New vaping cessation GP guidelines revealed

As vaping rates continue to skyrocket, alarmingly so in children and non-smokers, the RACGP has released updated guidelines to walk GPs through how best to help patients kick the habit.
 
On Tuesday, the college unveiled its long-awaited ‘Supporting smoking & vaping cessation: A guide for health professionals‘, designed to offer expert guidance in the wake of rising vaping uptake and regulation changes.
 
The new guide walks GPs through how best to support patients cease nicotine vaping products (NVPs), prescribing, support tools, and evidence-based risks and assessments.
 
It also offers specific and detailed advice for GPs on what to document in clinical notes, specifying brand and products, determining initial dose, and reporting adverse outcomes.
 
The guide’s release comes on the same day as new laws allow people aged 18 years and older to purchase nicotine vapes with 20 mg/mL or less from a pharmacist without a prescription.
 
A prescription from a medical or nurse practitioner is still required for nicotine concentrations greater than 20 mg/mL and for those aged under 18 years.
 
In Tasmania and Western Australia, there are plans to override these national laws and instead only allow vapes to be supplied by pharmacies to people older than 18 years with a prescription.
 
Professor Nick Zwar, Chair of the RACGP Smoking Cessation Expert Advisory Group, told newsGP that vaping has ‘changed the landscape’ worldwide, and described the rapidity of vape usage as ‘alarming’.
 
‘Even though the regulatory changes are complex, we want to summarise them as best we can and make clear the practical implications for health professionals, in particular GPs,’ he said.
 
‘Given the number of people who’ve taken up vaping, many of whom are non-smokers and particularly young people, we’re trying to provide guidance for practitioners on how you approach helping people to stop vaping.
 
‘Practitioners are facing more people coming in, young people particularly saying, “I’m now vaping every day”, or “I’m vaping, and I’ve clearly become dependent on it, what do I do?”, and that’s another important part of what’s new in the most recent iteration.’
 
The new guidance recommends that for people who want to quit smoking but have failed to achieve this with first-line therapy it ‘may be reasonable to recommend NVPs in conjunction with behavioural support’.
 
However, it says the decision to proceed with this treatment must be part of an evidence-informed shared-decision making process, and that the patient must be aware that the long-term health effects of NVPs are unknown.
 
It states that GPs must tell patients that NVPs are not registered therapeutic goods in Australia and therefore their safety and quality have not been established and that the lack of uniformity in vaping devices increases the uncertainties and risks associated with their use.
 
However, the Therapeutic Goods Administration also announced on Tuesday plans to introduce strengthened product standards for therapeutic vapes, including for substances, substance accessories, devices, and device accessories.
 
Its changes, to be rolled out in stages next year, include limiting the nicotine allowed in vapes to 50 mg/mL, restrictions to the maximum permitted container volume, and plain packaging requirements.
 
The RACGP guidance also points to a lack of evidence in using vaping as a cessation tool within certain patient groups, including those with a chronic illness, patients who are pregnant or breastfeeding, Aboriginal and Torres Strait Islander peoples, and those with mental illness.
 
When considering prescribing NVPs to patients, it recommends GPs consider risks including short-term adverse effects, unknown effects on major health conditions, interactions between nicotine and other medicines, and harm to adolescent brain development due to nicotine exposure.
 
It also states that, given the relative newness of vapes, not all risks can be determined and that as more evidence emerges, the full extent of short-term and long-term risks will become clearer.
 
Since the introduction of vapes in Australia in the early 2000s, the number of users has steadily increased, especially among young people and those who have never previously smoked.
 
Today, 9.3% of people aged 18–24 and 6.5% of people aged 25–29 use vapes daily.
 
Around 30% of Australian secondary school students had vaped in 2023, 16% of students had vaped in the past month, and 3% vaped daily.
 
Professor Zwar said he was particularly concerned with these young people’s new vaping habits.
 
‘It’s a challenge right across the world wherever vapes are available, which is most countries, it’s not unique to Australia and everyone’s grappling with what to do,’ he said.
 
‘GPs have remained very important to this, and I think the move to the pharmacy model does not remove the need for GPs to understand and decide how they’re going to engage with the whole issue.
 
‘I think vaping is going to be more regulated than it was, I think it’s going to be a big challenge for Border Force and reinforcement of the new arrangements, and time will tell how effective the new regulatory and enforcement environment is.’
 
The RACGP’s new guide states that there are notable differences between vaping and tobacco smoking behaviours, and that behaviours that trigger vaping are not necessarily the same as for smoking.
 
‘Unlike combustible cigarettes, e-cigarettes do not have a distinct “endpoint”: vaping is not punctuated by finishing and stubbing out a cigarette,’ it says.
 
Because vapes are easy to conceal and people can vape in a wider range of settings, the guide says finding a suitable location to ‘light up’ is not a limiting factor.
 
‘Therefore, frequent and sustained vaping can occur, with the user being less aware of how much or how often they vape,’ it explains.
 
The guide states that while there is currently limited research on interventions specifically targeting vaping cessation, strategies shown to be effective for smoking cessation may be considered, such as behavioural support and pharmacotherapy.
 
‘Health professionals should ask patients whether they vape or use e-cigarettes, the frequency of use and products used, and whether they vape and/or smoke combustible cigarettes,’ it says.
 
It recommends asking patients about vaping from the age of 10, the same as smoking.
 
‘But the context of asking is important,’ it states.
 
‘It is vital to ensure confidentiality for young people, so they feel safe to disclose the behaviour to a health professional.
 
‘Their vaping status should be recorded. It is known that implementing recording systems that document tobacco use almost doubles the rate at which clinicians intervene with patients who smoke, resulting in higher rates of cessation.’
 
It also recommends GPs schedule follow-up appointments, at a similar schedule to support for smoking cessation, to maintain a therapeutic relationship, manage pharmacotherapy, and to manage relapse and maintain support.
 
Log in below to join the conversation.

Smoking smoking cessation vaping vaping cessation