The Royal Australian College of General Practitioners (RACGP) is urging GPs to be prepared for changes to vaping laws coming into effect on 1 October.
Under the changes nicotine vaping products, such as nicotine e-cigarettes, nicotine pods and liquid nicotine, will be available only by prescription as a smoking cessation tool. People will no longer be able to buy these products or import them from overseas websites without a valid prescription.
GPs can prescribe nicotine vaping products by becoming an Authorised Prescriber (only takes a few minutes and is free), through the Special Access Scheme or providing a prescription for three months’ supply via the Personal Importation Scheme.
The RACGP has produced evidence-based guidance for health professionals to support smoking cessation. The guidance covers the evidence on effectiveness of nicotine vaping products for supporting smoking cessation, their place in therapy and the practicalities of prescribing them. In the absence of an evidence base for how to prescribe these products for therapeutic use, practice points have been developed to minimise risk to prescribers and patients, including:
nicotine vaping products are currently not approved therapeutic products, and it is valid and reasonable for medical practitioners to opt not to prescribe them
if prescribing, use the Authorised Prescriber or Special Access Scheme prescribing pathways instead of the Personal Importation Scheme to minimise the risk of the patient receiving imported products that do not meet the TGO 110 requirements. These include requirements on labelling, child-resistant packaging, and the prohibition of other active ingredients beside nicotine
avoid prescribing free-base nicotine at concentrations over 20mg/mL and limit the quantity of nicotine vaping products per prescription to a maximum of three months’ supply (and align the duration of supply with the timing of follow-up)
avoid the use of flavours or limit these to just tobacco flavour since flavouring chemicals are not standardised and their safety for inhalation into the lung is not known
provide follow up as well as behavioural support
RACGP President Dr Karen Price encouraged all GPs to familiarise themselves with the changes.
“GPs have a lot on their plate right now but it’s important that they are aware of what these changes to vaping laws mean for them and their patients,” she said.
“Prescriptions for nicotine vaping products are not a first-line treatment for smoking cessation and should only be tried when other measures, such as nicotine replacement therapy with behavioural support, have failed.
“It will be the job of GPs in communities across Australia to apply discretion and judgment when considering the patient’s individual circumstances.
“Those who do have a prescription will be able to obtain nicotine vaping products by filling the prescription via a pharmacy.”
The RACGP President said that there were resources available to help bring GPs up to speed with the changes.
“Any GP keen to learn more about these changes can take part in a webinar organised by Quitline and accredited by the RACGP on 5 October, which includes clinical guidance for nicotine vaping products,” she said.
“The webinar will describe the process for prescribing nicotine vaping products and outline all the clinical considerations involved. I encourage all GPs to sign up and learn about these changes that are coming into effect.
“It’s important that GPs are wary of being pressured into prescribing these nicotine vaping products. The laws governing these products are in place for a reason - the long-term health effects of using e-cigarettes or 'vaping' are unknown and the evidence base for their efficacy as a smoking cessation tool remains uncertain.
“A prescription for these products should only be used as a last resort, vaping is not a risk-free, harmless version of smoking cigarettes. These are addictive and harmful products that can prove fatal if ingested in certain amounts.”
Dr Price also urged people seeking access to nicotine vaping products to be patient and respectful of GPs and practice staff.
“I understand that these changes will take some people by surprise. Please don’t take your frustrations out on GPs, practice managers, nurses, receptionists or administrative workers,” she said.
“They are not the ones who made these rules and GPs will only be able to prescribe these products as a last line treatment for smoking cessation.
“I encourage anyone who smokes or vapes to consult with their GP about quitting and explore the pharmacotherapy and behavioural treatments and supports available. This includes nicotine replacement therapy in the form of a patch, spray, gum or lozenge. There are also several effective drugs that are available such as varenicline, which blocks the pleasure and reward response to smoking, as well as bupropion hydrochloride, which reduces the urge to smoke.
“Many people see quitting as just too difficult but with the right approach, including the support and guidance of a GP and having strong strategies in place, it is possible. It could be the best health decision you ever make.”
Details about the webinar on 5 October and registration can be found here.
The RACGP was selected as one of the recipients of the 2020 World No Tobacco Day awards for our valuable work including the release of new Smoking Cessation Guidelines 2020. Note: The smoking cessation guideline’s conditional recommendation 15 concerning vaping can be found here on the RACGP website.