For the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), New Zealand provides a particularly relevant case study for neighbouring governments that continue to prohibit or heavily restrict lower-risk nicotine products. Executive Coordinator Nancy Loucas argues that the results challenge predictions that regulated vaping access would derail progress against cigarettes.

Smoking decreases as vaping increases (worldwide)

These figures contrast dramatically with the U.S. youth smoking epidemic of previous decades. They also complicate the argument that introducing alternative nicotine products must inevitably renormalise cigarette smoking. Naturally, population trends alone cannot prove vaping caused declining smoking rates; taxation, smoke-free laws, changing social attitudes, prevention campaigns and other factors all contribute.

That distinction is really important. While it’s crucial to prevent young people from starting nicotine, tackling vaping and eliminating smoking are not the same public health goals. Cigarettes are especially dangerous since the combustion process creates a toxic mix that leads to most tobacco-related diseases.

Evidence for vaping as a smoking cessation tool keeps strengthening

In seven trials with 2,544 participants, nicotine vaping increased quit rates by 59% compared to NRT. To put it simply, about eight to ten out of every 100 people using nicotine e-cigarettes managed to quit for at least six months, while roughly six out of 100 who used patches, gum, or other NRT were successful.

That places vaping firmly within the evidence-based smoking cessation toolkit rather than merely making it an alternative consumer product.

A model to follow

New Zealand has increasingly attempted to combine adult access with measures intended to prevent youth uptake. Its government explicitly recognises less harmful alternatives such as vaping as practical tools for smokers trying to quit. CAPHRA argues that this approach deserves particular consideration across Asia, where millions continue to smoke while several governments favour prohibition or severe restrictions on vaping.

There are important qualifications. New Zealand authorities acknowledge that illicit cigarettes could account for part of the accelerated reduction in legal tobacco sales, while persistent smoking inequalities remain, particularly among Māori and more deprived communities. These challenges reinforce the need for targeted cessation support rather than complacency.

The undeniable case for tobacco harm reduction

New Zealand’s experience may not prove that vaping alone caused its remarkable decline in smoking. However, it does show that widespread access to vaping goes hand in hand with decreased smoking rates.

Punished for Success? New Zealand’s “Dirty Ashtray” Reveals The FCTC’s Embedded Bias

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Marijuana sales are increasing as purchases of alcohol are declining, according to a new federal report from the Canadian government.

Retailers in the country sold C$5.5 billion worth of legal recreational cannabis products in the fiscal year ending March 31, 2025, Statistics Canada reported, representing a 6.1 percent increase from the previous annual period.

Meanwhile, alcohol purchases were down 1.6 percent year over year, a dip that occurred despite a 1.6 increase in retail alcohol prices. The resulting decline in government revenue “was the largest annual decrease since Statistics Canada began tracking this series in 2004/2005,” the federal agency said.

While the C$25.8 billion worth of alcoholic beverages sold in the fiscal year still outpaces marijuana’s total, the two data points represent a trend where consumers are switching away from beer, wine and liquor toward cannabis, which is increasingly viewed as a safer alternative.

Even as marijuana sales in Canada increased in the last fiscal year, growth slowed, however, from the 11.6 percent increase in 2023-2024 and the 15.8 percent bump from 2022-2023. Still, the overall rise in cannabis purchase totals came even as prices dropped 1.1 percent over the last year.

Within the cannabis sector, inhaled extracts were the fastest growing product category in the most recent year, the government report, which was noted earlier by ICBC, said.

“The market share of inhaled extracts continued to increase in 2024/2025, up to almost one-third of total sales (31.1%),” it said. “Solid cannabis edibles (-2.2%) was the lone cannabis category with a sales decline in 2024/2025.”

Overall, cannabis sales during the fiscal year were equivalent to C$167 per person of legal age to consume marijuana.

A separate recent study funded by the Canadian government found that alcohol and tobacco cause far more harms to people who consume them, and to society overall, than marijuana does.

The findings about relative harms of different substances may help explain why alcohol consumption has been gradually declining over recent years, and why multiple surveys and studies have indicated that more adults are opting for marijuana.

For example, recent polling shows that younger Americans are increasingly using cannabis-infused beverages as a substitute for alcohol—with one in three millennials and Gen Z workers choosing THC drinks over booze for after-work activities like happy hours.

Another survey released last October found that a majority of Americans believe marijuana represents a “healthier option” than alcohol. And most also expect cannabis to be legal in all 50 states within the next five years.

Smoking marijuana is also associated with “significantly” reduced rates of alcohol consumption, according to a recent federally funded study that involved adults smoking joints in a makeshift bar.

A study published in 2024 that looked at adults who drink cannabis-infused beverages found more evidence of a “substitution effect,” with a significant majority of participants reporting reduced alcohol use after incorporating cannabinoid drinks into their routines.

Meanwhile, as the Trump administration considers moving marijuana out of Schedule I, the most restrictive category under U.S. federal law, another recent study concluded that cannabis isn’t as dangerous as its current classification would suggest.

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In a special edition of the Business of Cannabis Podcast, we go from ‘anecdote to evidence’ with Dr Anne Katrin Schlag, Head of Research and Interim CEO at Drug Science, and Graham Woodward, Chief Operating Officer at Releaf.

Together, they explore how the UK can move from anecdotal patient stories to robust, real-world evidence, and why this shift is vital for expanding safe, trusted access to cannabis-based medicines.

One of the key challenges in cannabis-based medicine is how to transition from impactful but anecdotal patient stories, to robust evidence that policymakers, clinicians, and regulators recognise and trust. 

In her role with Drug Science, Anne has played a key role in building the evidence base for medical cannabis, turning lived experience into real-world data, and helping ensure patients’ voices are heard where it matters the most. 

Drug Science’s T21 patient registry (formerly known as Project Twenty21) was the UK’s first observational medical cannabis registry, with around 5,000 patients enrolled over the last five years. Anne and colleagues have now published numerous publications demonstrating the real-world evidence for the safety and efficacy of medical cannabis in a range of conditions, as well as other outcomes such as reductions in the use of opioid medications.

In this conversation, Graham and Anne unpack how clinics like Releaf are investing in quality-of-life surveys and data-driven patient care.

They discuss the importance of using validated and standardised screening tools across clinics in adding to the clinical credibility of this evidence and whether more solid evidence can finally open doors with regulators and the wider healthcare system.

“I’d like to see different providers collect the same data, this would give us a huge database which, for us as researchers, is very exciting,” Anne says. 

The conversation also explores the barriers patients continue to face in accessing medical cannabis, such as cost and a lack of education and awareness among prescribers and the general public, as well as what can be done to address this.  

Graham and Anne discuss how engagement with policy makers and key decision-makers is key to making these medicines more widely available on the NHS, while highlighting the value in combining scientific evidence with patient stories to drive wider acceptance among the general public. 

“In addition to the science, patient stories carry a lot of power to change the narrative,” says Anne.

While RCTs are important, they are not the full picture. Regulators need to recognise patient-reported outcomes and real-world data for medical cannabis as not just anecdotal but scientific evidence that could shape the future of medicine. 

She adds: “If we would have waited for randomised control trials before introducing [penicillin], millions of people would have died.” 

For anyone interested in how data and patient outcomes can unlock the next stage of UK medical cannabis, this is a conversation not to miss. Listen to the full interview here 

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