Volume 210 - Issue 3
Unintended consequences of a cautious approach to e‐cigarette laws
Authors: Christian Catalano, Noel E Cranswick, Jeff Robinson, Joanne Grindlay, Mick Creati, Margie H Danchin, Nicola Williams and Amanda Gwee
Med J Aust 2019; 210 (3): 143-144. || doi: 10.5694/mja2.50001
Published online: 18 February 2019
Published online: 18 February 2019
While it remains illegal to sell ENDS products containing nicotine, an individual may import up to 3 months’ personal supply with a doctor's prescription.1 ENDS products are easily purchased online from overseas. Their attractive packaging and scent makes them appealing to children. As these products are not produced or licensed in Australia, there is no existing legislation around child‐safe packaging or labels warning of potential toxicity.
The Centers for Disease Control and Prevention reported a rise in nicotine poisonings from one to 215 per month over a 5‐year period,2 the majority involving children aged under 5 years. Furthermore, a retrospective study of children aged under 6 years found that poisonings from liquid nicotine compared with traditional cigarettes were five times more likely to result in hospitalisation.3
Nicotine is both highly toxic and readily absorbable and, therefore, the potential for poisoning is high. Nicotine poisoning occurs through initial stimulation and ultimate blockade of the nicotinic acetylcholine receptor, resulting in hypotension, bradycardia and coma at high doses.4 The minimum potentially lethal dose of nicotine in humans is 60 mg.5 A review of e‐liquid products purchased online found the standard nicotine concentration to range between 0 and 36 mg/mL.6 Therefore, ingestion of even a small volume could cause serious harm or even death.
We advocate for specific legislation to regulate the personal importation of these products. This legislation should include specific safety labelling highlighting the risks of poisoning in children and mandated supply in child‐proof packaging. Given the inherent difficulties in preventing and regulating the online trade of ENDS products, we strongly encourage the federal government to partner with organisations such as Quit Victoria to highlight the potential dangers of all imported nicotine products, whether they remain prohibited or not.
Competing interests
No relevant disclosures.
References
- Final decisions and reasons for decisions by delegates of the Secretary to the Department of Health. Canberra: Therapeutic Goods Administration; 2017; 23 March; p. 75. https://www.tga.gov.au/sites/default/files/scheduling-delegates-final-decisions-23-march-2017.pdf (viewed Dec 2018).
- Chatham‐Stevens K, Law R, Taylor E, et al. Notes from the field: calls to poison centers for exposures to electronic cigarettes — United States, September 2010 – February 2014. MMWR Morb Mortal Wkly Rep 2014; 63: 292–293.
- Kamboj A, Spiller HA, Casavant MJ, et al. Pediatric exposure to e‐cigarettes, nicotine, and tobacco products in the United States. Pediatrics 2016; 137: e20160041.
- Schep LJ, Slaughter RJ, Beasley DM. Nicotinic plant poisoning. Clinical Toxicol (Phila) 2009; 47: 771–781.
- Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self‐experiments in the nineteenth century. Arch Toxicol 2014; 88: 5–7.
- Walley SC, Jennsen BP. Electronic nicotine delivery systems — policy statement. Section on tobacco control. Pediatrics 2015; 136: 1018–1026.
Linked content
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MJA Letter: Unintended consequences of a cautious approach to e‐cigarette laws
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MJA Letter: In Reply