There was a time when many places were foggy with cigarette smoke and the smell of stale tobacco hung in the air. Cars, restaurants, bars, and workplaces - all were areas where people could light up as they pleased. But not any more. Smokers have been pushed outside, often enduring the glares and pointed coughs of non-smokers. But with the explosion of vaping, it has suddenly become cool once more to puff away on a little stick. But is vaping safe? With recent deaths in the US linked to vaping and calls for regulations in New Zealand, should vaping still be the answer to getting people to quit smoking? Cira Olivier finds out.
Waking up in the middle of the night, gasping and reaching for his inhaler, Rotorua's Joe Fraser knew his lifestyle would kill him if he did not do something.
His 15-year-old daughter, Ada, would often be woken up too, hearing her father desperately gasping for air, coughing uncontrollably.
She says more than once a night, every night, her dad would "just stop breathing".
What started as three cigarettes a day as a teenager became an $80-a-week addiction, one that also cost Fraser his health with severe asthma attacks, trouble breathing, struggling through his labour-intensive job at Arataki Honey, and constant pleading from his five children.
"I'll quit one day," he'd say when his children would ask him to stop; something he had already tried three times.
But they were just words. He did not think it would happen.
That was until five months ago, when Fraser swapped cigarettes for a cloud of melon vape.
And he has not looked back.
Fraser is not alone in vaping as a means to quit smoking, with the use of vapes exploding in recent years.
Data from Google Trends searches from 2004 shows the first searches for "vape" in the Bay of Plenty was in October 2013.
It was not until 2016 searches in the region took off, overtaking the searches for smoking in April 2017.
This was after the word vape won Oxford Dictionary's Word of the Year in 2014.
Fraser, a smoker of 25 years, has never been smokefree this long and says it is all thanks to vaping.
He started on 25mg of nicotine, moving to 18mg, then 10mg and is currently sitting on 3mg.
As well as a bigger appetite which he has more money to feed, he no longer needs his inhaler.
His daughter is proud: "I didn't think he was going to last."
A clinical trial by The Lancet Respiratory Medicine was recently conducted where 1124 adults were randomly chosen and motivated to quit smoking.
It's the first study to test the effectiveness and safety of using nicotine e-cigarettes with nicotine patches as combination nicotine replacement therapy (NRT).
The lead investigator, University of Auckland associate professor Natalie Walker, explains while nicotine makes people want cigarettes, the tar and 4000 chemicals in tobacco smoke is the killer.
"It's those other chemicals, not the nicotine, which kill up to two out of every three smokers."
The group was split into three groups:
• nicotine patches only
• patches and nicotine-free e-cigarettes
• patches and an e-cigarette with 18mg of nicotine.
People using patches with nicotine vapes were the more likely to have gone without smoking for six months after the treatment than those with the nicotine-free e-cigarettes.
Turning to vaping was what helped Tauranga's Cameron Rutten quit smoking.
About two weeks after he moved from cigarettes to vaping, he was coughing up brown phlegm. It was, he says, his body purging the tar.
It's now been two and half years since he made the switch. His addiction was 13 years in the making with moments of being smokefree and the longest before now was six months.
What made him quit? The rising cost of tobacco. But he says while the Government means well in raising the price, he believes it financially cripples people with addiction.
It has nearly been 10 years since the government began implementing the 10 per cent tobacco tax increase of each year, from 2010 to 2020.
Now, the cheapest pack of 20 costs $26.90.
"There were a lot of times I'd think, can I stretch this gas out until next week? Maybe I'll cut some meat out of the groceries," Rutten says.
"You make compromises with yourself," and consuming a 50g pouch in three days at his peak, it was costly.
Doctors told him he was heading towards a guaranteed death - which gave him the motivation to quit.
For him, the satisfaction he got from smoking was about the ritual.
"You go outside, take a break, have that cigarette for five minutes and those five minutes you're not really thinking about anything, you're just enjoying that moment of solitude."
He still occasionally craves a cigarette but switching to vaping has allowed Cameron to maintain that ritual minus the physical effects smoking was having on his body.
Smoking versus vaping: The differences
Vapes and cigarettes are similar in that they are vessels for nicotine.
Vapes are battery-powered, heating a flavoured e-juice to a vapour. Smoking burns tobacco and other additives and chemicals.
New Zealand health officials promote vaping as an effective, safer alternative to tobacco-based smoking.
The Ministry of Health's website Vaping Facts , gives information about vaping in an attempt to help people quite smoking tobacco.
"The healthiest option is not to vape or smoke. Don't vape if you don't smoke. Only vape to quit smoking," is the warning on the site.
However, the industry is unregulated in New Zealand and there are now news reports from the US of people dying or falling ill with severe lung conditions linked to vaping.
Health officials in the US say six people have died from a mysterious lung disease which has been linked to vaping .
There are now more than 450 possible cases of this disease .
People, mostly healthy and in their late teens and 20s, are suffering severe shortness of breath, often accompanied with vomiting, fever and fatigue.
Some are ending up in the intensive care unit, in an induced coma , or on a ventilator for weeks.
The first death among these cases was reported late last month.
Up to six deaths have been reported in the US.
However, New Zealand Ministry of Health tobacco control manager Jane Chambers says it hasn't received any reports of lung conditions that might be linked to vaping.
"Any presentations would be dealt with by health professionals and hospitals and advice sought as required from the National Poisons Centre."
She says the main issues linking vaping and severe lung disease in the US was what was being vaped. In at least some of the cases, tetrahydrocannabinol (THC) from unlicensed sources bought on the street has been linked.
"Inappropriately administered substances, adulterated or contaminated products appears highly likely. At this stage it is difficult to know what exactly is causing the problem.
"The ministry is not aware of any report of vaping with THC added to the juice in New Zealand. The ministry does not recommend that people manufacture vaping liquid themselves for safety reasons."
Chambers says there are no mandatory product safety standards for vaping liquid and devices but "these risks highlight the need for regulation and education".
The Government is planning to change the Smoke-free Environments Act 1990 to improve smokers' access to quality vaping and smokeless tobacco products, while protecting children and young people from associated risks.
She says to improve the safety of products on the market, Cabinet agreed there needs to be minimum safety standards for these products, with the detailed requirements being set out in regulations.
The new regulations will control commercial production and could include banning harmful ingredients, implementing maximum nicotine levels and container size for refill liquid and defining standards for the manufacture of devices.
Chambers says the timing for these changes is yet to be decided, depending on progress of the Smoke-free Environments (Vaping) Amendment Bill which should be before Parliament in the next couple of months.
"We expect at this stage to be consulting on the safety standards in the New Year.
"To support product safety, the amendment bill will require that manufacturers and importers must notify a vaping or smokeless tobacco product to the Ministry of Health before marketing it and certify that the product meets any applicable standards."
Other proposed product safety requirements include reporting symptoms, product recalls, suspensions and cancellations of product notifications, and the issuing of warning statements about products, she says.
Is vaping the lesser of two evils?
Watching someone get puffed from simply talking has stuck with Toi Te Ora Public Health's medical officer of health Dr Phil Shoemack.
"You think, wow, that's pretty distressing that you're so short of breath from smoking that you're having trouble carrying on a conversation."
He says there is nothing good about smoking tobacco.
The dangers stretch further than lung cancer, with the general functioning of the lungs, heart and other organs seriously affected.
A range of cancers and a fatal heart attack is on the cards, as are conditions such as gangrene and eyesight loss.
"It's tragic ... most smokers want to quit but find it difficult because they're literally addicted and it's really hard to overcome addiction of any type."
Vaping is what health officials call "risk reduction" - the lesser of two evils, but not risk-free.
Shoemack says there is evidence some smokers who've tried everything else to quit without success find vaping helps them either cut down or quit their tobacco smoking habit entirely.
But he worries about the lack of regulation and licensing regime on the industry.
"If it was just water and water vapour it would be a lower level of concern but the problem in New Zealand is there is currently no regulation of the vaping solution.
"We don't have any safety standards at this stage about the liquids ... we've got a whole industry that's functioning with no legal oversight.
"At the moment it is very much a case of buyer beware."
Shoemack says it is hard to say how many retailers sell vapes in Rotorua because they are not regulated.
"Almost every dairy, variety store, gas station, supermarket, superette sells vape products."
With products being readily available, the trend has naturally caught the attention of youth.
John Paul College principal Patrick Walsh says children as young as 12 have been caught vaping.
"It's becoming something cool," he says.
"We've had students in Year 8 engaged in vaping ... we've caught them and been advised by those students the equipment is readily available in Rotorua."
He says in his view if the Government does not urgently regulate it, "we are going to have another generation of young children lost to smoking.
"We've fought long and hard to get young people away from smoking and I don't want it replaced with an epidemic of vaping."
He says it's dangerous to promote vapes under a cloak of health, especially in light of the US cases.
How vaping is helping the Smokefree 2025 goal
According to the 2013 Census, the number of smokers in the Bay of Plenty region has dropped more than 9600 from the 2006 Census.
The number of people who smoke in the Lakes DHB has decreased by nearly 8450 from the 2006 to 2013 Census.
The largest smoking population is 20 to 24-year-olds with more women than men in every age group and higher among Māori.
The number of smokers in Bay of Plenty DHB area has dropped 1680 in the past two years.
Dr Hayden McRobbie, of the Lakes District Health Board, supports vaping as a way of reducing harm for people wanting to quit smoking but says people should aim to stop vaping when they feel safe not to go back to smoking.
There are also other methods and services to help people quit which he says should also be considered.
Bay of Plenty District Health Board population health portfolio manager Sarah Stevenson says the decline in smokers in the Bay of Plenty, which mimics the national trend, cannot be linked to vaping.
One of the country's top-performing smokefree services is the region's Hapainga - it has a 70 per cent success rate and supports people who wish to move to vaping.
Neither DHB records vaping and so instances of people turning up to the emergency department with vaping related illnesses isn't available.
Someone who has seen the benefits of vaping to help quit smoking is Tipu Ora Stop Smoking co-ordinator Daile Peni-LeVaillant, who says vaping is something many find helpful.
Daile says about 500 people enrolled for support in the 2016 financial year, when the support network first started. When they tallied it up this year, it was 900.
In the beginning, the success rate was low.
"Now it's increased about three-fold for people who have become smokefree."
The push for Smokefree Aotearoa 2025 has pushed up the price of cigarettes. From what Peni-LeVaillant sees day-to-day, money and health are the main reasons people quit.
In the last year, more people have shown interest in using vaping to quit and being increasingly successful.
"We understand it's 95 per cent safer to vape than to smoke tobacco because [with cigarettes] you're inhaling carbon monoxide which is the most harmful part of smoking," she says.
But there are also people who fall back into smoking because they can't master the art of vaping.
"There is a technique ... you learn how to smoke cigarettes, you've got to learn how to vape as well."
The centre offers incentives for people who've been smokefree including $200 worth of vouchers for pregnant women who quit for four weeks and $100 worth of vouchers each for any pair of smokers who both quit for four weeks.
Hapū māmā (pregnant mothers) and wāhine Māori are the largest demographic the centre supports, and are the largest demographic of smokers nationally.
Business and pleasure
Matt Swinn lives and breathes vaping; from his mission to make Rotorua smoke-free, going to vape conventions and an extensive vape collection.
"Between me and my partner, we've probably got about 70 devices," which includes rare collectables and his own homemade modules.
His latest purchase is a custom device with nordic Thor artwork on it which cost US$900 (NZD$1400).
For some, vaping is a hobby and Matt, known as the "Vaping Caveman" on Instagram, is one of those people.
This passion started nearly five years ago when he quit smoking, "because I was killing myself", he says.
As well as leisure, he says vaping helps with his recently-developed sweet tooth since starting the keto diet.
"Me vaping an orange candy flavour or a blueberry custard is stumping those cravings."
He also manages Vape Park which has boomed since it opened at the end of January, going from between five to 10 sales a day to now up to 70 sales.
He believes he has a 100 per cent success rate of getting people to stop smoking.
"I've got the knowledge and tools to help you quit smoking and will do everything in my power to help get you off your cigarette habit.''
Types of vapes
Walking into vape store will be a different experience for everyone depending on:
• what style of vaping you want to pick up
• how much you smoke.
Mouth to lung
This is a smaller device and mimics a cigarette in terms of the two-motion technique of into the mouth first and then into the lungs.
These are lower power, higher nicotine and cheaper to run.
Swinn pulls out a modest pen and explains it is easier to use and only needs a USB plug to charge it.
Direct to lung
This was more of the deep stretch. The deep breath, high power, low nicotine and anything but discreet.
"More for those who want to throw clouds around," he says.
But as the manager, he is getting fed up with lung disease claims, saying the fears are turning people away from looking into vaping to quit smoking.
"Nothing beats fresh air," he says, but adds that for some, vaping is a more realistic option.
He says while he believes there is not enough evidence to support the fears around vaping-induced lung disease, there are some dangers in vaping.
Mechanical devices don't have in-built safety protection or a circuit. This is what he says is likely being used, by inexperience vapers, in cases where vapes have blown up .
"People go 'these are dangerous' and that is true, but so is a gun if you don't know what you're doing."
Even though he advocates for the product to live a smokefree lifestyle, he says it's important people educate themselves.
Vaping in the Bay
The vape cloud above the Bay of Plenty is rising and, anecdotally, the number of people taking it up appears to be growing rapidly.
Vapes are as easy to buy as a pack of gum and vaping is being increasingly talked about.
But is it safe? And is it the answer to helping the country become smokefree?
Only time will tell.