Anxiety over nicotine change

Image courtesy Sarah Johnson:

Experts have welcomed the move to prohibit imports of e-cigarette products containing nicotine without a script, but others have concerns

The Therapeutic Goods Administration advised last week that the Federal Government plans to prohibit the importation of e-cigarettes containing vaporiser nicotine (nicotine in solution or in salt or base form) and nicotine-containing refills unless on prescription from a doctor, from 1 July 2020.

“The sale of e-cigarettes containing vaporiser nicotine (nicotine in a solution or in salt or base form) is already prohibited by law by each state and territory, because of public health concerns,” the TGA says.

“This measure further strengthens Australia’s precautionary approach to e-cigarettes, by prohibiting the importation of nicotine for use in e-cigarettes unless exempt under specific circumstances.”

A key reason the TGA cites is preventing the uptake of vaping by young non-smokers.

The Royal Australasian College of Physicians welcomed the decision, saying that “Vaping should only be prescribed as a last resort for patients seeking to quit smoking where other methods have failed”.

“For those seeking to quit smoking, the RACP advocates for the TGA approved smoking cessation products, including pharmacotherapies and counselling, ahead of vaping,” it said in a statement.

“The RACP supports the precautionary approach taken by the TGA.”

Associate Professor Alexander Larcombe, Head of Respiratory Environmental Health at Telethon Kids Institute, said that the move is a “positive step towards regulating a harmful drug of addiction, although it is important that the ban is actually enforced”.

“If enforced properly, this ban will be highly beneficial in preventing adolescents and other vulnerable populations from buying nicotine-containing e-liquids, and hence stop them becoming addicted to e-cigarettes.

“Users of nicotine-containing e-cigarettes will still be able to approach their GP for a prescription to import liquid nicotine.

“This means that current e-cigarette users who have used them to assist in quitting tobacco should not be disadvantaged, nor should they have to return to smoking tobacco.

“With a range of studies, including one published by Telethon Kids Institute researchers, showing that e-liquids often contain potentially dangerous chemicals, in addition to illegal nicotine, this ban should have significant benefits for public health in Australia.”

Associate Professor Gillian Gould, an NHMRC and CINSW Translating Research into Practice Fellow from the School of Medicine and Public Health at the University of Newcastle, said that “Nicotine containing liquid has already been restricted for e-cigarette use in Australia and available only if prescribed by a doctor, so this is not a new change”.

“The dose and availability of nicotine used via e-cigarettes is highly variable and unregulated.

“Those who switch to e-cigarettes are more likely to continue their use of nicotine long term than those using nicotine replacement therapy.

“Using nicotine replacement therapy is safe, effective and well researched, but tends to be under-utilised by most smokers as a quit strategy.

“Improving access to higher doses of conventional nicotine replacement therapy through subsidised use of combined patches and oral forms is warranted. NRT is more effective when used with supportive counselling from the GP and/or the Quitline.”

However, there are some dissenting voices.

Associate Professor Coral Gartner from the School of Public Health at the University of Queensland said that there is evidence from clinical trials and observational studies that nicotine vaping can help smokers quit smoking.

“Australia already has some of the world’s most restrictive laws for use of nicotine vaping products. The ban on personal importation will make it even more difficult for smokers to access this option,” she said.
“The government appears to be keeping some access options open, but it is unclear how these will operate in practice and how difficult it will be for doctors and pharmacists to obtain authorisation to import and supply nicotine vaping liquid on prescription to people who smoke.
“Regular tobacco cigarettes represent the greater threat to public health, and should be the focus of greater regulation. When compared to this extreme regulation of vaping products, it is quite astounding that tobacco cigarettes, which are much more harmful than vaping, are still able to be sold from convenience stores and supermarkets.”

And Professor Amanda Baker, a NHMRC Senior Research Fellow and Clinical Psychologist at the University of Newcastle, said that limiting e-cigarettes to prescription only whilst allowing the widespread sale of cigarettes is not good public health policy.

“E-cigarettes should be easier to access, especially for heavy smokers, many of whom have tried many times to quit,” she said.

“Not all smokers find NRT effective. A range of NRT options should be available to people.

“I am afraid not all GPs will be confident to prescribe and pharmacists to dispense nicotine liquid in a short time frame.

“This action will cause a lot of anxiety among people trying to quit smoking with e-cigarettes.”

When the AJP reported the TGA’s decision last week, a number of readers expressed concern, including that the ban would drive people back towards smoking cigarettes.

Pharmacist Jarrod McMaugh noted in comments that the change prohibiting users from importing nicotine for use in e-cigarettes without a valid import permit is “unusual”.

“There has always been a specific allowance for people to important medicines for personal use with a prescription unless it is a banned item or a narcotic,” he wrote.

“This will require a company to sponsor a product for use in Australia—not an easy matter to organise.”

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  1. Andrew

    A strategic miss. This could have been anticipated and a genuine public health measure by pharmacy implemented.

    Had the will or foresight existed a scheduled and registered nicotine vaping device could have been developed and delivered exclusively through pharmacies, making the pharmacist the primary contact in smoking cessation. The writing was on the wall since tobacco tax increases came about in the late 00’s.

    I wish there was a pharmacy organisation with the public health and policy nous to anticipate and respond to the obvious public need for such a service. Instead we’ve got poorly evidence based professional services that increase the already massive paperwork burden for an undefined public benefit and not much revenue.

    • Jarrod McMaugh

      Andrew, if it were so easily anticipated, how come you aren’t the one coming to market with an innovative startup to fill the void?

      Your assertion that pharmacy organisations would be in a position to predict/act upon public health policy in that manner, and the expectation that they are in a position to act as a sponsor for a therapeutic device, reveals that you don’t actually know what peak bodies etc actually do.

      Plenty of complaints, but you don’t provide any solutions….

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