DoHAC predicts early peak for vape prescriptions

The number of patients visiting GPs for vaping prescriptions is expected to be highest in the first 12 months following major reform then decline year on year, according to documents published by the Federal Government Office of Impact Analysis (OIA) this week.
 
The assessment, carried out by the Department of Health and Aged Care (DoHAC), predicts around 450,000 patients will seek vaping prescriptions from GPs an average of twice every 12 months in 2024–25, after the introduction of legislation designed to restrict the availability of vapes.
 
Working off an estimated 1.3 million adult vape users, it calculates that 20% use non-nicotine vapes and around 520,000 are casual users who will not seek a prescription. Of the rest, DoHAC officials concluded 70,000 people have an existing script they will continue to use, leaving around 450,000 likely to seek prescriptions as the Government’s crackdown on illegal vape use takes effect.
 
While the analysis says it ‘conservatively assumed’ no year-on-year reduction in the rate of prescriptions to avoid underestimating costs, its authors predict a drop.
 
‘It is expected, in line with policy intent, that the population of vape users will decrease following implementation of the proposed regulatory changes, due in part to incidences of successful smoking cessation attempts and increased consumer awareness of the health risks of vaping,’ they wrote.
 
They estimate a 10% reduction in vape prescriptions sought each year, with the number projected to dwindle to 348,678 by 2034–35.
 
Regulatory costs for the reforms are assessed at around $59.46 million per year, which does not include the costs of vaping store closures.
 
DoHAC’s work setting out the evidence in their impact analysis was found to be ‘good practice’ by the OIA, the Federal Government organisation which states its aim as ensuring ‘policy and decisions are supported by the best possible evidence and analysis’.
 
‘In particular, the [DoHAC Impact Assessment] has done an exceptional job of explaining how the Government will implement the recommended option, including a detailed implementation plan for this complex proposal,’ correspondence published this week states.
 
RACGP President Dr Nicole Higgins said that endorsement of the policy is a welcome sign.
 
‘Nicotine addiction is a serious health issue, whatever the source,’ she told newsGP.
 
‘We completely back the Government’s vaping reform – the thought of standing by as a new generation of young people becomes hooked is completely unacceptable to anyone who cares about public health.
 
‘Helping patients with nicotine addiction is the bread and butter of what we do.’
 
The ban on the import of disposable vapes came into force on 1 January, as did reform that widens the number of medical practitioners who can prescribe vapes to include all GPs – but Dr Higgins said that it is too early to assess the accuracy of the report’s estimates.
 
‘This approach is a world first, and with more changes yet to come it’s too early to say whether the modelling in the report will play out as projected – but what is beyond doubt is that general practice is the absolutely the right place for nicotine addiction to be managed,’ she said.
 
‘Quitline, over-the-counter resources such as nicotine replacement therapy patches and gum, and therapeutic vapes are tools in the armoury.
 
‘When used with the support of a GP, people will have the best chance of leaving addiction behind.’
 
The OIA documents also offer some insight into the effect of existing regulatory changes, introduced under the previous Government in October 2021. 
 
The current pathway (SAS B) scheme saw 2987 applications for nicotine vapes from 641 medical practitioners up until 31 August 2023, while there were 2333 active Authorised Prescribers (AP) as of the same date.
 
‘This is still only a fraction of the estimated 100,000 medical practitioners eligible to be APs,’ the analysis notes.  
 
It cites 69,987 unique prescriptions to patients for nicotine vapes, which it says represents a small fraction of adult vape users.
 
It also says that GP consultations will lead to a prescription for therapeutic vapes around half the time, noting ‘this number may even be lower’.
 
‘This estimate is based on current RACGP guidelines, which highlight that vaping is second-line treatment for smoking cessation or nicotine addiction,’ the analysis states.
 
‘Medical practitioners strongly direct patients to other primary pharmacotherapy, accompanied by behavioural support, and therefore would be less likely to prescribe a nicotine vape.’
 
The success of the reforms is due to be assessed in July 2026. Significantly reduced vaping rates in all age groups, particularly for those aged 25 years or younger, will be one of the main measures used to judge the policy’s success.
 
The RACGP recently published updated provisional smoking cessation guidance on its website, which includes a new section on vaping cessation. 
 
Professor Nick Zwar, Chair of the RACGP Smoking Cessation Expert Advisory Group, said apart from a shift from ‘low’ to ‘moderate’ in the grading of evidence to support vaping as a smoking cessation tool, the advice had broadly stayed constant.
 
‘It doesn’t change our recommendation, which has stayed basically the same,’ he told newsGP.
 
‘Nicotine vaping products can be considered for people who have not been able to quit successfully using standard therapy with all the caveats about lack of long-term evidence on long term safety, the fact there’s no therapeutic product, and the risks of dual use.’
 
The guideline authors also note there is ‘little evidence on supporting vaping cessation strategies, and we rely very much on what we know works for smoking cessation’. 

Professor Zwar said that situation is likely to change relatively soon.
 
‘It’s such a pressing research need,’ he said.
 
‘Given the number of people around the world who may never have smoked but have become addicted to nicotine via vaping, that is an area of active interest.’
 
Stakeholder consultation on the RACGP’s provisional smoking cessation guidelines is open until 19 January.
 
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