The number of toddlers accidentally exposed to e-cigarettes almost quadrupled after the 2021 up-scheduling.
Rates of e-cigarette poisoning increased significantly just before and after legislation was introduced to reclassify liquid nicotine as prescription-only medication, with toddlers leading the rise in numbers.
Victorian researchers have found that the proportion of poisonings from inhalation soared after legislation was introduced in October 2021.
Toddlers (one to four-year-olds) made up more than half of all cases of exposure to e-cigarettes, the researchers said.
The mean number of toddler poisonings jumped from one to nine per month after October 2021, and “significant increases were also seen amongst infants, children and adults”.
There were 103 reported cases of e-cigarette exposure in the two years before the legislation was implemented in October 2021, and 358 in the following two years, according to the analysis of e-cigarette exposure cases reported to the Victorian Poisons Information Centre between 2017 and 2023.
The median monthly cases increased from three to 15 during that period, the researchers said in the International Journal of Drug Policy.
Of the 547 reported cases of exposure to e-cigarettes, 83% were unintentional exposures via inhalation or ingestion, and 137 were referred to hospital or already were admitted.
The researchers said that “dramatic rise” mirrored e-cigarette data from the Australian National Drug Household Survey which showed daily use increased from 42% in 2019 to 49% in 2022–23, “suggesting increased exposures are correlated with increased use”.
“Regulation and policies implemented in October 2021 were insufficient to prevent nicotine e-cigarette sales for non-therapeutic purposes, indicating that stricter importation laws are required,” the researchers said.
After the legislation was introduced, the proportion of poisoning cases due to ingestion decreased from 53% to 23%, but inhalation increased from 21% to 68%.
The researchers said the increase in inhalation cases could be due to mandatory child-resistant closures introduced as part of the 2021 legislation, or the popularity of disposable vapes which are often breath-activated.
“The 2021 Australian federal legislation did not prevent increases in e-cigarette poisoning exposures in the context of their increased use, supporting the need for further regulation,” the researchers said.
“Toddlers were identified as being particularly at risk, suggesting educational campaigns for parents are warranted.”
The researchers said infants and children account for at least a third of e-cigarette exposures reported to poison centres in Australia.
Most accidental ingestions by children were asymptomatic, but higher nicotine concentrations and larger exposures caused more serious adverse effects, they said.
At least one Australian child has died from liquid nicotine ingestion, with similar cases documented in the US and South Korea.
