Does prohibition protect public health - or can it make the problem worse?
At #GFN26, Brent Stafford speaks with Alex Wodak and Ian Fearon about the unintended consequences of prohibition, the rise of illicit nicotine markets, and the growing divide over tobacco harm reduction.
The conversation also examines a contentious issue within public health: why, according to Fearon, good-quality science on tobacco harm reduction can face resistance while weaker research can gain widespread attention
Transcription:
00:04 - 00:11
[Brent Stafford]
The strapline for this year's conference is prohibition and public health. Do those go together?
00:11 - 00:42
[Alex Wodak]
Of course they don't go together. And we knew that already in U.S. alcohol prohibition back in the 1920s and early 30s. It's a disaster for public health. But it works politically for a while until it doesn't. And our efforts in drug policy, including tobacco, have to be directed to ending drug prohibition as soon as we can.
00:44 - 00:51
[Brent Stafford]
Is prohibition an intervention of public health?
00:52 - 01:41
[Alex Wodak]
Sometimes, very occasionally, it is. But this is quite exceptional. Drug prohibition, like other drug prohibitions, work if the demand for that good or service is very small, if it's very hard to produce or smuggle those goods, and if the replacement drug, and there always is a replacement drug, isn't even worse. We had those conditions with the prohibition of the barbiturates in the 60s and 70s when they were replaced by the benzodiazepines, which are not innocuous, but they're not nearly as bad as the barbiturates. So that was a prohibition that did work. Very, very unusual.
01:42 - 01:58
[Brent Stafford]
In Australia, your home, we just learned that the government's finally admitted that there's been an increase of nicotine use by 40% in an environment where some of the harshest prohibitions on nicotine in the world.
01:58 - 03:59
[Alex Wodak]
Well, what Australian policy involves is... Technically speaking, not a prohibition. It's a quasi-prohibition or a de facto prohibition. But vaping is not actually banned. Cigarettes aren't banned. But it's very important for us to realize that prohibition covers a spectrum of conditions and severe restrictions, very high prices, legal prices. are sometimes tantamount to prohibition without actually technically being a ban. Yes, those policies in Australia have produced multiple severe adverse unintended consequences. The government revenue from cigarette excise has been decreased by $77 billion over five years. A staggering amount of money. We have soaring black markets for cigarettes, tobacco and vaping. We have rampant extortion of retail. We have pervasive violence, including over 250 arson attacks on retailers. We've had several homicides. We've had the organiser of the illicit tobacco trade in Australia and vaping trade in Australia has been involved in organising an attack on a synagogue. in Australia, a firebombing of the synagogue. So the negatives are just overwhelming, and sooner or later these are going to cause the current policy to collapse.
04:01 - 04:08
[Brent Stafford]
Alright, so Ian, the strapline for this year's conference is prohibition and public health.
04:08 - 04:40
[Ian Fearon]
they go together i don't think they do i i think we have a variety of next generation tobacco and nicotine products which are clearly reduced risk and banning them will encourage an illicit trade of those products it will force people back to cigarette smoking so i don't think prohibition is good for public health i think just the opposite we need more people taking these reduced risk Nicotine and tobacco products and public health will improve massively if we do.
04:40 - 04:58
[Brent Stafford]
We heard from Euromonitor International this week that the illicit e-vapor market in the US, or sorry, globally, is $47 billion a year. And that's 76% of the entire e-vapor market. Did that surprise you?
04:58 - 05:35
[Ian Fearon]
Not really. I mean, I think we know in the U.S. and you can see you just have to go into any convenience store and you just see a whole host of illicit products. And I think in fairness, the FDA is trying to get a handle on that. And, you know, with their recent enforcement discretion guidance really kind of tries to hit that issue of illicit products. I think they need to do more. I think they really need to get out there and take these products off the shelves and only allow approved products or products that have an application filed to be on the market. So there's a lot of work to be done, but that doesn't surprise me. You just see it in every shop you go to.
05:35 - 05:38
[Brent Stafford]
Now, so you know your opinion is not the most popular one.
05:38 - 06:03
[Ian Fearon]
Right. No, I know. I think the opinion is that illicit products are bad and that regulators need to do more to take them off the market. And I think the FDA are beginning to do that. Okay, they're an oil tanker, a slow-turning beast, but I think at least they're making the right signs of knowing there's an issue and trying to address it.
06:03 - 06:09
[Brent Stafford]
Is public health amenable to better understanding this tobacco harm reduction stuff?
06:10 - 07:03
[Ian Fearon]
I don't think they are. I think it's just the opposite. We're seeing opposition to good quality science. We're seeing poor quality science proliferated. A lot of population level evidence misrepresented, unfortunately. and we are seeing some of that evidence retracted from journals and that's obviously good but unfortunately the harm's already been done it's made newspaper headlines that vaping causes strokes or heart attacks and that's what's in people's minds um there's a there's a whole lot more that we that you know i'm a scientist i try and publish papers of good quality science and there's always pushback from journals from peer reviewers and then poor quality science proliferates, makes newspaper headlines. It's baffling at times because we should all be fighting for one thing and that's the health of people. But unfortunately we seem to be increasingly pulling one another apart.
07:04 - 07:11
[Brent Stafford]
Would it make a difference if the pitch to the public was for recreational nicotine?
07:11 - 07:44
[Ian Fearon]
I don't know if we're in a place where we can, you know, stop talking about recreational nicotine at the moment. I think that's a few years off. I think we need more evidence that there is a societal good of recreational nicotine. It works the same way as there's a societal good of caffeine. You know, it gets everybody open to work in the morning and include, you know, clarity and sharpness of mind and so on. I don't think the evidence is quite there for nicotine yet. But once it is, I think certainly we should have a debate on that.