TOBACCO FREE: The e-cigarette allows users to quit smoking but still inhale nicotine.

The Government should open the way for e-cigarettes, argues Murray Laugesen.

Smokers wishing to live a normal lifespan should consider trying an electronic cigarette (e-cigarette), unless their doctor advises otherwise.

These battery-powered nicotine inhalers emit vapour not smoke and the vapour is far safer and less toxic than cigarette smoke.

Quality is improving and the best brands provide adequate nicotine. An e-cigarette starter kit costs $33 to $100, and internationally nicotine costs $2 to $5 a day.

Nicotine does not cause cancer, lung disease or heart disease as does smoking tobacco. There is no flame, no smoulder, no secondhand smoke, no ash, no tar.

The user or "vaper" inhales nicotine, water vapour, propylene glycol, glycerol and flavours, none of which is known to cause disease in e-cigarette users.

Quitting altogether remains the best advice, but unfortunately, most New Zealand smokers postpone quitting for decades and pay later with their lives, at the rate of 5000 a year.

If smokers could quit but still inhale nicotine, they may in future quit sooner. The University of Auckland trial due to report in September will determine whether the e-cigarette they studied helps smokers quit successfully and safely.

This year in Britain and the United States, The Lancet and the New England Journal of Medicine reported on the fate of millions, finding that 21st century smokers shorten their lifespan by an average 11 years, that two-thirds of them die from their cigarettes, and men and women who smoke cigarettes experience similar mortality.

Since 2007 safer alternatives such as e-cigarettes have been sold widely in those countries but are banned here. It is an offence in New Zealand to sell nicotine e-cigarette refills. (Non-nicotine e-cigarettes are legal to sell, and nicotine refills can be imported for private use.)

This ban on nicotine refills sits most awkwardly with the Government's 2025 smokefree nation goal. Ministerial action is required, for if the Auckland trial proves positive, thousands of would-be quitters will instead buy untested but life-saving nicotine from China via the internet, while the overseas-owned tobacco companies exploit their monopoly of deadly cigarette nicotine in 10,000 New Zealand shops.

A grey market would burgeon, and indeed become a black market if the Ministry of Health enforces the current ban (which would regrettably persuade many users to resume smoking, contrary to the Government goal). All that is needed is some advance testing of nicotine refills, some temporary approvals and the drafting of nicotine regulations.

Once the supply of nicotine refills is legalised, and tobacco excise increases again, more smokers will switch to vaping as the safer option. Media campaign messages could be extended to include "quit and switch".

E-cigarettes may need legislation, possibly through a private member's bill. In Britain e-cigarette use is confined to smokers and ex-smokers, with near-zero use by non-smokers and young people. Some fear e-cigarettes would re-normalise tobacco smoking, but this looks unlikely with e-cigarettes this year starting to threaten US cigarette sales.

Vaping is banned on airlines, and though legally permissible indoors, in- your-face vaping would be socially unacceptable.

Smokers smoke for nicotine-driven satisfaction, and although cigarette price influences how much they smoke, quitting means giving up nicotine.

For example, the current annual tobacco excise increases are expected to only half achieve the Government's 2025 smokefree nation goal (of under 5 per cent of adults smoking).

On the other hand, the Government can legalise a product that mimics the act and pleasure of smoking, to compete against deadly tobacco cigarette. For good measure, add multiparty parliamentary support for increasing tobacco taxes.

Legalisation of margarine sales in 1972 ended the butterfat monopoly of the yellow-spreads market and heart disease mortality fell steeply thereafter.

Similarly legalisation of nicotine e-cigarettes would end the tobacco monopoly of the inhaled nicotine market, and providing choice would enable addicted smokers to safely enjoy nicotine into old age.

The first minister of health who legalises nicotine e-cigarettes for sale will gain enormous backing from the thousands who choose nicotine over tobacco, will achieve the 2025 goal, and reduce smoking more rapidly than any country in the world.

Dr Murray Laugesen, chairman of the End Smoking NZ Trust, is a former principal medical officer for tobacco policy in the Ministry of Health and researches nicotine-substitute products. He has no financial interest in any tobacco, pharmaceutical or nicotine company.