Nicotine e-cigarettes and nicotine vaping products are set to become available on prescription across Australia from 1 October this year. This decision announced by the Therapeutic Goods Administration (the TGA), will legalise another alternative to support people quitting tobacco, and is also hoped to reduce illicit recreational use of such products.
Currently nicotine e-cigarettes and liquid nicotine are illegal in Australia, although people have managed to access them online or through some tobacconists.
There has been concern about the rise in recreational use of vapourised nicotine by children and adolescents, which can be a pathway to develop nicotine dependence.
The US National Youth Tobacco Survey data found a dramatic increase in current e-cigarette use among high school students: 1.5% in 2011 to 20.8% in 2018.
An association has been observed in young people between e-cigarette use and future experimentation with smoking.
Tobacco smoking remains the biggest single avoidable risk factor for ill-health. It is a leading cause of many types of cancer, cardiovascular disease, and chronic lung disease.
Under the new legislation people will be able to purchase nicotine solutions or salts from Australian pharmacies upon prescription by their doctor or nurse practitioner.
Whilst Nicotine vaping products are to be classified as “Non- Approved Substances” by TGA, legalisation will enable the introduction of Quality & Safety standards pertaining to products and packaging, as well as encouraging quitters to engage with their GP’s for support and to monitor users progress.
The Royal Australian and New Zealand College of Psychiatrists have supported the legalisation and regulation of nicotine-containing e-cigarettes and other vaporised nicotine products to facilitate their use as harm reduction tools, in recognition of the disproportionately high smoking prevalence and low quit rates among people living with mental health illnesses.
The Royal Australian College of General Practitioners (RACGP) has published guidelines which stipulate that whilst nicotine containing e-cigarettes are not first line treatment for smoking cessation, for people who have tried to achieve smoking cessation with approved pharmacotherapies but failed, and who are still motivated to quit smoking and have discussed e-cigarette use with their healthcare practitioner, nicotine containing e-cigarettes may be a reasonable intervention to recommend.
Concerns about e-cigarettes include lack of evidence for long-term safety, continued concurrent use with smoking (i.e. dual use), and potential to promote nicotine use and renormalise smoking among non-smokers, especially young people.
From 1 October 2021, the law for consumers to import nicotine e-cigarettes and liquid nicotine will align with the law for them to buy such products domestically.
There will be three alternative pathways for prescribing and purchase, which may place an additional administrative burden on GPs.
- The first pathway requires individual GPs to register to become “Authorised Prescribers”.
- A second alternative will be for GPs to submit a Special Access Scheme [SAS] application for each patient treated.
- Under the third pathway any GP may write a script for a single patient to personally import a limited quantity [up to 3 month’s supply of vaping products for their own use.
Evidence is still emerging as to any benefit from vaping nicotine, over existing delivery methods of NRT such as patches, gums or sprays, and if so for which particular patients. Whilst RACGP doesn’t recommend nicotine vaping as first line treatment, it supports the new changes which will facilitate yet another choice of delivery method to accommodate individual needs.
This measure is designed to prevent the use of such products by non-smokers, particularly youth and young adults. It will provide an opportunity for current smokers to receive appropriate advice from their healthcare practitioner on the use of, and risks associated with, these products.
Nicotine replacement therapies (including sprays, patches, lozenges and chews) that do not require a prescription will continue to be available from pharmacies and some retail outlets.
*This article was written by Dr Nic Brayshaw (WVPHN Clinical Lead Prevention)