quite useful for preventing older people who are not internet savvy and also people who are very poor or disadvantaged because of mental illness or being Aboriginal or whatever, having limited access or understanding of buying things over the internet. If we had vape shops like they do in the UK, it would be a lot easier for people who really need to these products for their health to access them.

CHAIR: Your point is that there is substantial civil disobedience going on and the law is largely not being enforced anyway, but those who cannot be civilly disobedient because of technology or finances or whatever are the losers out of this. Is that your proposition?

Ms Stone : Yes, that is what I am saying.

CHAIR: What is the situation in Western Australia? What is different about Western Australia from the rest of the country?

Ms Stone : In Western Australia there is a legal case that is ongoing. A vendor, a man who was selling through the internet the actual devices and non-nicotine liquids, was prosecuted under the law that prevents selling toys and products that look like cigarettes to entice young people. There is a law in most states, I think. He was prosecuted under that law in 2011. That case is still ongoing. The sentence for the latest appeal will be handed down tomorrow, I think. Basically, it is illegal to sell the devices or anything in Western Australia.

CHAIR: Is it illegal to possess them?

Ms Stone : No. It is not illegal to possess the e-cigarette device but, like all states, it is illegal to possess the nicotine e-liquid.

CHAIR: It is not illegal to import it, though. Am I right there?

Ms Gordon : I think you need a prescription from your doctor to import. I think it is legal to import, but you need a prescription to possess it.

Ms Stone : It is not illegal to import it, but it is illegal to possess it.

CHAIR: It is not illegal to import it, so that is what everybody is doing, but once they import it and take possession of it they have broken the law. Is that correct?

Ms Stone : That is correct.

CHAIR: In Western Australia it is also illegal to—

Ms Stone : Sell the hardware.

CHAIR: To sell the hardware, but it is not illegal to own it?

Ms Stone : As far as I know, I do not think it is illegal to possess it.

Mrs Wolters : Or to import over the internet or to order it over the internet.

CHAIR: Or to import the device into Western Australia.

Mrs Wolters : Yes.

Dr Wodak : Although there have been few prosecutions, the fact there is a shroud of illegality hanging over e-cigarettes has undoubtedly dampened down the utilisation of e-cigarettes compared to, say, the United Kingdom where there is a less suppressive legal environment for e-cigarettes and there is much greater utilisation of e-cigarettes to the benefit of people in the United Kingdom.

CHAIR: I have read your submission. That was interesting. We will get onto that. I have had the benefit of reading your submissions, but, by having them in the Hansard, people will know your personal stories and how you became vapers. Ms Gordon, we have not heard much from you. Have you got a story to tell us?

Ms Gordon : I smoked for 35 years. I made many quit attempts in that time. I tried patches, which just gave me rashes; I tried chewing gum and lozenges, which were useless; inhalers tasted nasty; I was prescribed Champix by my doctor and, two weeks into that course, I was driving along the road and had this incredible urge to drive head-on into a semitrailer that was coming. It was just bizarre the way that happened. I had to pull over from the road and sit quietly for an hour. I later found out that there have been a few thousand suicides as a result of people taking Champix. It was an absolutely terrifying drug. My most successful attempt was when I quit cold turkey. I lasted a year, but I gained 10 kilograms in weight and was quite depressed and just as short of breath then as if I had been smoking, and I ended up going back to smoking.

I was 50 years old and I was quite sick. I was smoking well over 40 cigarettes a day. My throat was killing me. I had palpitations and black rings under my eyes. I was so desperate to give up, but the more stressed I got about it the more I smoked. It is the way it often goes with people. I got onto the internet looking for a miracle at that stage, and I found it with electronic cigarettes. I started on a little Cigalike, which I ordered from overseas, and, with the first puff I took of that, I knew that this was the end of smoking. This was the end of it for the world. This was going to take over smoking, and I have not smoked another cigarette since. My doctor considers me an ex-smoker. I no longer get the six-week bouts of bronchitis that I used to get three times every couple of years. My health has improved dramatically. It is as if I have given up nicotine entirely.

CHAIR: Mrs Wolters, we touched on your personal story, but give us—

Mrs Wolters : My father got me to light cigarettes in the car for him when I was about five, but I did not start using regularly until I earned my very first money at 14. I smoked increasing amounts through my life. The first time I tried stopping smoking I was probably only about 17 and I tried cold turkey. In my next attempt I enrolled in a pilot program—I think it was at the University of New South Wales—which was basically research into using aversion therapy for people to stop smoking, which did not work. I tried cold turkey many times. I think nicotine gum was the first thing, but, anyway, I tried many nicotine replacement therapies. I tried Zyban. I tried Champix. I tried hypnosis. I basically tried everything. For at least 45 years I was trying everything, and at the end I was smoking at least 50 rollie cigarettes a day.

CHAIR: 50?

Mrs Wolters : Yes.

CHAIR: Rollies?

Mrs Wolters : Yes. I was very ill. I was dangerously depressed at that time, and I read about e-cigarettes and started looking. I dual used. It took me five months. It was recommended to me that I use 24 milligrams liquid at the start. I used for five months. I mainly smoked and used one like this. Then I realised that I needed very strong nicotine liquid, so I mixed my own at 36 milligrams, which is very strong, but that actually worked. This is the one that got me off smoking. Oh, sorry, I am not allowed to do that, am I?

CHAIR: Yes, you are. It is just that Hansard will not record it.

Mrs Wolters : I was a fairly advanced vaper by then. I had to build my own coils for this. It is mechanical; it is not regulated. You have to know what you are doing for safety. Mostly, these days they are electronically regulated so you cannot blow yourself up. With these ones you have to be a bit careful. So, for five months I dual used. That is the amazing thing about vaping: there are so many variations; people can adapt different strengths, different flavours and different shapes of mods. It is all so variable, so people can create the environment for themselves that they need to give up smoking.

CHAIR: I will come back to the devices and the market for devices. I still want to hear the personal stories.

Ms Darvill : I smoked daily, full-time, from the age of about 15, but, prior to that, probably from the age of 10 I was dabbling in it. My mother was a smoker, and my best friend was my cousin and her parents were smokers. I remember getting her father's rollie papers, stealing a small bag of tea out of the tea pot and taking them down to the school on the weekends and trying to roll them up with the pine leaves at the time. So obviously I was pretty dedicated way back then. When I was 15, we were still able to smoke in our workplaces. Although this may go against the grain of some people who are pro-smoking or pro-choice, to a certain degree I think it did allow people like me to become much more addicted smokers, because they had no restrictions whatsoever. I was a receptionist and I would have my cigarettes on my reception desk and would be puffing away.

The laws started to change when I got to about 23. I had made a couple of attempts at giving up smoking before that, but no really serious attempts. By that stage I was probably smoking 20 to 25 a day. When I went to change jobs at 23, there were no-smoking laws in offices, so I thought, 'This is a good time to change careers.' I decided to become a sales rep and that way I could continue to smoke all day, every day. I had kids when I was about 28 and married a non-smoker when I was 27, but I was with him from about 23.

I tried acupuncture; I tried 'Stop smoking in one hour—money-back guarantee.' The thing was I never went back for the money-back guarantee, so they have got me down as one of their successes. I tried Quitline; I got the quit packs; I had the phone counselling and, in later years, the SMS service. I used Champix. I had a feeling after about eight days on Champix that I was going to die if I continued to take it and die if I stopped it. I hate going to doctors. I am not a doctor's person, but I found myself ringing the after-hours service at nine o'clock one night saying, 'I'm going to die from this. What can I do?' I tried Zyban.

I got pregnant with twins when I was 28. I loved or needed smoking so much that I continued to smoke—not as heavily, but to my guilt I continued to smoke. As soon as they were born I was back up to a pack a day. I started smoking more because I then became a single mum. I was poor and I had no company. You cannot leave the house when you have two small children, so the best thing to do is go out in the backyard to sit and smoke. I found myself getting to the stage where I smoked a minimum of 30 a day and up to 45 a day. I could not afford it. I would make choices that were detrimental to my children. I do mean that I did anything terrible to them. I still fed them and put a roof over their heads, but, if I had a choice of buying watermelon at $2 a kilo or apples at a $1a kilo, if they wanted the watermelon they were not going to get it. I would make buying decisions based on whether I needed a packet of smokes or not.

I tried quitting cold turkey several times. Probably nearly every Sunday night I would say, 'Right, that's it. I'm not going to smoke again tomorrow.' The only quit attempt that I ever made for more than a week that worked was through the Allen Carr method—another money-back guarantee if you do not quit. I never went back again because I felt like a failure, because every time I tried to quit and I could not, or I relapsed, I was a failure. I would become very sick. I was coughing day and night. I would wake up in the morning and I would be coughing so much I would vomit. I started to work out how old my kids would be and, 'if I live to 55, that means they were going to be 24; if I live to 60, that means they were going to be 29, so I might actually end up seeing grandchildren'. This is how I felt.

Anyway, then I watched a program called The Project. I had given up giving up, and I had decided that I was just going to die early—and this is before I was 50. I watched a program on The Project and it was not particularly a fantastic program but there were a couple of ex-smokers on there that said that they got off cigarettes with vaping and it was so good, it was so easy. But then I tried to find them, 'how do I buy them?' No-one would tell me. I would search online, and I had never bought anything online before. So I went to The Project's Facebook page and there were people talking about the show on there and I said: How do I buy this nicotine?' I was private-messaged by a vendor that was in Queensland that said: 'We will sell it to you.' And they were a lovely couple but they were selling black-market, under the counter. I did not have a credit card to buy online but they allowed me to pay it into their bank account, so I paid $110 and I got two devices and two power packs. I got a sample box of 20 e-liquids. It arrived in the post and within my first three puffs I thought, 'I think this is going to work'. Within three days I had given up smoking, and that is more than 2½ years ago now and I have not had one since.

CHAIR: You gave us a bit of an idea, and you were smoking quite a lot before you gave up; tell me your story, Dr Danko.

Dr Danko : Going through medical school and becoming a doctor, I was obviously aware of the health consequences of smoking but, like I said, I just got something from it that I did not get anywhere else. I tried to reduce my risk by not smoking too much. I would give up for periods of time, but then I would be lured back to it. And I honestly felt better when I was a smoker than not a smoker, in myself. I was trying to do everything else I could—exercise, eat well—to reduce my harm. When my sister told me about the electronic cigarettes I thought it was worth a go. I got some from a shop in Melbourne and got my e-liquid online, and started using it, just as an experiment to see what would happen, without too many big expectations of it. Neither did I have a desperate need to quit. I had a bit of a smoker's cough and I was getting a bit puffed out, but it was not like some of the other people.

Interestingly, I immediately reduced most of my smoking to about two or three a day. I still felt I needed those for quite a while and I actually dual-used for about a year. Part of it was a self-experiment. I wanted to see what sort of combination of e-liquids or other things you would need to swap entirely without wanting to. There are certainly a lot of accidental quitters, people who just start trying e-cigarettes and then decide, 'hey, this is better; I don't want to smoke any more'. For me it was not quite there, and so I did some research and found out about other components in tobacco, and I obtained some Swedish snus and also some nasal snuff, and together with those things, once I started that I was able to give up without any effort whatsoever. That to me is the holy grail of smoking cessation. If you can find a combination of device, liquid—anything which is significantly harm reduced; so we are talking about 95 per cent or better harm reduction.

If we can get this out to the whole population, then we could make smoking obsolete. That is what really excites me—it is the idea that 1 billion people could die this century from smoking-related diseases, and if we can find a way to innovate our way out of this tragedy—this disaster—by allowing companies to innovate, allowing consumers to try different things and tell each other about it through social media, then we could save that many lives, potentially.

CHAIR: I am going to come back to Dr Wodak on a different issue. I do not think you are an ex-smoker are you?

Dr Wodak : No. I am not.

CHAIR: Ms Stone, could you tell us your story please?

Ms Stone : I smoked for 30 years. I started when I was 16 or 17, in my last year or two of high school. Prior to starting smoking, I was very against it because I knew it was increasing risks of lung cancer and that it was a bad idea in terms of health. I also knew that they were very addictive. Both my parents smoked and most of the adults I knew smoked, so I used to tell them that they were stupid. Then—I do not know what happened—something changed. I thought, 'Well, everybody says don't do it, and so I am just going to do it.' It was a little rebellion of mine. I was not a particularly rebellious teenager. I also thought that I was immune to the risk, that I had plenty of time before there would be any negative health impacts and that I would just stop.

Gradually over the years I started to smoke a bit more and a bit more until I realised in my mid 20s that I was quite addicted and that it would be hard to stop. I made a couple of not serious quit attempts in my 20s and 30s—just cold turkey attempts which did not last more than a day or two. Then when I was in my 40s I tried hypnosis, which did not work at all but cost me a lot of money. So it was basically a cold turkey quit attempt. That was extremely difficult, and I had a period of about a month where I felt really quite depressed. I put on I think about 12 kilos, which made me feel more depressed, and I did not feel very well. But then I went on a diet and started to lose that weight and I felt better, but after about six months I just got tired of wanting a cigarette. It never went away after six months. It got a little bit better after the first month or two, but it just kept coming, and it was sometimes an incredibly strong need to have a cigarette. I think that those urges just wore me down, and after about six months there was a minor crisis in my life and I went straight out and bought another packet of tobacco and started smoking again.

The second attempt was a few years later. I went to my doctor and got prescribed Champix. That was quite effective. I took it for, I think, about 2½ or three months. I stopped taking the medication early, because I felt strange on that drug. I did not feel like myself and it began to disturb me. So I stopped taking the drug and started smoking about a week later. After that, I thought a lot about smoking. I do not drink a lot. I do not really have any other vices. I try to eat well, although I do not always. So I weighed up the pros and cons, as I said earlier, and decided that I was going to smoke because I enjoyed it, and if I died early from smoking then so be it.

A friend that I had not seen for a while came around and she was using an electronic cigarette. She had not smoked for a year, and I knew that she was a dedicated smoker prior to that. So I was curious. I did not think that it would make me quit smoking, and I had no urge to quit smoking at that stage, but I bought one out of curiosity. Pretty much from when I first started using it I did not need to smoke. I continued to smoke one or two a day for a few weeks and then I thought, 'Why am I bothering to do that?' So now I vape pretty much full-time although I do still have a cigarette every now and then when I am in the company of other smokers and having a drink. That was three years ago, and I have been vaping instead of smoking.

CHAIR: Do you still have an occasional smoke?

Ms Stone : Yes, I do.

CHAIR: Do you think if you stopped vaping that would increase?

Ms Stone : I think, yes, definitely.

CHAIR: Is there any reason why you think you have continued to have a smoke? I think Mrs Wolters or Ms Darvill suggested tweaking the dose. Do you think tweaking the dose would get you off those smokes?

Ms Stone : No, because I think it would be easy not to have those smokes. I just have them because of the environment. I am with friends who smoke and they are lifelong friends so there is a long history of having a glass of wine with my girlfriends—the two friends who smoke. When I am with them it is more for nostalgic reasons. Because I do not feel afraid of being addicted to smoking any more. I know that I prefer vaping, and as long as I can vape there is no fear that I would ever go back to smoking, so I just have one. I am not into that absolutism: 'I am never going to have another cigarette again.' I do not see any reason for that. I think having two cigarettes a month is not going to impact on my health or life anyway.

CHAIR: Dr Wodak, you draw a distinction between tobacco harm reduction and tobacco control. Would you like to discuss that for the committee please?

Dr Wodak : In the middle of last century evidence started accumulating in Britain from Richard Doll and others about the devastating health impacts of smoking, which were at the time not known. This is soon after World War II, in Britain. The evidence accumulated over the next couple of decades and a David and Goliath struggle developed between public health tobacco control people and the tobacco industry, which was extraordinarily powerful and influential. Bit by bit David started to overcome the corporate Goliath and the result has been that hundreds of lives have been saved around the world.

Tobacco smoking prevalence dropped dramatically in this country and other rich countries although unfortunately it continued to rise in poorer countries. I strongly supported the kind of measures that people I regard as heroes were capable of somehow getting through the system. Another dimension was going on in this debate and that was the issue of tobacco harm reduction. Michael Russell, who was a psychiatrist in Britain who did a lot of the research showing how essential nicotine was to the continuation of smoking, coined a phrase which has been often quoted around the world that people smoke for nicotine but die from tobacco. That is really essential to the thought of harm reduction.

I have worked a lot in harm reduction for illicit drugs, but harm reduction is all pervasive in public health and indeed in public policy. It is a form of mitigating risks. Those of us who came here by car today and put on safety belts were practising harm reduction. Harm reduction is everywhere when you go to a children's playground and you see kids playing on swings and underneath them is a foam mattress on the ground rather than concrete. That is harm reduction.

A battle unfortunately began after the development of e-cigarettes early last decade in China by a pharmacist who had lost his father from smoking and had sat around and developed the first generation of e-cigarettes. After that, unfortunately, the public health movement split into those of us who strongly support harm reduction and others who strongly support tobacco control. For those of us from harm reduction, the central objective is decreasing harm—that is, death, disease, crime, corruption, violence and so on. In this case also there is the huge economic cost of smoking. If people can find some way of still ingesting nicotine which is much less harmful than tobacco, so be it. That is what we advocate in terms of methadone instead of street heroin use, and sterile needles and syringes instead of re-using dirty needles and syringes in the street, thereby controlling HIV. There is a consistent thread in all of this. That battle still goes on, and for me the central issue is whether e-cigarettes are less harmful than tobacco and, as well as that, whether e-cigarettes help people to quit smoking, and that debate still goes on. I think that the evidence increasingly favours the idea that e-cigarettes do help people to quit; we have heard that this morning. But, even if they do not help people to quit but all they do is reduce the lung cancer and the heart disease and the strokes and the gangrene, I think that is very positive and I think the regulation of e-cigarettes in Australia is far too oppressive and far too negative. As Attila has just said, the unintended consequence of the heavy-handed regulation of e-cigarettes in Australia is to favour tobacco, which is crazy.

I take this debate as being like many other harm reduction debates that have been raging and still rage today, and we are hearing about pill testing that I am involved in. These debates seem as though they are different, but in reality they are all the same. They are about whether we have a jihad about a particular drug or whether we look for pragmatic, effective ways that respect human rights but nevertheless focus on trying to reduce harm.

CHAIR: Okay, it makes sense. The other side of the argument, the tobacco control people plus the public health lobby, do not like e-cigarettes.

Dr Wodak : No, they do not.

CHAIR: What are their arguments and what do you think of their arguments?

Dr Wodak : They are not really arguments; they are suppositions and concerns. One of the concerns is that e-cigarettes will normalise smoking, and they have been desperately searching around for evidence for this, but I think as time goes by it is becoming clearer and clearer that they have not really got evidence for this.

CHAIR: What do they mean by 'normalise smoking'?

Dr Wodak : That, after decades of demonising and stigmatising smoking of cigarettes, e-cigarettes will somehow change the public image and change the public policy, and that policy will become tolerant and encourage smoking. That is the sort of thing they are talking about, but, again this kind of debate is very common in all of the other harm reduction debates—on illicit drugs, for example. You will see in the current debate about pill testing that one of the concerns of opponents of pill testing at raves is that this would normalise such drug use. The same was said about needle and syringe programs. The same is said in every harm reduction debate.

The same was said, for that matter, about car safety belts. When car safety belts were introduced in Australia in the late 1960s, there were critics of car safety belts, and their argument was, because we try and keep our risk levels at an equilibrium, if a risk behaviour is made safer then that unwanted risk behaviour will become more reckless and more prevalent. That is the argument. It is based on something in psychology called the risk compensation hypothesis. In the case of car safety belts, it became very clear that, even though there might be the occasional motorist who drove a little bit faster or a little bit more recklessly, the net effect of introducing car safety belts was hugely positive. There was a huge reduction in deaths and serious injury. Likewise, in all the other harm reduction debates we find the same kind of battle between fear and evidence. The needle and syringe program debate had a lot of that element to it. There are other fears they have. Dr Danko might take over. He is more familiar with all these debates.

Dr Danko : The first thing I wanted to say about other people in public health is that there are many people in tobacco control and tobacco issues in public health who are for e-cigarettes, and particularly in the UK where they have the greatest experience of a society where they are awash with e-cigarettes. As the use of them has increased, the public health organisations there have all come out pretty much in favour of them. They are pushing the agenda more and more, to the point where even the Prime Minister made a statement about how we should encourage smokers who cannot quit any other way to have e-cigarettes. Their quit-smoking services are moving to be e-cigarette friendly. They are supporting it as a positive health initiative. There would be no-one in the UK, even the opponents of e-cigarettes in the UK, who would ever go as far as to call for their banning to the level we have here.

In Australia we have to realise that tobacco control establishment is quite an insular group that generally has this idea that e-cigarettes are a plot from big tobacco to hook children and then to provide a gateway for smoking. They keep repeating that line in spite of the evidence. They refuse to debate this issue openly with us. They enjoy having media time when they are allowed to speak without any answer, without any question, and there is certainly a bit of support within politics and the ABC for continuing this stance. They tend to roll out the same people again and again and do not allow them to engage in open debate.

CHAIR: This is interesting, because it leads into a comment in one of your submissions in relation to the state of the art of the e-cigarettes, the devices themselves. The comment was that big tobacco is stuck playing catch-up but this is an innovative area. As I am sure you are well aware, innovation is our Prime Minister's favourite topic at the moment. You have got lots of devices sitting there. What does that reflect? What is the industry like?

Dr Danko : The industry is made of many small groups, many small businesses, that are competing with each other to make more and more effective and satisfying substitutes for smoking. They are coming out with new things often every few weeks. Not only are they increasing the effectiveness of them; they are also increasing the safety of them because of consumer demands. There are innovations such as temperature control that avoid overheating the e-liquid.

CHAIR: Why is that important?

Dr Danko : That is important because there was a study, which the people against these desperately hold onto, that e-cigarettes produce formaldehyde. This study has been debunked quite a few times, but it is still often brought out as an argument against e-cigarettes that they can contain formaldehyde five to 15 times greater than a cigarette. The truth is that immediately after that study came out vapers tested their own equipment at the same voltages under the same test conditions that the researchers used and found that those settings were absolutely unvapeable. They involved temperatures much higher with much less fluid on the wick than anyone would ever tolerate, even for an instant. Temperature control means that the temperature is automatically limited so that those conditions never arise. No matter how the device is used or misused, no matter how little liquid is on the wick, it simply will not fire to produce the formaldehyde.

CHAIR: I want to come back to this issue of the market—where the impetus is coming from for this innovation and so forth. Looking forward to the UK, where what you have described is a much more deregulated market than Australia by a long shot, where do you think it is likely to develop over the next decade or two?

Dr Danko : I think it will continue to develop in much the same way, that we will get increased effectiveness and safety. The consumers who have come off smoking demand increased safety; they want more studies—but studies which are done without bias. They want studies that look at e-cigarettes as an opportunity rather than a threat, that look not for ways to support an argument for banning them but for ways to make them safer. I think that this will continue; it is very hard to predict where it will end. When digital photography came out, Kodak still thought they were going to be a player and they rapidly found out that they were not.

CHAIR: What are the possibilities that the market will, as happens with many markets, see the emergence of a relatively small number of major players who dominate—such as we see with mobile phones, televisions and lots of other things? Do you think that is likely to occur with these?

Dr Danko : It is possible, but let us say I wanted to fight a vape shop now. With a thousand dollars I could easily order online and get myself set up. If I were trying to start a tobacco company, I would require probably $100 million or more—it would probably never happen. The barriers to entry are really very small. The essence of the device is simpler than a light bulb. It is just a heated wire and you do not even have to worry about a vacuum, as Edison struggled with. At the same time, there are a huge number of variables that can be changed. One of the interesting things about this phenomenon is that consumers have been the ones at the forefront of developing new methods of using these products. Often smaller companies then follow.

People found that using cotton instead of silicone in the wick gave a better experience and a safer one as well. Then, a couple of years after consumers had developed this on their rebuildable devices, companies came out with premade coils with cotton in them. Again, with different types of coils, tinkerers at home would try different ways of coiling the devices and then talk about it on social media. As some of these ways became popular, small companies followed suit again. This is very much a consumer led revolution—people taking recreational nicotine into their own hands with the smaller companies following that.

CHAIR: Do you foresee a time when any of the tobacco companies—BAT, Imperial Tobacco, Philip Morris—might have a major presence in this area?

Dr Danko : It is not impossible. They have several advantages with distribution networks and resources to undertake new developments that consumers themselves cannot. I do not have any opposition to it. If a tobacco company changes to just selling reduced risk products, they are no longer a tobacco company and they should no longer be pariahs. At the moment, though, they are falling further and further behind because the cost structure and the business model they have makes it very difficult for them to keep up with the rapid pace of innovation of the smaller companies and the consumers.

CHAIR: I imagine that the anti-tobacco lobby that you are referring to, the tobacco control group, would argue that, if the tobacco companies sold e-cigarettes, they would use them as a device for enlisting customers one way or another onto tobacco—or onto whichever of the two was more profitable.

Dr Danko : Yes, that is their argument.

CHAIR: How would you address that argument?

Dr Danko : E-cigarettes were not invented by tobacco companies, but as soon as the tobacco companies entered the market and produced their own little cigalikes they immediately created massive advertisements which harked back to the old days of tobacco companies. The interesting thing is, are they trying to eke out a market within this? Or are they trying to convince tobacco controllers to react against them by creating all these flashy ads to try and get tobacco control to do their dirty work for them in suppressing the e-cigarette market? I do not know the answer to that.

Mrs Wolters : There are some companies, mainly in China, that are emerging that are probably going to be leaders within the industry, possibly fairly exclusively internationally unless regulation is done carefully. If vaping is overregulated, it is almost certain that the tobacco companies and the pharmaceutical companies are going to be the only ones that have the funds to jump through regulatory hurdles. And if tobacco companies and pharmaceutical companies are in that position, they are also in a position to control things like what liquids go in, size, price—and it will make it far less attractive to switch to vaping from smoking. Basically, the status quo is maintained and probably a lot of people would be happy with that.

Ms Darvill : In South Australia, they have just had a regulatory process and they have put out some recommendations that are currently going back to parliament. One of the recommendations is that a vape shop must be licensed. Now that sounds okay, doesn't it? You need a licence to be a vape shop. But the other thing they have done is they have said that anyone that sells e-cigarettes cannot have a tobacco licence. I am undecided as to whether that is good or bad; in one way it is bad because it means that someone that normally smokes and goes into a smoke shop does not get the opportunity to buy a vapour device and maybe never sees or has the opportunity. On the other side of the coin it means that, if you are buying vape equipment, you are not going to go into a tobacco shop to buy some and therefore be tempted back to smoking. Governments do see, in their wisdom, one way or the other. Which one is right—who knows?

CHAIR: It is a very good point. I would like to ask you now about using e-cigarettes in smoking and non-smoking areas. Where can you do it, and where can't you do it? As I understand it, New South Wales recently passed regulations that said that wherever you are not allowed to smoke, you are also not allowed to use an e-cigarette. Is that right?

Ms Darvill : No.

CHAIR: Is that not right?

Ms Darvill : No. That is the case in Queensland. In New South Wales, they have not touched that yet. They have restricted the sale et cetera, but there are no rules at this stage.

CHAIR: Do you mean on where you can use an e-cigarette?

Ms Darvill : On where you can use an e-cigarette.

CHAIR: What do you think about that? I am asking anybody in the group. What do you think about the fact that people have become accustomed to the idea that smoking is not done indoors at all and that if somebody is puffing on an e-cig and there is a bit of vapour coming out, that is also not to be permitted. How do you respond to that?

Ms Gordon : It means that where these regulations have come into place, people who have given up smoking now have to go out with the smokers. And we have been told over and over and over again that passive smoking is really bad for you. Why would you send someone who has given up smoking to go and breathe the smoke of all the smokers? It does not make sense. I will vape anywhere; that is because I will stealth vape. Stealthing is when you hold the vapour for 20 seconds or so inside your lungs and you breathe out invisible air. It is completely unenforceable anyway. Those of us who are experienced, we just get around it—I have vaped in hospital and on aeroplanes—because it is just so ridiculous. It is an insult. We are bullied and bullied and bullied to stop smoking—and when we do it the wrong way we are sent out with the smokers again like troglodytes being sent out into the darkness. It is completely counterproductive.

Ms Stone : The laws on smoking indoors, and restricting smoking in places where there are lots of people or children, are based on evidence that passive smoking is dangerous to bystanders. But there is no evidence for that with vapour; it is not toxic to bystanders. So there is an ideological basis to restricting vaping to areas where people smoke; there is no actual evidential reason to do that.

Dr Wodak : A very good place to look for this battle between tobacco prohibition and tobacco harm reduction is in our prisons in Australia. Unfortunately there are state and territory tobacco prohibitions coming into our prison systems with very little debate or discussion in the community. There are very sensible reasons why you would want to see lower smoking rates among Australian prisoners. It is a serious health hazard. There are very high smoking rates and very high rates of mental illness. It contributes to their poverty in prison. They get very low rates of pay for doing some work while in prison and they end up using a lot of that money to pay for tobacco rather than nutritious food; the prison diet is pretty terrible. Also, it is in everybody's interest to have savings at the end of that period of imprisonment when they go back into the community so they can pay their first bond on somewhere to live rather than having to steal to pay for somewhere to live. Not many people realise this, but their risk of relapse to other forms of drug use such as heroin and amphetamines is much higher if they are smoking than if they have become nonsmokers. So the grounds for trying to reduce smoking in prison are overwhelming.

On the other hand, when this has been tested in courts, very often the courts have found that a prison is somebody's home—while they are imprisoned, that is where they are living. For the state to say to somebody that they are not allowed to smoke while they are in their own home is in my view quite a philosophical leap. The courts, not always but very often, have found that as well.

CHAIR: As far as I have read, the prisoners do not take kindly to it either.

Dr Wodak : We have no evidence that tobacco prohibition is for the long-term benefit of prison inmates—that is, there are no follow-up studies that show that, where there is tobacco prohibition in prison, people who pas through prison benefit in the long term; they relapse as soon as they leave the prison. Are there other problems associated with tobacco prohibition in prison? Yes, there are. There are stories—and we cannot document these—of prisoners rioting and setting fire to prisons. We have had this in Australia as well as overseas. These things are difficult to document because of the secretive nature of prisons. There is a lot of evidence, admittedly of different quality, that when tobacco is banned in prisons other currencies re-emerge or are expanded. There are two other currencies in prison—sex and illicit drugs. There are many case reports of prison systems that have banned tobacco only to find that the heroin problem in the prisons got much worse. So there are many reasons to be concerned about this and there are many reasons to consider other ways of dealing with this problem.

Another dimension to this is that the prison authorities are increasingly aware of the occupational health and safety risks of allowing prison warders to be exposed to smoke from prisoners. How else can we manage this problem? I have done a lot of research about tobacco smoking cessation in prisons, so it is a familiar problem to me. One way of dealing with this problem would be to segregate prisoners who smoke from prisoners who do not smoke and prison employees who smoke from prison employees who do not smoke. According to senior people I know who work in the correctional system, that is not all that hard to do. So we could segregate the two groups—staff and inmates. And, for those prisoners who want to keep on taking in nicotine but do not want to smoke, we could provide e-cigarettes. There are e-cigarettes that have been deliberately designed to be used in prisons. There are risks with e-cigarettes in prisons as well, but they can be revised. Donna has examples of those and can tell you about the technical modifications that make these suitable for the prison environment. I do not see why we have not had this debate in Australia.

CHAIR: One other area that I want to touch on is the importance of the cost of tobacco relative to e-cigarettes and also options for cost reduction in sticking with tobacco as well. How important do you think that is to you? For those of you who smoked and then moved to e-cigarettes, how much of a factor was cost?

Mrs Wolters : For me the cost was not a major factor; staying alive was my motivation. But what has amazed me since I stopped smoking is the fact that I have money to spend on luxuries such as books and decent clothing instead of the cheapest I can buy.

Ms Stone : Cost was not a big factor for me because I was smoking rolling tobacco. That was three years ago. Back then, it was not costing me any more than $40 a week. It is a lot more now. But I think cost is a huge factor for people who are disadvantaged.

Ms Gordon : For me, cost was not a factor in converting from smoking to vaping; that was for health reasons and I just wanted to quit. To save money on smoking I just used black market tobacco. That is the way to save money for people who want to smoke but do not want to pay the tax. And that market—chop chop— is getting bigger and bigger; it is everywhere. So it was just for health reasons that I converted to vaping.

Dr Danko : For me personally it was not a cost issue. But one of the tactics we can use to help other smokers to quit smoking is to initially tell them: 'Give it a try. It's going to cost you a lot less. You're spending a lot of money on smokes at the moment.' What we have with vapers is a whole team of people who can help other people to quit smoking; it is a social, viral phenomenon of people helping each other to quit smoking. It should be seen as a public health bonanza, an opportunity.

Ms Darvill : For me, it was fifty-fifty cost and health—when I say health, I also mean mental health. I could not afford to smoke but I smoked more and more every single day, every single week, because I was so stressed about cost and health. I am absolutely appalled that one of the parties in the next election is proposing to put up the price for smokers by another 12.5 per cent a year. Even though I would love the opportunity to convert every single one of those smokers, I think it is the most aggressive thing I have ever heard. It is appalling. It is only going to hurt the kids, the homeless, the sick and pensioners. People who can afford to smoke already do not; it is the people who cannot afford to smoke who still smoke. That is my view.

CHAIR: That is a good note to end on. Thank you very much for your attendance today. We really appreciate it.

Proceedings suspended from 11:10 to 11:27