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19 July, 2019

An Opinion Piece by ATHRA A/Prof Colin Mendelsohn on LIQUID NICOTINE

The Victorian Coroner released a heartbreaking report today into the death of an 18-month-old child who died after ingesting a highly concentrated form of nicotine liquid.

By Carl Portella

The Victorian Coroner released a heartbreaking report today into the death of an 18-month-old child who died after ingesting a highly concentrated form of nicotine liquid.

The Coroner found that the death was not a case of negligence, but a “momentary lapse of
vigilance” by the mother who had taken up vaping nicotine to quit smoking.

This case highlights the clear and present danger of Australia’s ban on the sale of nicotine
liquid which forces vapers to import unregulated nicotine in dangerously high
As the Coroner said in his report, ‘if the product is banned in Australia, how can we in this
country enforce safeguards … of a product manufactured overseas’.

It is vital that we now pause to reflect on how to prevent further tragic episodes like this.
Vaping nicotine is the most popular aid for quitting smoking globally.

It involves heating nicotine liquid into an aerosol which the user inhales. Vaping delivers the nicotine smokers are addicted to and mimics the hand-to-mouth action of smoking. Importantly, there is no combustion and no tobacco smoke that is responsible for almost all of the harm to health from smoking.

The latest research suggests that vaping is at least twice as effective as nicotine replacement therapy, such as patches and gums, and that long-term use is likely to be no more than 5%of the risk from smoking.

Because of the ban on nicotine e-liquid and lack of regulation Australian vapers are unable
to legally purchase safer pre-mixed, ready-to-vape nicotine liquids locally. These products
contain nicotine in low concentrations ranging from of 3-24mg/ml.

As occurred in this case, many users instead import a highly concentrated form of nicotine
liquid (100mg/ml), mainly from New Zealand, the United States or China to mix their own.
These solutions are much cheaper and require smaller volumes of liquid to be imported.
However they are much more toxic and are unregulated.

Small quantities of the concentrated liquid are extracted using a pipette or syringe at home
and mixed with nicotine-free e-liquid purchased from local businesses.

Concentrated nicotine is usually imported in bottles with a childproof cap but no other
protective features. If the cap is left off, the highly toxic liquid can be freely accessed.
Although unintentional, the flaws in Australia’s regulations have now resulted in tragedy.

The Australian Tobacco Harm Reduction Association (ATHRA) recommends that pre-mixed,
ready-to-vape nicotine e-liquid in concentrations up to 24mg/ml be made legally available
for sale in Australia.

These safer nicotine preparations would be sold only in child-proof bottles with appropriate labelling. Once the cap is removed, the bottles are still childproof,
usually having a squeeze mechanism to release the diluted liquid directly into the vaping
This would eliminate the need to import dangerous, highly concentrated nicotine liquid in
unsafe bottles.

There would be no need for home mixing which involves risks from
accidental overdose, spillage and mixing errors. Strict rules around bottling, labelling, safety warnings and child-proof containers should also be enforced for additional protection.

The tragic death of this 19 month old child was due to a combination of human error as well as flawed legislation which forces users to import highly toxic solutions in unsafe bottles which can be accessed by small children

The Coroner has recommended a risk awareness campaign about nicotine but stopped short of recommending legalisation and regulation.
However, Australians will continue to import liquid nicotine to help them quit smoking in
spite of the ban and regulatory guidelines are needed to help prevent further tragic cases
like this one. Governments need to step up and introduce these changes.

Australia is currently the only western democracy to ban the sale and use of nicotine liquid for vaping. Legalising and regulating low concentrations of pre-mixed nicotine e-liquid would deliver a win-win outcome.

It would support smokers who wish to switch to vaping and reduce the
risk of further episodes of child poisoning. It really is a no-brainer.

A/Prof Colin Mendelsohn (ATHRA)

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