A survey of drug users in New Zealand has found that more people are using nicotine vapes, even if they have never smoked.
Massey University's New Zealand Drug Trends Survey also found that doctors were more willing to prescribe medicinal cannabis, but many patients were still too nervous to ask for it.
The survey is conducted every two to three years by the university's SHORE and Whāriki Research Centre to keep track of Aotearoa's ever-changing drug landscape.
More non-smokers were using nicotine vapes with senior researcher Dr Marta Rychert saying they had become extremely common.
"Sixty-nine percent of people who responded use vapes, compared to 55 percent in 2020," she said.
"Of those, around 90 percent were nicotine vapers. It's overwhelmingly nicotine."
Even though nicotine e-liquids were designed to help smokers quit, Rychert said one in five vapers had never touched a cigarette.
"That's a worrying number because it's not what nicotine vapes are all about," she said.
Rychert said the survey was targeting adults, but she expected it to be even more common among younger people.
"We've had the proliferation of stores and marketing on social media, it's been normalised."
Compared to vapers who used non-nicotine or cannabis liquids, those who used nicotine liquids vaped far more often.
"We found nicotine vapers were predominantly daily users, they use their vapes daily or a few times a day. It speaks to the addictiveness.
"For non-nicotine vapers it was much more occasional, maybe at a party, and cannabis vapers were also less frequent."
That meant nicotine vapers were more exposed to the health risks associated with vaping, she said.
"Vaping anything is bad, a pulmonologist would tell you breathing anything other than fresh air is not the best idea for your lungs."
Medicinal cannabis users opt for grey, rather than green
Most medicinal cannabis users are too nervous to ask for a prescription.
Rychert said doctors and patients were still coming to grips with the government's medicinal cannabis scheme, with many users still choosing to source their cannabis illegally.
"There is positive movement on the implementation of the scheme," she said.
"Users are more willing to ask their doctors for a prescription [than three years ago], and more of those requests are successful."
But a vast majority of people who used cannabis for pain relief, mental health issues or other medical reasons accessed it through the grey market, Rychert said.
"Roughly one in 10 medicinal cannabis users had a prescription, which is an improvement [over just one in 50 in 2020]."
The rest used "different sources," such as sharing with friends, buying from dealers, or growing their own.
"One of the leading reasons was that they didn't think their doctor would prescribe it, or they were scared to ask," she said.
"There's still a stigma around talking about cannabis."
She said acquiring cannabis illegally had several risks that could be avoided by getting a prescription.
"You don't actually know what you're getting when you get cannabis from the grey market," she said.
"They haven't been through all the testing and procedures the legal products have been."
Rychert said doctors appeared to be more open to the idea of prescribing medicinal cannabis than they were when the scheme first started in 2020.
"When we did this survey a couple of years ago we saw that roughly one in three requests were successful, but now it's actually two in three," she said.
She said the opening of private cannabis clinics around the country had also made it easier to access legally.