Australia: Increase in child poisonings from nicotine in e-cigarettes

Calls to the New South Wales Poison Control Centres for e-cigarette poisonings in children under four have increased by nearly 70% in one year. This alert comes at a time when conventional e-cigarettes are relatively expensive and are generally only sold in Australia with a prescription. The boom in sales of disposable puff-style cigarettes appears to be the cause of this phenomenon.

In New South Wales, calls to poison control centres for e-cigarette poisonings in children under four increased from 127 in 2021 to 213 in 2022.[1]In Australia, access to regular electronic cigarettes has been regulated since 1^er October 2021, and reserved only for adults wishing to quit smoking and provided with a prescription.

On the other hand, like many other countries, Australia has been the site of a massive distribution of disposable electronic cigarettes ("puffs") since the end of 2021.

The toxicity of e-liquids in question

Young children put e-cigarettes in their mouths and become intoxicated by nicotine. Signs of nicotine poisoning in these children include nausea, vomiting, coughing, rapid heart rate, loss of consciousness, and even seizures. Beyond the acute toxic episode, it is possible that exposure at a very young age to toxic doses of nicotine, a powerful drug, may have consequences for the brain development of these children.

Exposure to nicotine in puffs is all the more dangerous because it is present in salt form, which increases its addictive power, and nicotine concentrations can be very high, even above legal limits.

Worrying growth of electronic cigarettes, despite legislation

The sharp growth in the use of vaping products in Australia in recent years has mobilized public health stakeholders. For example, in New South Wales, the proportion of regular vapers among 16-24 year olds increased from 4.5% in 2020 to 11% in 2021, raising fears of the emergence of a new pediatric epidemic.[3].

Current legislation restricting e-cigarette sales to smoking cessation situations is currently poorly enforced, with a thriving black market for e-cigarettes. The Australian government's health minister has announced his intention to strengthen legislationn on tobacco and vaping products, and conducted a six-week consultation which ended in mid-January 2023[4] contrasting the arguments of public health prevention, particularly that of young people, with those expressing the possible interest for smokers wishing to quit smoking. However, a study published in May 2022 by the Cancer Institute NSW reported that quitting smoking was a reason for consuming e-cigarettes for only 16% of regular vapers, which puts this latter point of view into perspective.[5].

Keywords: children, poisoning, e-cigarettes, puffs, Australia, New South Wales

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[1] Stonehouse G, NSW parents report alarming rise of e-cigarette poisoning in young children, ABC News, published January 31, 2023, accessed 1^er February 2023.

[2] Electronic cigarette, DGCCRF, published on September 27, 2019, consulted on 1^er February 2023.

[3] Ward M, Number of young people vaping doubles in a year as smoking rates drop, The Sydney Morning Herald, published May 31, 2022, accessed 1^er February 2023.

[4] Chrysanthos N, Labor prepares to take on Big Tobacco again, The Sydney Morning Herald, published January 21, 2023, accessed 1^er February 2023

[5] Cancer Institute NSW, NSW Smoking & Health Survey 2021, May 30, 2022.