Australia’s latest Illicit Drug Reporting System report is confronting. It describes a group of people living with risks that should never be minimised or pushed aside simply because one set of figures happens to strengthen an argument about tobacco policy.
Among the 902 people interviewed, 19 per cent had experienced a non-fatal overdose in the previous year. Twenty-eight per cent had experienced an injecting-related health problem in the previous month. Almost two-thirds reported high or very high psychological distress. Heroin and methamphetamine use remained common, and many participants were living with unemployment, disability, mental illness and unstable housing.
These are serious human difficulties in their own right. They require properly funded treatment, needle and syringe programs, naloxone, infection prevention, mental-health care, housing support and services designed around the lives people actually lead. Nothing about discussing tobacco should diminish the urgency of any of that.
But neither should those other problems be used to make smoking disappear from the picture.
The same report contains a set of nicotine figures that should deeply embarrass Australian tobacco control.
Eighty-six per cent of participants had used tobacco during the previous six months. Among those tobacco users, 88 per cent reported daily use. Seventy per cent of the entire sample had recently used illicit tobacco, a statistically significant increase from 63 per cent in 2025.
Twenty-eight per cent had used e-cigarettes obtained outside pharmacies. Only 1 per cent of the entire sample, just seven people, reported obtaining an e-cigarette from a pharmacy. Of those who reported any e-cigarette use and answered the question, 36 per cent said they used vaping as a smoking-cessation tool.
The people facing some of the greatest health and social disadvantages in Australia are still smoking at extraordinary rates. They can find illicit cigarettes. They can find illicit disposable vapes. What they are almost completely failing to find is the government’s approved vaping pathway.
That is not a minor implementation problem. It is a warning about whom the system was designed to serve.
The 2025 National Drug Strategy Household Survey estimated that 5.8 per cent of Australian adults smoked daily. That figure has been celebrated as evidence of extraordinary national success.
The IDRS should not be placed beside that number as though the two surveys measured the same population in the same way. They do not.
The NDSHS is a general household survey. The IDRS is a sentinel survey of people who regularly inject illicit drugs, recruited largely through needle and syringe programs, other harm-reduction services and peer referral. The IDRS authors explicitly warn that its results do not represent the general population or even all people who inject drugs.
That limitation matters. But it does not make these participants irrelevant. In fact, it makes the contrast more important.
A national average tells us what is happening across a population. It can conceal what is happening to particular groups within it. Australia can record a falling national smoking rate while some of its most disadvantaged citizens remain heavily concentrated among those who continue to smoke and suffer the consequences.
The IDRS does not disprove the NDSHS estimate. It exposes the human beings who can disappear behind it.
If tobacco control celebrates the national average without confronting the groups left behind, it is measuring the people easiest to reach and calling that universal success.
Australia understands harm reduction when it chooses to.
We provide sterile injecting equipment because requiring abstinence before preventing blood-borne infection would be reckless. We distribute naloxone because a person should not have to prove recovery before being protected from a fatal overdose. We offer opioid-dependence treatment because real public health begins with people as they are, rather than as policymakers wish them to be.
The IDRS found that 79 per cent of participants had heard of take-home naloxone and 56 per cent had obtained it during the previous year. Eighty-seven per cent had accessed a health service for alcohol or other drug support during the previous six months. Those figures show a health system at least attempting to meet a highly marginalised population where it is.
Then we reach nicotine, and the philosophy changes.
The smoker is expected to recognise vaping as a therapeutic intervention, find a participating pharmacy, approach a pharmacist, accept a narrow range of products and strengths, tolerate the cost and inconvenience, and persist through a system that bears little resemblance to the ordinary retail environment in which cigarettes are encountered.
That model may be navigable for a motivated and well-resourced patient. It is much less realistic for somebody dealing with unstable housing, poverty, trauma, mental illness, stigma or complex substance use.
The result in the IDRS sample was stark: seven people reported obtaining a vape through a pharmacy, while more than one-quarter used vapes from non-pharmacy sources.
For illicit drugs, Australia recognises that barriers cost lives. For nicotine, barriers are presented as safeguards even when the most harmful nicotine product remains readily available.
Harm reduction should not cease to be a principle simply because the person is smoking.
The finding that 36 per cent of respondents who vaped said they were using e-cigarettes to stop smoking deserves far more attention.
It does not mean every person succeeded, nor does it establish that every illicit product was safe or suitable. It tells us something more basic: a substantial proportion were not merely vaping for novelty. They were trying to move away from cigarettes.
Yet the products they were using were overwhelmingly obtained outside the legal pathway.
Australia has created the perverse situation in which a highly disadvantaged smoker’s attempt to reduce risk is more likely to involve the illicit market than the healthcare system. The government may call the product illegal, but the consumer’s objective may still be entirely consistent with public health.
The failure is not that people want a safer substitute for smoking. The failure is that the regulated system is not supplying one in a form they will actually use.
The NDSHS may describe a much lower-smoking population, but its findings about supply do not rescue the pharmacy model.
It found that 34 per cent of Australians who currently smoked had recently used illicit tobacco, up from 16.7 per cent in 2022–23. Among people who used e-cigarettes, only 2.5 per cent obtained them from a physical pharmacy and another 4.8 per cent from an online pharmacy. The remaining 93 per cent obtained them from illicit sources, most often tobacconists.
So the IDRS is not identifying an entirely separate phenomenon. It is revealing an extreme version of a broader national failure.
The legal vaping market is marginal. The illicit market is dominant. Disadvantaged smokers are heavily exposed to both illicit cigarettes and illicit vapes. The government’s answer remains more enforcement, more seizures, more closures and more declarations that the policy itself is sound.
But enforcement does not eliminate nicotine dependence. Closing one seller does not tell us whether customers quit, return to smoking, switch products or find another supplier. A seizure counts goods removed from the market. It does not count lives improved.
When demand remains and the legal alternative is inaccessible or unattractive, the illicit market is not an unexpected side effect. It is the market responding to the conditions government created.
There is a temptation to look at people who inject drugs and assume that smoking must rank low among their problems. That view is understandable, but dangerously incomplete.
Overdose prevention is urgent. Safe injecting, infection control, drug treatment, housing and mental-health support are urgent. These needs should never be set against one another in a contest for sympathy.
Tobacco dependence is usually slower and less dramatic. It does not produce the same immediate crisis as an overdose. Its harm accumulates quietly through cancer, cardiovascular disease and chronic respiratory illness. That slower timetable makes it easier for institutions to neglect, particularly among people already carrying other risks.
But a preventable death does not become less preventable because the person also uses another drug.
Nor should people be denied accurate information and safer choices because policymakers decide they have more pressing problems. That is not compassion. It is a form of triage in which one major source of disease is allowed to continue because other harms appear more immediate.
A genuinely comprehensive harm-reduction system would address both.
A serious response would begin by treating the IDRS findings as an equity warning rather than a statistical curiosity.
It would provide accurate, non-alarmist information about the relative risks of cigarettes, vaping, nicotine pouches, nicotine-replacement therapy and other non-combustible alternatives. It would integrate smoking reduction and cessation support into the services people already trust, including needle and syringe programs, alcohol and other drug services, community health centres, mental-health services and homelessness services.
It would make regulated lower-risk products affordable, acceptable and easy to obtain. It would offer choices rather than assuming one device, flavour, strength or clinical pathway will suit everyone. It would measure whether people actually move away from cigarettes, not merely whether illegal products are seized.
Most importantly, it would ask the people affected what would help them switch.
Australia does not need to choose between addressing injecting-related harms and reducing smoking. The infrastructure of harm reduction already demonstrates how both can be done: respect the person, understand the behaviour, reduce the immediate risk and keep the door open to further change.
The national smoking rate matters. If the NDSHS decline is accurate, it is welcome news. Fewer people smoking means fewer people exposed to the enormous harms of combustion.
But public health cannot stop at the average.
The IDRS describes Australians facing overdose, injecting injuries, psychological distress, poverty and complex drug dependence. Those realities deserve attention in their own right. They also make the near-total failure of the regulated vaping pathway more serious, not less.
These participants are not inconvenient outliers to be excluded from tobacco control’s success story. They are citizens whose lives carry the same value as everyone else’s.
Australia congratulates itself on historically low smoking while some of its most disadvantaged people remain surrounded by illicit cigarettes, supplied with illicit vapes and almost completely untouched by the government’s approved alternative.
That is not comprehensive tobacco control.
It is success measured among the people the system finds easiest to reach, while those facing the greatest risks are left outside the pharmacy door.
Great article, thanks Alan
Sad indictment on the likes of albo n bumlet and their inhumane policies. Thank you 😊 sir