Wastewater Doesn't Lie: Are Australia's Smoking Rates Accurate?

2 June 2025

by Pippa Starr

There's something in the water that we need to have a national conversation about!

A quiet walk and a little bit of observation in any busy area around Australia will soon bring you to the realisation that smoking isn't going away any more than it was 10 years ago.

The prominent stench from the woft of cheap black market smokes scent the air as many others cup their vapes in their hands while taking sneaky puffs around every second corner.

Yet if you believe what some are saying in regards to smoking being on the decline, the picture we see on our walks should be about smelling the roses and all the beautiful scents that we should experience on a sunny day here in Australia, but the reality just doesn't seem to match that narrative.

Why are there more dubious-looking tobacconists/vape shops popping up in our suburbs than ever seen before in history?

Why are their prices cheaper than ever seen before this century?

If there isn't a demand for all these nicotine products, then why do they exist?

I reflected on these questions while staring into a pond in the Brisbane City Gardens, only to see this beauty disrupted by seeing the local birdlife plucking away at the soaked used cigarette butts at the waters edge. Maybe there's something there, in the water!

So, I tried to make some sense of all this and investigate what the real smoking rates might be.

Heres what I have learned:

Australia's public health narrative celebrates a significant decline in smoking rates, with the Australian Institute of Health and Welfare (AIHW) reporting a drop in daily smoking among individuals aged 14 and over from 12.2% in 2016 to 8.3% in 2022–2023 .

However, data from the National Wastewater Drug Monitoring Program (NWDMP) presents a contrasting picture, indicating an increase in nicotine consumption over the same period. This discrepancy raises questions about the accuracy of smoking data and the need for a more comprehensive understanding of nicotine use in Australia.

Contradictory Trends: Survey Data vs. Wastewater Analysis

The AIHW's National Drug Strategy Household Survey (NDSHS) relies on data from a sample representing less than 0.1% of the population, which may introduce biases such as underreporting due to social desirability or recall inaccuracies. In contrast, the NWDMP (National Wastewater Drug Monitoring Program) analyzes wastewater samples covering approximately 56% of the population, providing an objective measure of community-wide substance use.

Report 23 of the NWDMP highlights that,

"Over the life of the Program, average consumption of nicotine has increased in the capital cities and regional areas."

This finding suggests that, despite reported declines in smoking prevalence, overall nicotine consumption is on the rise!

The Role of Vaping in Nicotine Consumption

One possible explanation for the increase in nicotine detected in wastewater is the rise in products that are much safer than smoking like vaping. The AIHW reports that the use of electronic cigarettes and vapes nearly tripled between 2019 (2.5%) and 2022–2023 (7.0%) . However, it's important to note that vapes are typically sealed devices, and their contribution to nicotine levels in wastewater is likely minimal compared to traditional cigarettes.

Even if we generously attribute 10% of the nicotine detected in wastewater to vaping and other smoke-free nicotine-containing products, the remaining 90% would still be from combustible tobacco products. This suggests that smoking rates may not have declined as significantly as other surveys like the AIHW's National Drug Strategy Household Survey indicate.

Implications for Public Health Policy

The discrepancy between AIHW-reported smoking rates and objective wastewater data implies that current public health strategies may be based on incomplete information.

If actual smoking prevalence is higher than reported, this could impact the allocation of resources for smoking cessation programs and the evaluation of tobacco control policies.

To obtain a more accurate picture of smoking rates, it's essential to integrate multiple data sources, including:

• Wastewater analysis: Provides objective, population-level data on nicotine consumption.

• Sales data: Offers insights into the volume of tobacco products sold.

• Healthcare utilization: Tracks smoking-related illnesses and hospital admissions.

• Biomarker studies: Measures nicotine exposure through biological samples.

By triangulating these data sources, policymakers can develop more effective strategies to reduce smoking rates.

The increasing nicotine levels detected in wastewater challenge the narrative of declining smoking rates in Australia. While some surveys suggest progress in tobacco control, objective measures indicate that nicotine consumption remains a significant public health concern and could mean that there has been a lack of real-world progress. To ensure accurate assessments and effective interventions, it's crucial to consider a broader range of data sources beyond surveys that only measure less than 0.01% of the population.

After all, wastewater doesn't lie, and nor does the real world picture we are all seeing!