The Northern Territory's health department, which has a smoke-free policy, purchased hundreds of packets of cigarettes for smokers isolating at the Howard Springs quarantine centre, emails obtained by the ABC reveal.
The Howard Springs facility, also known as the Centre for National Resilience (CNR), served as Australia's leading quarantine complex during the height of the COVID-19 pandemic.
Operated largely by NT Health, the centre housed more than 63,800 people, including about 41,800 domestic residents, as well as 22,000 Australians repatriated from overseas, between July 2020 and June 2022.
While most people residing at the facility were able to purchase their own cigarettes using click and collect services, internal departmental emails show NT Health supplied cigarettes to some smokers between November last year and at least February this year.
That was despite NT Health having a smoke-free policy aimed at "reducing tobacco related harm in the workforce and to our clientele", which bans staff, contractors and visitors from smoking at NT hospitals or health centres.
Emails reveal high demand for tobacco
In one email, the centre's operations manager told staff the facility had "received another 300 packs of cigarettes", including 150 packets of 20 cigarettes and 150 "rollies".
"As per our previous experience with our humanitarian flights, residents will continually request cigarettes and expect them daily," the manager wrote on November 23, 2021.
Demand for cigarettes was so high the facility was "unable to keep up" and a register had been created to manage distribution, the email said.
In the email, the manager said smokers could receive a packet of 20 cigarettes every second day of their stay in quarantine, or a pack of rollies every third day.
In a separate email in January, a staff member from the pandemic coordination cell said the department had "purchased some more cigarettes on the weekend as we were almost out".
"We have started informing residents that they can have three, but then need to source their own," the staff member wrote.
"Some residents have started doing this and we will continue to encourage their own purchase".
In another email in February, the director of quarantine programs wrote: "Tobacco will be issued to approved residents [age appropriate] on arrival to CNR ... and then on day three and day six automatically."
In Australia, a packet of 20 cigarettes costs between $35 and $45 on average, and a 25-gram pouch of tobacco costs about $55.
However, the emails do not disclose how much money NT Health spent on the cigarettes, or whether residents were required to reimburse the department.
Managing nicotine addiction in quarantine
In a statement, a spokesperson for NT Health said "under special circumstances" cigarettes were provided to some residents, "including those on humanitarian flights from Afghanistan, who were unable to access them via click-and-collect".
The spokesperson said most smokers staying at Howard Springs quarantine centre were able to purchase their own cigarettes online.
"Residents could also access smoking cessation aids including nicotine patches or gum," the spokesperson said.
"Residents were not permitted to smoke in their rooms, however could smoke in designated areas and in line with infection prevention requirements."
Robert Parker, president of the NT's Australian Medical Association (AMA), said although he recognised the "terrible" damage caused by smoking in the NT, in this case he supported the decision by NT Health to supply residents with tobacco.
"When people are contained against their will for reasons they probably don't understand that well ... and with restrictions to tobacco, which would make them more agitated, it makes it very difficult for the staff trying to look after them," he said.
Dr Parker said it was "quite sensible" for the department to try to calm down residents suffering nicotine withdrawal, "particularly people with low health literacy .. to make sure things didn't get out of hand".
"The AMA, in this case, would accept that NT Health had a right to do that," he said.
'It was a fairly difficult time'
The Northern Territory has the highest smoking rate in Australia, according to reports from the NT government, with lung cancer the most common form of cancer death.
Professor David Thomas, head of the tobacco control research program at the Menzies School of Health Research, said most addicted smokers regretted having started in the first place.
"The tobacco industry uses the addictive nature of nicotine to keep people buying it's product, which continues to kill eight million people worldwide every year," he said.
Reflecting on the decision by NT Health to provide cigarettes to some quarantine residents, Professor Thomas said "it was a fairly difficult time".
"Everyone was trying to do things very quickly and make decisions quickly," he said.
"What people didn't want to do was harm or discriminate against people who were doing the right thing by going to Howard Springs."
Given residents stayed in their own separate cabins with a verandah, Professor Thomas said the risk of inhaling second-hand smoke at the facility "would've been fairly negligible".
