- National wastewater testing shows total nicotine use in Australia has not fallen and has trended upward since 2016.
- Regional areas consistently record higher nicotine consumption than capital cities, with the Northern Territory highest overall.
- Wastewater analysis reports total nicotine only and “cannot distinguish” whether it came from smoking, vaping or nicotine replacement therapy.
- A separate study found Australia’s prescription-only vape policy neither prevented youth experimentation nor led to widespread use of regulated products for quitting.
Australia has some of the toughest vaping restrictions in the world – but new data suggests nicotine use overall has not declined.
The latest results from the National Wastewater Drug Monitoring Program (NWDMP) show that total nicotine consumption across the country remains broadly steady and has trended upward over the life of the program, despite years of tightening controls.
The NWDMP, run by the Australian Criminal Intelligence Commission (ACIC), analyses wastewater samples to estimate drug and alcohol use at a population level. The most recent collections, taken in August and October 2024, cover roughly half to just over half of Australia’s population.
The headline finding is that nicotine levels are not falling.
What bans are in place?
Australia began restricting access to nicotine vaping products in October 2021, when nicotine vapes became legal only with a doctor’s prescription. Non-prescription sales were prohibited, and products supplied through pharmacies were required to meet therapeutic standards.
In 2024, further reforms tightened controls on imports and retail supply, aiming to curb youth access and reduce the availability of disposable devices.
The prescription-only model was designed as a compromise, to allow adult smokers to access vapes for quitting, while preventing uptake among young people and non-smokers.
However, wastewater data suggests that, at a population level, overall nicotine consumption has not declined under these settings.
What the wastewater shows
Wastewater testing works by detecting chemical by-products excreted after substance use. In the case of nicotine, the program measures two metabolites – cotinine and hydroxycotinine – to estimate total consumption per 1,000 people.
The latest reporting period revealed several patterns:
- Nicotine levels in August 2024 were close to the long-term average.
- Over the longer term, nicotine has trended upward, while alcohol has broadly trended downward.
- Regional Australia has recorded higher nicotine consumption than capital cities in every reporting period since 2016.
- The Northern Territory reports the highest nicotine and alcohol loads nationally.
The report notes that the method “cannot distinguish” whether nicotine came from cigarettes, vapes or nicotine replacement therapy (NRT). That means the data captures total nicotine use – not specifically smoking.
For consumers and policymakers, that distinction is important. Smoking remains the leading cause of tobacco-related death and disease. If smokers switch to lower-risk nicotine products, overall health risks may fall even if total nicotine use remains stable. Wastewater totals alone cannot answer that question.
Did prescription-only vaping work?
A separate peer-reviewed commentary, published in the journal Addiction, examined how the prescription-only model operated in practice. In “Commentary on Lim et al.: Real-world e-cigarette use under prescription-only regulation,” Dimitra Kale and Sarah Jackson reviewed national survey data from 21,500 Australians aged 14 and over.
They wrote: “Prescription-only access to e-cigarettes has been proposed as a policy solution that strikes an appropriate balance between preventing youth uptake and enabling adult smokers to access e-cigarettes as smoking cessation aids.”
They said the Australian experience has failed to prevent people from experimenting with vapes, and shifted use to the black market. They wrote:
“Evidence from Australia’s experience suggests that this model neither prevented experimentation among never-smokers nor facilitated the widespread use of regulated products for cessation, instead shifting use toward unregulated supply channels.”
Much of the vaping identified in the survey reflected short-term experimentation, particularly among younger people who had never smoked.
The authors reported that this experimentation occurred “almost entirely through non-prescription sources.”
They also found that even among people trying to quit smoking, use of prescribed vapes was rare. “This suggests that legal access through medical prescribing did not translate into the widespread use of regulated products for smoking cessation,” they wrote.
The commentary added that “limiting legal supply does not necessarily reduce demand but may instead redirect use toward less controlled and potentially higher-risk products.”
