E-cigarettes, commonly known as vapes, have gained popularity, especially among young people. 

While they may seem harmless, it is essential to understand the risks associated with vaping and the recent regulatory changes in Australia to address these concerns. 

Vaping is not risk-free and can harm your health, particularly your lungs, even though e-cigarettes do not contain tobacco.

A vape is a lithium battery-powered device that uses a cartridge filled with liquids, or ‘juice’, which typically contains nicotine, a highly addictive substance, artificial flavourings, and various toxic chemicals that can be harmful when inhaled.

On 2 May 2023 the Federal Health Minister Mark Butler announced regulatory changes: 2023-24 Budget Allocation and Vaping Reforms, an investment of $737 million to fund measures to protect public health from tobacco and vaping, and reforms to ban non-nicotine vaping products, with exceptions for prescription use. 

It is illegal to sell or buy nicotine for use in e-cigarettes in Australia unless a doctor has prescribed it, as nicotine is a Schedule 7 poison. NSW law bans the sale of vaping devices to those under the age of 18, but this has not prevented its prevalence in high schools.

Australian toxicologist and researcher Dr Jody Moller, from the School of Chemistry and Molecular Bioscience at the University of Wollongong, studies the toxicology of e-cigarettes and nicotine. She says, “We need to be really clear, and people need to know that e-cigarettes are not good for you, there’s no pathway by which they’re healthy to inhale for non-smokers.” 

Asked specifically about statistics for our local area Dr Moller says, “We don’t have any specific usage statistics for the local area among teens – though we know through anecdotal reports that a significant number are using e-cigarettes. 

“A pre-print of our latest paper is currently available which shows that high school aged students in NSW (including some local schools in the Illawarra) are vaping e-cigarettes which almost all contain nicotine. Additionally, about four percent of these devices contained a substance which is banned by the TGA.”

Dr Moller indicates that the danger of imports lies in the toxicity and concentration of nicotine, with no labelling on the bottles, and often no indication about how concentrated the nicotine is and no safety warnings. 

She also warns of another issue around the bottle because when people mix liquids themselves, they have to supply the liquids in bottles with open tops. 

Bottles with open tops make it easier for people to mix the wrong amount accidentally or for children to drink from the bottle.

A solution could lie in a regulated e-cigarette fluid market that limits the maximum concentration of nicotine to 24 milligrams per ml and has child-resistant product packaging, with dropper-style tops to prevent accidental exposure through spillage and appropriate warning labels and ingredient lists. Dr Moller hopes these recommendations will be included in the Standard for Vaporiser Nicotine (TGO 110) which the TGA will release in the next few months.

Can vaping lead to tobacco use? 

Studies have shown that vaping can be a gateway to nicotine addiction and cigarette smoking. The studies found experimentation with e-cigarettes encouraged the use of tobacco cigarettes, particularly among young people. According to the Australian Bureau of Statistics, more than one in five (21.7 per cent) young Australians aged 18-24 and 7.6 per cent of 15–17-year-olds have used an e-cigarette or vaping device. These figures are most likely under-reported because responses were provided by an adult living in the same household.

Even short-term vaping is unsafe and potentially dangerous. There is a common misconception that vaping is merely harmless water vapour. It’s an aerosol made up of toxic particles. Whilst the long-term health effects are unclear, vaping in the short term has been associated with nausea, vomiting, mouth and airway irritation, chest pain and heart palpitations. 

What's in vape aerosols? 

Research on vape ingredients from The Johns Hopkins University, a private research university in Baltimore, published in October 2021 revealed thousands of chemical ingredients in vape products, most of which are not yet identified. 

Among those the team could identify were several potentially harmful substances, including caffeine, three chemicals never previously found in e-cigarettes, a pesticide and two flavourings linked with possible toxic effects and respiratory irritation.

• Formaldehyde and acrolein, which can cause irreversible lung damage
• Propylene glycol, which is toxic to human cells
• Nicotine, which is highly addictive and can harm the still-developing adolescent brain, particularly in areas that control attention, learning, mood and behavioural control.

The Australian National University's review of international evidence highlights the health harms associated with vaping. These include: 

• Nicotine addiction
• Intentional and unintentional poisoning 
• Acute nicotine toxicity causing seizures
• Burns and injuries
• Lung injury
• Indoor air pollution
• Environmental waste and fires
• Dual use with cigarette smoking – increasing exposure to harmful toxins.

Vaping is also associated with the uptake of cigarette smoking and can be considered a gateway to further risk and health complications.

In 2020, the Center for Disease Control and Prevention in the US (CDC) confirmed 2,807 cases of e-cigarette or vaping use-associated lung injury (EVALI) and 68 deaths attributed to that condition. It confirmed an outbreak of lung injuries and deaths associated with vaping. 

Healthcare practitioners should advise patients that vaping should not be considered safer than smoking and that there are real dangers associated with vaping that still require further study.