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A pragmatic approach to nicotine addiction

Nicotine addiction cannot be eradicated, but its harms can be reduced by giving people safer options and refusing to make the perfect the enemy of the good, writes Shane Te Pou

Of my eight brothers and sisters, only three have been cigarette smokers and I've never smoked myself. To be honest, that's a pretty modest ratio for a Māori family of our generation. 

What's sad, though, is that these days, of among close to 100 nephews and nieces, I can't think of many non-smokers.  

That reality in my whānau flies in the face of the common view that smoking is on the way out, as successive governments promote aggressive smoke-free policies and jack up the price so that a packet of cigarettes today is roughly $35. For a 20-a-day smoker, that habit now costs $245 a week, way beyond the reach of most Kiwis who work for a living, and certainly for people who depend on benefits to survive. It's more than they could afford in rent. 

So, just as a matter of basic household economics, why do so many keep smoking? It's not like it's 'cool' like it was when I was a kid. In fact, it's frowned upon like never before. And the spaces for smokers to congregate are shrinking all the time, even in outdoor areas. 

The simple and only explanation for why people in my family and elsewhere continue to smoke is that they are addicted to nicotine. An addiction powerful enough to overcome considerable stigma and financial hardship; and plainly impervious to decades' worth of concerted public health messaging. 

Prohibition and punitive sin taxes are blunt instruments that breed unintended consequences. They lead to black markets, and create new classes of criminal.

In recent times, thousands have turned to vaping as an alternative. Many others, particularly young people, have skipped cigarettes altogether to embrace the new tech. 

Until now, e-cigarettes and vapes have been mostly unregulated in New Zealand. My view on vaping has changed for purely pragmatic reasons. 

With a bill currently being shepherded through Parliament by Associate Health Minister Jenny Salesa, the law is about to change. 

The proposed legislation, currently awaiting its final reading, will allow dairies, service stations and other general-purpose retailers to vend three nicotine vape flavours - tobacco, menthol and mint. For other flavours, customers will have to shop at specialty vaping stores. It will also impose an age restriction in line with cigarettes, reflecting growing concerns among parents and school leaders that the vaping fad among teenagers will produce a new generation of nicotine addicts. 

On balance, it's a good bill that deserves cross-partisan support. A more heavy-handed public health approach - one that might have introduced yet another sin tax - risks being counterproductive. Vaping products are a cinch to manufacture on the black market, and a prohibition approach would simply drive the industry underground. If this happened, the health risks would skyrocket. We've seen this play out already with outbreaks of 'popcorn lung', arising from the unregulated use of Vitamin E Acetate as a thickening agent in some vape juices.

Prohibition and punitive sin taxes are blunt instruments that breed unintended consequences. They lead to black markets, and create new classes of criminal. Just the other day, an otherwise law-abiding mate of mine wanted to know if I was in the market for Chinese-made cigarettes, available at a fraction of the usual price. I asked him how readily available they are. "Everywhere" he told me. "Nobody can afford smokes over the counter." 

With two young kids myself, I worry about vaping, along with a thousand other things they will encounter in the years to come. At the moment, they don't seem keen. But I'd rather they vaped than smoked – and it's not even close. The UK government has estimated vaping reduces the harm of smoking by 95 percent, and other research points to considerable health improvements once a smoker switches to e-cigarettes. It's a new field for researchers, and there's plenty we don't know about the long-term effects, but there isn't a GP in New Zealand who wouldn't prefer a heavy smoker patient switched to vaping. It's clearly not as harmful. And as a properly-regulated industry, the Government will be well-placed to mitigate any further risks by closely monitoring ingredients and promoting safe manufacturing practices. 

Salesa aimed for balance, and I think she achieved it. Nicotine addiction cannot be eradicated, but its harms can be reduced by giving people safer options, and refusing to make the perfect the enemy of the good.

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