What the experts say…on pharmacy vapes

Vapes will only be sold over the counter in pharmacies after the government agreed to amend its vaping legislation to secure the support of the Greens. Under the new changes, vapes will not be a prescription-only medication and will instead be regulated as a schedule-three pharmacist-only medication, and be subject to plain packaging rules. What do the experts say?

Professor Brian Oliver leads the Respiratory Molecular Pathogenesis Group at the University of Technology Sydney and the Woolcock Institute and says “Our own research has shown how dangerous vaping is, these are not innocuous curiosities – these are very well designed nicotine delivery devices, designed to get as many people addicted to nicotine as possible.

I can only view these proposed changes as an illogical step backwards. The lack of a prescription now puts the responsibility on a pharmacist to decide who should be able to be dispensed a vape. Do pharmacists want this responsibility? Are they equiped to deal with the backlash when they say no? Who pays for the pharmacist’s time? E-cigarettes were a cheap alternative to smoking, and this accelerated their use.

We know that people make choices based on cost, for example Australia had one of the lowest cigarette smoking rates in the world, in part due to the high cost of a packet of cigarettes. If the cost of e-cigarettes at a pharmacist is substantially higher than the black market, the black market will always have customers. If people can now use a disposable vape with any fear of breaking laws, how will the more expensive pharmacy delivered non-disposable vape be the preferred choice?

The argument made was that a visit to a GP, who may or may not bulk bill, was cost prohibitive, but someone will have to now cover the cost of the pharmacist’s time. Of course this might prove to be a lucrative niche area – will tobacconists..ahem.. tobacco-pharmacists be the new norm? I’m sure if I can see the gap in the market someone else has already thought of the idea: vape only pharmacies.

There are so many questions. Without a record of the number of times a person has collected their vape we will have no idea if a person is using these as a quit aid, or as a source of nicotine. What is to stop someone buying from several pharmacies and on selling? Why stop at e-cigarettes, perhaps pharmacists should “dispense” cigarettes too? ”

Dr Joshua Trigg, from the Flinders Health and Medical Research Institute at Flinders University is a behavioural scientist researching tobacco, nicotine vaping, nicotine use and health risk behaviours.

He argues that “This new level of restriction of the sale of nicotine vaping products in the community will benefit the health of many Australians, whilst maintaining access to adults for the purpose of tobacco smoking cessation. Directing access via pharmacies will provide a point of contact for people seeking pharmacotherapeutic support for their tobacco smoking cessation.

The removal of prescription requirement for adults via this route will alleviate some perceived barriers from the current approach. However, we will need to closely monitor how this affects youth access of these devices, as clear public health concern for younger Australians and those highly susceptible to the addictive nature of nicotine vaping.”

Associate Professor Emily Stockings is an NHMRC Fellow and Program Lead of ‘Smoking, Vaping and Mental Health’ at The Matilda Centre for Research in Mental Health and Substance Use at The University of Sydney.

She warns that “The vaping ‘epidemic’ among young people has been driven by the ease of access to these products and their sheer abundance on the market. The new vaping reform bill passed in parliament today is, unfortunately, unlikely to stem this supply: adults will be able to buy vapes through pharmacies without a GP prescription, which essentially opens a door for continued supply to young people.

Even if young people can only access via prescription (when clinically appropriate), we already know that young people access vapes via older siblings or friends who on-sell them via social media platforms such as snapchat. This new regulation will essentially allow the illicit supply of vapes to young people to continue.

Striking the balance between prevention of youth uptake and reduction of smoking harms via vaping is challenging. We do appreciate that for an important minority of smokers -many of whom already experience significant health, social and financial disadvantage – access to vapes via pharmacies without the additional financial and logistical burden of a GP visit is a win. However, when accessing smoking cessation treatment, discussion with a trained health professional and provision of brief advice is the gold standard, and it remains to be seen if this is going to be feasible in busy community pharmacies.”

Dr Colin Mendelsohn, a retired academic, researcher, and smoking cessation clinician, says “This is good news for smokers, vapers and public health.

This decision is an improvement over the failed prescription model but is a temporary political solution and is unlikely to be sustainable in the long term. It is likely to be rejected by most vapers due to the limited availability of flavours (tobacco, mint, and menthol), higher costs, and the small selection of supplies in most pharmacies.

As a result, the black market, which currently supplies 90% of Australia’s vaping products will continue to thrive and will continue to provide unregulated products to vapers of all ages, including teenagers.

Furthermore, the capacity of pharmacists to effectively service the vape market is questionable. Pharmacists have shown little interest in vaping and remain poorly informed about vaping products.

The preferred model is for vapes to be sold by licensed retail outlets with strict age verification, like tobacco and alcohol. This model is implemented in most other Western countries and is supported by the majority of Australian voters.”

Associate Professor Gary Chung Kai Cha is from the National Centre for Youth Substance Use Research at the University of Queensland

“This will achieve a better balance between two competing goals – improving access to smokers who want to quit using vape, and reducing access to non-smoking youth. From the past few years, we know that the prescription model did not work as intended because it increases the barrier for smokers, but at the same time did not seem to reduce youth access. The next step will be for the government to also restrict access to combustible cigarettes, which is the real killer in our country. It still does not make sense that combustible cigarettes are widely available while access to vapes, a much less harmful product, is more restricted.”

Professor Dr Muhammad Aziz Rahman, the Discipline Leader of Public Health and Research Adviser in the Institute of Health and Wellbeing at Federation University Australia, warns that “Allowing people to buy e-cigarettes without prescription from the pharmacies will downplay the continued efforts by tobacco control advocates in recent years. Restricting to the adults-only will not justify the importance of tackling this new tobacco product. Lifting the restriction will pose risks of making e-cigarettes available to non-smokers, who could be the first-time users of tobacco, then shifting to traditional cigarette smoking.

E-cigarettes are deemed to be an effective smoking cessation aid which is also promoted by the tobacco industry, whereas scientific evidence has not provided any evidence so far that smokers were able to quit successfully. Rather they became dual users of smoking and e-cigarettes users. Therefore, having the prescription will regulate the use, so that GPs can make the clinical decision of prescribing e-cigarettes when smokers have tried all other proven NRTs. Such a political decision by the Government will facilitate tobacco industries to be active again and undermine the success of tobacco control in Australia.”

Professor Simone Pettigrew, a Research Professor at the George Institute for Global Health, believes “This is a missed opportunity to maximise the impact of e-cigarette bans to reduce youth vaping. The watered-down policy will still be important to reduce underage access to e-cigarettes, and the Albanese Government is to be congratulated on taking long overdue action on this issue.

However, the change forced by the Greens will weaken the laws, pushing the problem down the line when further action will be needed to address high rates of nicotine addiction among young adults. Nicotine is a highly addictive substance and vapes enable the delivery of large amounts of nicotine. Making such products available without prescription is likely to result in ongoing vaping problems in Australia for the foreseeable future. Australia is a world leader in tobacco control, but is missing the opportunity to be a world leader in vaping control. Our young people will be the ones to suffer the consequences.”

Professor Coral Gartner of the School of Public Health at The University of Queensland says “Minister Butler should be applauded for finding a workable solution that ensures health practitioner oversight of vaping product supply while reducing a key barrier for people who smoke from accessing products that can help them quit smoking.

Pharmacists were at the frontline of the Covid response by delivering vaccines in a way that maintained patient safety while reducing the burden on GPs. Pharmacists are trusted healthcare professionals who will supply vaping products for smoking cessation purposes to adults who smoke, rather than selling to kids as has happened with general retailers supplying vaping products.

The Government should also provide resources to enable pharmacies to invest in delivery of comprehensive smoking cessation support to accompany this model for therapeutic vaping product supply.

This option should also encourage manufacturers to seek full medicines approval from the TGA for their vaping products to participate in supply without a prescription via pharmacists.”

Simon Chapman, an Emeritus Professor of Public Health at the University of Sydney, says “The huge good news is that the cheap, disposable, sickly-sweet flavoured and colourful vapes that magnetically attracted huge numbers of Australian kids will be outlawed, with anyone selling them subject to brutal, deterrent penalties. All promotions and advertising will also stay illegal. This is a weapons-grade advance.

But the hugely disappointing bad news is that the Greens have flushed the prescription-only access component of the reforms down the public health toilet. Stand by for armies of 18+ entrepreneurs hovering outside pharmacies and buying vapes for kids for a fee. If your child is vaping after these reforms, thank the Greens who feel they knew better than every significant health and medical body in the country. My heart goes out to visionary health minister Mark Butler, who must be bitterly disappointed.”

Jonine Jancey, a Professor of Health Promotion and Public Health at Curtin University, argues that “Mark Butler’s leadership in the vaping arena has been commendable and it’s so disappointing to see that, due to lack of support for vaping reform, his proposed legislation has now been watered down.

It seems nicotine vape products will be sold as a schedule 3 drug in a pharmacy. This means no longer will the doctor or nurse practitioner just prescribe the vape drug. Neither will they provide expert guidance regarding their use as a last-line smoking cessation device. Instead, they will be able to be bought by anyone over the counter.

Our elected members had a critical opportunity to make these a prescription-only vaping drug. This approach would have made these vaping drugs accessible to people who want to quit smoking while keeping them out of the hands of younger people.

It seems that an opportunity to prioritise community health has been lost!”

Associate Professor Michelle Jongenelis, the Deputy Director and Principal Research Fellow at the Melbourne Centre for Behaviour Change at The University of Melbourne, finds “It disappointing that the Vaping Reforms Bill developed by the Labor Government failed to receive support in its tabled form, especially given the Bill was backed by public health and supported by almost 80 health organisations and experts.

A silver lining is that the reforms regarding the retail sale of vapes remain untouched and that from July 1 it will be illegal for unscrupulous retailers to sell any vape or related product, regardless of nicotine content. These products are harmful, especially to those who have never smoked. We must control access to ensure they are kept out of the hands of children.”

Associate Professor Becky Freeman from the School of Public Health, Charles Perkins Centre at the University of Sydney is a tobacco control policy expert with over 20 years of experience in the field. She is Chief Investigator of the national Generation Vape study and provided evidence to the Australian Senate in support of the reforms to protect young people from vaping products.

She says “This world first legislation shows Australia has made decisive action in preventing vaping and protecting public health, especially for young people.

The amended and proposed legislation will end the general retail sale of both nicotine, and non-nicotine vapes, and close loopholes exploited by the vaping industry that made it easy for young people to access addictive and harmful vapes. Vape access will be tightly controlled and all vapes will only be available for sale behind the counter from pharmacies with valid ID.

While it is disappointing that the amended law will now allow vapes to be available as pharmacy-only medicines, instead of requiring users to have a prescription, this legislation remains a world-first approach in preventing easy access to vapes. Monitoring and enforcement will be crucial to ensuring the law prevents retailers from illegally selling vapes.

Our Generation Vape study found that 87% of young people found accessing vapes in Australia, EASY. This legislation means young people will no longer be able to readily purchase vaping products in the very same shops that sell sweets, ice cream, and soft drinks.

Restricting vape access is a public health priority. This law will mean that other vaping prevention efforts, like school-based education and media campaigns, are well supported and more likely to be effective.

It’s important to note that the new legislation will not be going after individual vape users, and a key component of the government’s initiative includes support for people who are addicted to smoking and vaping.”