ActivePaper Archive HOOKED ON VAPES - The Age, 6/17/2023



E-cigarettes have ignited a health crisis among teenagers and young adults. Despite crackdowns by government and schools, kids are fi nding ways to sidestep restrictions.

JADE* HAD her first vape in year 8, during a maths class. It was banana-flavoured. Or maybe mango. She can’t quite remember. It was a long time ago, after all. She was 14. She’s 18 now, and despite her best efforts – three attempts at quitting, calls to Quitline, help from her parents – she’s still vaping. “It controls my life pretty much,” she says. “It’s the first thing I think of when I wake up, and the last thing when I go to bed.” Sometimes she wakes up in the middle of the night, takes a hit, and goes back to sleep. “I know,” she says sheepishly. “Pretty bad, huh.”

Jade lives on the northern beaches of Sydney, in a two-storey, recently renovated, brick-and-tile home. There are lots of books and artwork (Jade’s dad paints watercolours), plus a black cat called Ebby and a tabby called Gingy. Jade’s room is off the corridor; a print of Matisse’s Blue Nude hangs above her bed, together with some old vinyl 45s, including the Mamas & Papas’ California Dreamin’. “I bought them at a thrift store in Mosman,” she says.

Despite her sideways, teenage smile, ear-piercings and the girlish gap between her two front teeth, Jade is something of an old soul. A self-described “history nerd”, she’s studying arts and cultural administration at TAFE – “I think I’m the only person under 40 doing the class” – with an eye to getting into archaeology at Macquarie University. “I love the study of humans and human relationships,” she says. “And I just love old stuff. I would love nothing more than to dig up a gold coin from the Roman Empire.”

The first time she did vapes, in 2018, the whole thing was a novelty. There was no nicotine in it, so the thrill soon wore off. But before long, small, disposable nicotine vapes were popping up everywhere. “You’d turn up to school and someone would have one,” she tells me. Usually, she’d bum someone else’s, but then she began buying her own from a friend’s oldest sibling. They were about $15, and had 1000 puffs in them – the nicotine equivalent of about four packs of cigarettes. “Your level of immaturity is such that you don’t realise what’s happening at the time. In hindsight, I realise I was becoming addicted. If you’re hanging with friends, it’s the same as eating chips, you have a vape. Before long,” she says, “I wasn’t doing vaping, the vaping was doing me.”

She took her vapes everywhere. When her dad drove into the country to paint en plein air, Jade would go along, sitting in the front seat, vaping right beside him. “I’d put my seat down and turn away from him and have it up my sleeve. And he’d go, ‘What’s that smell?’ And I’d say, ‘It’s just a Mentos.’ ”

On a flight with her father to Broken Hill when she was 16, she took a vape through the X-ray machine and onto the plane. “I actually smoked it on the plane, next to him. I’d pull a ‘ghosty’, which is sucking [the vapour] back into your mouth, and he didn’t even notice.”

She tried to give up soon after that, but the withdrawal symptoms were horrendous: she became anxious and withdrawn; she got the shakes, headaches, dry mouth. And she couldn’t seem to think straight. “It’s like you’re all gloopy in the head,” she says. She tried to kick it another two times. She even went three months without vaping, using gum and patches. But as soon as she reduced the nicotine dosage, she relapsed.

At her worst, she was finishing a 3500-puff vape – in four days. “It’s your mental health, too. If I don’t have one, I can’t enjoy my day,” she explains. Recently, she went away to Melbourne with some friends, without her vape. “And they were all seeing that I had no joy without this little plastic thing, and they said, ‘Just go buy one!’ Because I was ruining it for them.”

Soon, she’ll be travelling to Greece, to view an archaeological dig in Crete. “It’s an Athenian temple,” she tells me. She’ll be gone for two months, and she’s not taking any vapes. “I’m going to use it as an opportunity to detox,” she says. “It’s going to be amazing, but it’s a little weird, because at the moment the biggest thing on my mind isn’t, ‘Oh, I’ll be seeing an ancient ruin or the Eiffel Tower.’ It’s, ‘Will they allow me to get my vape?’ ”

E-CIGARETTES, OR vapes, are small, battery-operated devices that heat a liquid, often containing nicotine, into a vapour that users inhale. They are essentially little hand-held kettles. The first commercially available model was invented in 2003, in China, by Hon Lik, a 52-year-old pharmacist who was looking for a novel way to kick his three-pack-a-day smoking habit. By 2006, vapes had found their way to Europe, and then the US.

In the beginning, vapes were widely regarded as a kind of “smart cigarette”. Unlike tobacco, which releases carcinogenic tar when burnt, e-cigarettes produce what appeared to be relatively harmless water vapour, and were touted as a medical aid in smoking cessation, even by health experts. “E-cigarettes are about as safe as you can get,” Robert West, professor of health psychology and director of tobacco studies, at University College London’s department of epidemiology and public health told The Guardian in 2013. “All they contain is water vapour, nicotine and propylene glycol [which is used to help vaporise the liquid nicotine].”

Despite the absence of any definitive science about their longterm effects, the British neuro-psychopharmacologist Professor David Nutt described e-cigarettes in 2014 as “the most significant advance [in medicine] since antibiotics”.

The first mainstream vape player was a San Francisco start-up called Juul, which hit the market in 2015. Founded by Stanford grad students, Adam Bowen and James Monsees, Juul was marketed with typical Silicon Valley boosterism, a messianic fervour that positioned Juul as something approximating a publichealth initiative.

“I would tell people, anyone who would listen, 50 years from now, nobody’s going to be smoking cigarettes,” Bowen said in a promotional video. “They’re going to be looking back and think, ‘Oh my god, I can’t believe people used to do that.’ And now I think it’s actually going to happen much faster, in large part because of the progress that we’ve made.”

But there was nothing about the marketing that suggested that Juul was a medical aid. For its campaign launch, called “Juul Vaporized”, the company commissioned Steven Baillie, a New York-based creative director, to come up with a series of slickly produced ads featuring bright-eyed, beautiful young models sucking on Juuls while hamming it up and winking at the camera. The company gave Juuls to teen influencers like Leonardo DiCaprio and Bella Hadid, while paying social media influencers, such as Christina Zayas, thousands of dollars to feature Juul on their sites. (Zayas has since said she regrets taking part.)

Before long, the manufacturers of vapes, almost all of whom are based in China, abandoned any therapeutic pretence and began aiming their product squarely at children. There were ads on cartoon websites and teen magazines. Vapes became brightly coloured, resembling pens, highlighters, lollies, even teddy bears. They also began arriving in a Willy Wonka-esque array of crazy flavours, including mango peach guava, pink lemonade and kola champagne.

By 2019, vaping had become a full-blown youth epidemic, with more 5.4 million American highschoolers using them, according to the US Centres for Disease Control. “In Australia, it really took off at the beginning of COVID,” says Becky Freeman, an associate professor of public health at the University of Sydney. “The market became flooded with cheap, flavoured vapes that were full of nicotine, and that didn’t have the same social stigma as smoking.”

In 2021, the NSW Population Health Survey found that onethird of the 16- to 24-year-olds surveyed had vaped, more than double the rate of 15.5 per cent three years earlier. Separate research, by Freeman and the Cancer Council NSW in September 2022, suggested that more than half (54 per cent) of teenage vapers had never smoked before.

Vaping has rapidly undone decades of work by the Australian government to reduce smoking rates, not least because of price. Disposable vapes can contain hundreds, even thousands of puffs, and cost between $20 and $30 from your local shop. Meanwhile, a packet of 20 cigarettes that contain maybe 200 puffs can cost up to $40. And vapes are more palatable. Using nicotine salts, rather than the freebase nicotine found in cigarettes, allows manufacturers to increase the nicotine content without causing throat irritation.

In June 2022, a student at Blue Mountains Grammar, west of Sydney, collapsed in the school toilets and had a seizure while vaping, before being rushed to hospital with nicotine poisoning. A five-yearold boy in Victoria also ended up in hospital in 2022, after vaping at school with his brother and seven-yearold classmate. In the US, meanwhile, a previously healthy 16-year-old boy had a double lung transplant, in 2019, following heavy vape use.

While the long-term effects of vaping are still unknown, the practice is thought to be far from safe. Every puff of a vape bathes your lungs in up to 200 dangerous chemicals, many undisclosed by manufacturers, including those found in weedkiller and nail polish remover. Research by Johns Hopkins University in the US found several conditions associated with vaping, such as primary spontaneous pneumothorax (collapsed lung) and lipoid pneumonia.

As with smoking cigarettes, vaping is not allowed on school grounds, but the prohibition has become farcical. Kids vape in the school toilets, they vape in the playgrounds, they vape on the bus. At my 14-year-daughter’s athletics carnival, groups of girls were regularly disappearing into the toilets to vape. Some kids even vape up the back of the class, using a technique called “zeroing”. “If you hold it in long enough for as long as possible, it condenses in your lungs, and when you exhale no smoke comes out,” says Jade.

As vaping took off, vape websites began popping up in their thousands. Perhaps the biggest of these is the US-based Vaping Daily. Founded in 2017, Vaping Daily claims to be a “quit smoking website” while at the same time offering tutorials, for example, on how to perform “Vape Tricks for Beginners”, including the Jellyfish, the Bow Tie, the Bullring, and of course, ghosting, the sine qua non of aspiring vapers, wherein the user exhales a dank, liquidy ball of smoke before “sipping” it back into his mouth.

In a peerless example of marketing doublespeak, Vaping Daily claims to “believe in the potential of vaping to help people stay smoke-free”, while only mentioning, 32 lines down in its Disclosures section at the bottom of its website, that “we do not claim or market [vapes] as a smoking cessation device”.

You might say that schools are playing catch-up with vapes, except that this would imply they are even in the race, which they are not. When vaping first took off in schools, principals and teachers reportedly mistook the flavoured smells for cheap perfumes or strong deodorants. Some schools have now installed vape detectors in the toilets (at $2000 each). “If a bunch of girls come out of the toilets together, a teacher sometimes checks their pockets,” my 17-yearold daughter tells me. Other schools have taken to locking the toilets outside of break times, with students using toilets in the administration blocks. This has created a secondary problem, with wait times for a single toilet at some schools reportedly being as long as 20 minutes. (Last year, The Sydney Morning Herald reported that two teenage girls had experienced visible menstrual bleeding at school as a result of not being able to access a toilet in time. Parents of schoolchildren with Crohn’s disease and irritable bowel syndrome told the newspaper that the new toilet policies were causing anxiety and “potential health issues”.) Then there were beleaguered teachers, faced with sharing their toilets with hundreds of teenagers.

But given the scale of the problem, anything schools do seems destined to fail. Australia is now awash in cheap, disposable vapes – it’s estimated that between 45 million and 90 million of them are imported into Australia every year. Almost all the vapes are made in just a handful of factories in Shenzhen, the gritty industrial city bordering Hong Kong. The largest of the factories, the Shenzhen Hanqingda Technology Company, has more than 10 production lines pumping out half a million vapes a day, mostly under the HQD brand. The company’s website claims that its mission is to make “human life colourful”, and to “promote healthy development and serve the progress of community civilization [sic]”. Ordering in bulk is simple. “You can order 500 or hundreds of thousands,” the company’s CEO, Hou Shoushan, told the SMH in 2021. Since 2021, it has been illegal to import vapes containing nicotine without a valid prescription, but most manufacturers get around this by falsely claiming that their vapes are nicotine-free. Telling the difference between a vape that contains nicotine and one that doesn’t isn’t easy. Unlike tobacco, liquid nicotine cannot be identified by sight and smell, and the Australian Border Force (ABF) do not have the means, nor indeed the authorisation, to test for it on the spot. Instead, the ABF must send suspicious vapes to the Therapeutic Goods Administration, which tests the products for nicotine in a lab, a process that can take anywhere between two and 40 days. The ABF, meanwhile, must store the cargo at the airport, where space is limited. If the vapes are found to contain nicotine, they must be destroyed. But unlike tobacco, which can be incinerated, each vape has to be taken apart, with its components – canister, battery, liquid – and dealt with separately. For an agency with limited resources, such measures are costly and time-consuming.

In any case, the ABF scans just 1.4 per cent of the 6.3 million containers that arrive in Australia by sea every year. Not surprisingly then, seizures are vanishingly small. In the seven months from October 2022 to April 2023, as many of 28 million illicit, unregulated vapes came into the country. The ABF seized 738,000 of them. “It’s impossible to stop this at the border,” says Rohan Pike, a former detective superintendent with the Australian Federal Police, who specialised in fraud and corruption and who led the ABF’s Tobacco Strike Team in 2015. “We have a huge border and not enough resources.”

Vapes have become highly attractive to organised crime. They are lightweight, and designed to look like other objects, such as watches, pens or USB drives. They are also hugely lucrative: a disposable vape that costs $3 from a factory in China can sell in Australia for $35. “The margins are huge, the enforcement is low, so it’s a low-risk, high-profit business,” says Pike.

Crime groups are now smuggling vapes into the country packaged in boxes of clothes and textiles, and routed through third-party countries, such as Singapore or Malaysia, to disguise their point of origin. “The same organised-crime groups who are bringing in illicit tobacco are bringing in the vapes,” Pike says.

“They’re Lebanese groups, Iraqis, Egyptians and, more recently, Chinese organised crime.” But one of the biggest drivers of the vaping epidemic is, paradoxically, the law. For years, vapes have been subject to a hopelessly complex and deeply dysfunctional web of regulations and overlapping jurisdictions, with multiple state and federal agencies having different levels of involvement and responsibility. It is, in this sense, little different to the illicit tobacco trade, the regulation of which then Liberal senator Eric Abetz described in 2017 as a “greasy pig … with no department or authority willing to claim responsibility”. In 2021, then federal health minister Greg Hunt attempted to harmonise the state and federal laws, but the framework remained unclear, and enforcement was underfunded. This year, Health Minister Mark Butler committed nearly $250 million to further crack down on the black market, with a ban on all non-prescription vapes – non-nicotine and nicotine alike – and tougher controls at the border. There will also be restrictions on the flavours and packaging. Medical access, meanwhile, will be made easier: previously, only a small number of GPs were authorised to prescribe vapes for their patients; Butler’s reforms allow all doctors to do so.

Not everyone is in favour. Vape advocates, including Legalise Vaping Australia (LVA) and Responsible Vaping Australia (RVA), favour a consumer model, where e-cigarettes can be sold at retail outlets, including convenience stores, with enforceable product standards and age restrictions. “Prohibition of any product from a regulated market almost always leads to the creation of a thriving black market,” says Theo Foukkare, CEO of the Australian Association of Convenience Stores, whose members stand to lose millions from the government’s ban on retail sales.

The big cigarette companies, most of which now have their own vaping products, have remained aloof from the public policy debate, preferring to fund groups like the LVA, RVA and the Australian Retail Vaping Industry Australia, to lobby backbenchers. According to The Australian Financial Review, Philip Morris International (PMI) signed a contract in 2020 with global PR firm Burson Cohn & Wolfe to channel hundreds of thousands of dollars to the Australian Retailers Association to lobby for looser regulation around vaping. (The ARA stopped the association with BCW in 2021.) The message from the pro-vape lobby is that “bans don’t work”, a sentiment that has an instinctual appeal, particularly among young people.

When I tell my 17-year-old about the government’s prohibition of retail sales, she shakes her head. “Every year, the government says, ‘We’re implementing new bans, and we’re like, ‘Yeah, no you’re not.’ Because it’s a joke. There has never been anything that has ever prevented kids from accessing vapes.”

VAPES MAY have birthed a new generation of nicotine addicts, but they have also proved rich pickings for young marketeers. Any even vaguely entrepreneurial teenager can import vapes in bulk from China online, then sell them to their friends or schoolmates, either through word of mouth or social media. Dealers commonly sell vapes through Instagram, Telegram, Facebook Marketplace, or, most commonly, Snapchat, the instant-messaging app, sending alerts to their followers whenever a new shipment arrives, complete with brands, prices and flavours. “Often the same people who deal the weed, deal the vapes,” my 17-year-old tells me. “I know of one [in our local area]. He’s cheaper than the others, and he has multiple people, like a little mafia, who deliver alcohol, weeds, vapes. Whatever.” She adds: “It’s usually to younger kids, like 13- or 14-year-olds, because anyone older than that can pretty much buy them over the counter.”

Pricing is highly competitive, according to Jade. “Dealers will drop off one vape for $20, if you want, but they’ll also offer, like, two vapes for $35, or they’ll put on a $5 delivery fee. It’s quicker and easier than Uber Eats.”

When Snapchat dealers are found out, their accounts are deleted. “If they want to get a new Snapchat account, they have to get a new phone,” says my 17-year-old. “But when their account is deleted, so are their followers. So what they do is get a friend who has lots of followers to give them a shout-out, by saying, ‘Here is so-and-so’s new account, follow him, he deals.’ ” (A spokesperson for Snapchat said that it is “against our rules to use Snapchat to sell vaping products to people of any age, let alone minors. As well as taking swift action to remove accounts when we’re made aware of violations of our policies, we restrict search terms associated with vaping and do not allow adverts that promote the sale of vape products.”)

THERE ARE strict medical guidelines about how to use vapes as cessation aids: the Royal Australian College of General Practitioners recommends that patients vape a fixed dosage of nicotine, gauged according to the severity of their smoking habit, which is then carefully reduced over a 12-week period until the smoker is breathing nothing but fresh air. Needless to say, this is not how most kids vape. Recreational users can suck on one until their gums bleed. (Swollen gums is a common side effect of vaping, caused by the high temperature of the vapour.) Vapers can also become nauseated and dizzy with overuse. “It’s called ‘nic-sick’,” my 14-year-old daughter says.

Then there’s “blinkering”. “Blinkering is when you hit a vape so hard in one go that the light at the bottom of it starts blinking, which shows that you’ve pretty much killed the battery,” says Jade. “People go, ‘Yeah, you blinkered it!’ ” One girl tells me that if you use a vape too quickly, the battery can heat up and burn. “You can taste it, like burnt tinfoil,” she explains.

Hacking vapes is not uncommon, with users refilling cartridges with stronger nicotine liquids or tampering with the batteries to produce a hotter element.

Advocates of the government’s reforms hope that a medical access framework will provide some guardrails. “The prescription-only access to vaping products ensures smokers who use these products will do so under the guidance and support of their doctor,” says Becky Freeman. “The prescription pathway balances making vapes available to smokers who may benefit from using them to fully quit smoking and ensuring vapes are not so easily accessible to children.”

This is bad news, not only for the makers of illicit vapes, but for the major tobacco companies. “Making doctors, not retailers, the access gateway to nicotine is a threat to Big Tobacco’s long-term business model,” says Richard Lee, CEO of Liber Pharmaceuticals. “No doctor is going to prescribe a vaping product to someone who doesn’t already smoke, which means there are no new customers coming into the market.” Liber, which is based in Brisbane, evolved out of a company called Nicovape, which was founded in New Zealand in 2016. The company has positioned itself as the ethical alternative to Big Tobacco, and is currently the only nicotine vape manufacturer in Australia to have its product, called NicovapeQ, stocked by major pharmacies and national wholesalers. (Liber manufactures its devices in China and sources its nicotine liquid from the UK.) Liber plays by the rules: it abides by the ban on advertising and does not market or sell directly to consumers. Philip Morris International (PMI) is less coy, openly selling its vape device, called VEEV, online via an Australian weblink. PMI is also trying to muscle in on the prescription-only market. There was outrage last year when it emerged that the company planned to offer kickbacks to pharmacies who stocked VEEV, paying pharmacists a “readiness payment” of $275 if they ordered at least $250 worth of stock, plus $10 for educating a customer about the product, and $5 every time a new VEEV script was dispensed. A PMI spokesperson says the plan had been “designed to educate pharmacy stakeholders and reimburse them for their time [and] not as an incentive to sell a product.” Nevertheless, he added, “the program never commenced, and we have no plans to revisit it.”

SO WILL the government’s reforms keep vapes away from kids? “Nobody thinks the new rules will completely stop the illegal market,” says Richard Lee. “But if it stops, say, 80 per cent of the illicit vapes coming in, then that’s a great result.”

Ultimately, the Australian market is small change, of course: but it’s a significant threat should the prescription-only model be copied around the world. Jade, for one, is cautiously supportive. “The reforms are brilliant,” she says. “But it’s only until I see consistent action being taken for a sustained period of time that I’ll truly have trust in the system.”

When I last speak to her, Jade has been off the vapes for three weeks. But it’s a constant battle. “I cannot emphasise enough how much strength it takes to go through the quitting process and maintain a healthy state of mind,” she says. Her efforts have been bolstered by her parents, and ameliorated by regular intakes of junk food. “Biscuits, crackers, chocolate, pizza,” she says. “Just little things to occupy me, so it’s not at the front of my mind.” Her trip to Greece is fast approaching. “I think I’ll be able to make it through till then,” she says. In any case, she’s going with her boyfriend, who has always supported her quitting. “So there’s that. And I’ll be doing all that researching and taking photos of ruins. That should keep my mind occupied.” She giggles excitedly. “Fingers crossed, hey.” n

* Name has been changed