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24 September 2020

RACGP welcomes TGA stance on e-cigarettes

The Royal Australian College of General Practitioners (RACGP) has welcomed the Therapeutic Goods Administration’s (TGA) interim decision clarifying the regulation of e-cigarettes containing nicotine and nicotine fluids for vaping.

If made final, the interim decision would mean that these products could only be supplied via a doctor's prescription.

A doctor will provide such a prescription to assist with smoking cessation where other measures, such as nicotine replacement therapy, have failed. Individuals will no longer be able to import these products for their own personal use from overseas.

The RACGP’s Supporting smoking cessation: A guide for health professionals conditional recommendation 15 states that nicotine-containing e-cigarettes are not first-line treatments for smoking cessation but may be a reasonable intervention for smokers who have tried to quit and raised e-cigarette usage with their healthcare practitioner.

RACGP Acting President Associate Professor Ayman Shenouda welcomed the TGA’s decision.

“This is a sound decision from the TGA because we need to be very cautious when it comes e-cigarettes or ‘vaping’,” Associate Professor Shenouda said.

“Some pro-vaping organisations claim that these products cause less harm and constitute an effective harm reduction approach.

“However, we simply do not know the long-term health effects of using e-cigarettes. The question of whether they are an effective smoking cessation tool has also divided public health experts.

“This is not a smoking cessation aid that should be embraced by all smokers in the community. We view it as a last resort prescription for people who have tried and tried to quit smoking but nevertheless failed.

“So if a person goes to their GP and they have already tried smoking cessation options with a strong evidence base such as nicotine replacement therapy and not succeeded than e-cigarettes are an option. However, these products should not simply be handed out to all smokers.”

The RACGP Acting President urged all people who smoke to talk to their GP about strategies to quit.

“Quitting smoking is not easy but with the right kind of support from your GP you can get there,” Associate Professor Shenouda said.

“Please book a consultation with your GP and explore the many, evidence-based pharmacotherapy treatments available. This includes nicotine replacement therapy in the form of a patch, spray, gum or lozenge.

“Your GP may also prescribe drugs such as varenicline, which blocks the pleasure and reward response to smoking, as well as bupropion hydrochloride, which reduces the urge to smoke.”

Associate Professor Shenouda said that e-cigarette use must be guided by a strong evidence base.

“There are some very determined pro-vaping enthusiasts in Australia. It is a free country and they are entitled to their point of view; however, it is disappointing that the RACGP’s stance has been misrepresented in the past.

“We are not in ‘in support’ of vaping; our smoking cessation guidelines state that e-cigarettes are a reasonable intervention in limited circumstances and that the long-term health effects are unknown – we must be guided by the evidence.”

The RACGP was selected as one of the recipients of the 2020 World No Tobacco Day awards for the College’s valuable work on tobacco control including the release of new Smoking Cessation Guidelines 2020.

The organisation also put forward a submission to the TGA opposing the approval of “heat not burn” tobacco products in Australia as part of the RACGP’s high profile stance against Big Tobacco. The TGA has since made an interim decision retaining the ban on these products.

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