‘The end point… is nicotine freedom.’


Image courtesy Sarah Johnson: https://www.flickr.com/photos/157551927@N08/44614233182

Health officials have outlined how nicotine for vaping, if it was to become regulated by the TGA, would be a smoking cessation aid, not a consumer good – but retailers are still attacking the pharmacy model

Appearing before the Community Affairs Legislation Committee, Deputy Secretary of the Department for Health, Adjunct Professor John Skerritt was asked by Senator Hollie Hughes whether e-cigarettes and vaping products were harm reduction products.

“I think the evidence is that vaping is less harmful than tobacco smoking, but I don’t think the harm is trivial, and I don’t think it’s 95%, or any figure like that, less harmful,” Dr Skerritt said.

“In fact, there’s a significant body of evidence on harm due to vaping containing nicotine. Nicotine is a dangerous poison. It’s also highly addictive.

“But, say, for someone who has a mental illness—and that’s a group that is disproportionately high in their smoking rates—certainly many people who work with people with mental illness are transitioning them from combustible tobacco smoking to vaping.

“But the end point for most doctors is nicotine freedom—not smoking and not vaping.”

Senator Hughes asked how pharmacists would feel about selling nicotine liquids.

“Are pharmacists going to be prepared to work with people that are going through smoking cessation in managing their vape—in helping them with product management, as occurs now through people that own vaping stores?

“Are they going to be prepared to help people learn how to fill their vape—mix vaping juices?

“Are they going to be selling premixed nicotine into vape juices? Will they be selling nicotine in different flavoured juices? How is this going to work? Are pharmacists going to have to develop an entire new skill set for over half a million people who might take up this product?”

Dr Skerritt said in response that “there’s actually a dedicated budget put aside, if this goes ahead, for working together with the pharmacists and the doctors.

“We’ve already had a number of preliminary meetings with the Pharmacy Guild, the Pharmaceutical Society of Australia, the Royal Australasian College of Physicians, the Australian Medical Association and about six or seven other groups, but they’re preliminary meetings—although we’ve had some of them two or three times—because no final decision has been made.

“There are actually two lots of dedicated budget put aside for significant education and communication activities with doctors and pharmacists on all the things you listed.”

Currently only about 10 doctors currently prescribe nicotine in this manner in Australia, because of a “massive loophole” which Dr Skerritt said means that “I could go online today and have it delivered to my home here in Canberra and not go to a GP”.

When Senator Hughes pushed as to whether vaping was less harmful than combustible cigarettes, Dr Skerritt replied that, “That’s the balance of evidence, but I think there’s only one group that’s really regularly pushed this 95% figure.

“There are certainly a number of studies in humans indicating that nicotine vaping can be quite harmful, especially in adolescence.”

When asked whether nicotine for vaping could become a consumer good, Dr Skerritt replied that, “Any decision to change nicotine to a consumer good would require a change to legislation by this place, and it would also require similar thinking, and potentially similar legislative or regulatory changes, by every state and territory of the Commonwealth.

“So I can’t say that it will never happen. On the other hand, I believe that others, especially when I talk to public health and regulatory colleagues in places like Canada and the US, are somewhat envious about our approach, given the significant increases in youth vaping.

“The main concern is the increase to vaping in youths in Australia and similar and similar countries, such as the US and Canada.”

Following the Committee session, the National Retail Association, which represents retailers and fast food businesses, welcomed the comment about vaping’s harms compared to traditional cigarettes, but again slammed the pharmacy-only model.

“Under questioning from Senator Hollie Hughes, the Deputy Secretary of the Department for Health, Adjunct Professor John Skerritt, said ‘the evidence is in that vaping is less harmful than tobacco smoking’,” the NRA said in a statement.

As above, the Hansard transcript reports that Dr Skerritt said, “I think the evidence is that vaping is less harmful than tobacco smoking, but I don’t think the harm is trivial”.

NRA CEO Dominique Lamb said that on the basis of Dr Skerritt’s statement, it does not make sense to limit vaping products to pharmacies.

“[Small retailers] are really struggling to understand why the Health Minister and Health Department plan to hand a highly lucrative monopoly right to sell less harmful smoke-free vaping products to multi-billion dollar listed and privately owned pharmacy groups, but lock small businesses out from being part of the solution,” she said.

“It’s completely illogical that, whilst retailers across Australia are permitted to sell cigarettes – the most dangerous way for humans to consume nicotine – they are barred from retailing much less harmful smoke-free vaping and heated tobacco products.

“This makes even less sense now that one of the Minister’s own advisers has confirmed smoke-free tobacco products as being less harmful than cigarettes, which are available everywhere,” Ms Lamb said.

“This approach represents the worst of both worlds in terms of damaging small businesses and reducing the opportunity for smokers to transition away from cigarettes.”

Before the Committee, Secretary of the Department of Health, Dr Brendan Murphy noted that “I think it really is important that our focus is to use vaping as a smoking-cessation aid.

“There is a big industry push to make it as a consumer product for non-smokers to get them addicted, and the harm that is being done in Canada, New Zealand and the UK is very concerning.

“They are very worried about the uptake of vaping in non-smoking young people. We agree that it is, in some cases, a successful smoking-cessation product.

“This approach is to limit it to smoking cessation, not to have it widely available as a consumer product.”

He said that if combustible cigarettes were to be introduced today, “they would almost certainly not be a consumer product”.

“We are living with the reality of combustible cigarettes, but we don’t want to be in the position of others.

“The Canadians are terrified now about the huge uptake in vaping in their young people, and we’ve seen in the US some deaths associated with vaping. There is no question that many, many companies are keen to promote vaping not as a smoking-cessation product but as an alternative product to get young people addicted to it as a consumer product.

“The goal is to keep it as a smoking-cessation product.”

Before the Committee, Dr Skerritt noted that the consultation on final regulatory changes is still underway, closing on November 6, and a decision would not be made until at least mid-December, depending on how quickly the delegate reviews the submission.

He also outlined the three possible pathways for regulation of nicotine liquids for vaping.

“One is personal importation,” Dr Skerritt told the Committee. “It will be with a doctor’s prescription but there will be an element of ‘buyer beware’, and you could argue that’s exactly the situation people have now.

“The good news there is that many countries, like New Zealand and European countries such as the UK, have [a] range of quality standards…

“The second and third pathways are through a pharmacy, either a physical pharmacy or a pharmacy that ships to you, and pharmacy procurers tend to require a range of quality standards. We’ve been meeting with them about the possible quality standards they could enforce, such as the New Zealand, UK or European ones.

Due to the “buyer beware” element, “it may be that many prescribers will say, ‘Hey, get it from an Australian pharmacy’.

“That’s the same message we give for medicines writ large: you know what you get if you get the medicine from the Australian pharmacy.”

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3 Comments

  1. pagophilus
    05/11/2020

    It is interesting how with most other drugs harm minimisation is the principle, whereas with tobacco we aim to stop its use, and whereas with other drugs we’re mindful of not stigmatising users yet tobacco users are highly stigmatised and this is seen in health promotion materials and anti smoking campaigns. Perhaps we should expand the principles we apply to tobacco to other drugs. Maybe we will have more success.

    But I think the government got this one right. There is no benefit to smoking, and e-cigarettes lead to an increase in takeup of tobacco smoking compared to non-users, but may be beneficial as an aid to smoking cessation or reduction, especially if it is prescribed rather than available for purchase. (I’ve just reviewed systematic reviews on this topic in my postgraduate study.)

    • Jarrod McMaugh
      05/11/2020

      I agree with you Leo

      I still struggle with the availability of tobacco products being simpler than vaping even as a quit smoking product (let alone as a consumer product), but this is the same situation in all harm reduction; alcohol, opioids, and now nicotine…. it’s easier to access the substances causing harm than the treatment.

      The arguments put forward in by the people quoted in this article are pretty absurd too…. without trying to sound elitist, there is little that a person who owns a vaping shop can teach a person that a pharmacist cannot teach a person about their choice of vaping product…… so long as the pharmacist in question invests their time in learning the correct methods.

      It’s also strange that the NRA is claiming that pharmacies (small business) are going to have unfair advantage over small businesses….. especially when some of the businesses they represent include large chains who are not owned by the people in the store – it’s all very hypocritical.

  2. Anthony Zehetner
    11/11/2020

    Yes interesting with the frowns you receive when prescribing/dispensing nicotine replacement therapy (NRT) for adolescents and young adult smokers in hospital recovering from surgery and wanting to go outside for a cigarette due to withdrawal. Surely NRT is preferable? We don’t usually withhold analgesia from a person with a history of opioid abuse when they are in hospital and have pain.

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