New vaping cessation module planned as clampdown looms

A new vaping cessation module will form part of an update to RACGP smoking cessation guidelines, which has been prompted by Federal Government legislation designed to counter a vaping boom in Australia.
 
Professor Nicholas Zwar, Chair of the Expert Advisory Group of the RACGP Smoking cessation guidelines, confirmed the change to newsGP on Tuesday, following a Government announcement of a ban on imported, single-use vaping products from 1 January.
 
From the same date, all GPs, alongside medical practitioners and nurse practitioners, will be able to prescribe therapeutic vapes to help patients combat nicotine addiction – if clinically appropriate – from the beginning of 2024.
 
It means the number of GPs able to prescribe vapes under a new Special Access Pathway, will expand exponentially overnight, with the current settings restricting prescriptions to approved prescribers only.
 
While a prescription had been the only legal way to obtain vapes in Australia since October 2021, take-up has been low, in large part due to the extent of the black market.
 
‘It’ll be particularly welcome if the importation of disposable vaping products can be stopped, because they are poor quality, typically quite high nicotine concentration, and therefore prone to produce dependency, and they create toxic environmental waste,’ Professor Zwar said.
 
He said the announcement also confirms the need to adapt existing smoking cessation guidelines to reflect the new legislation.
 
In particular, there will be an update on nicotine vaping products for the smoking cessation module, and a new module to support vaping cessation.
 
Professor Zwar said the planned module is due to the huge increase in vape use over the past few years, particularly among young people.
 
According to an announcement from Federal Health and Aged Care Minister Mark Butler, in the first quarter of 2023, around one in seven 14–17-year-olds, and one in five 18–24-year-olds are believed to be current vapers.
 
‘The need [for the new module] has been discussed over some months, particularly as the rate of abuse by young people of vaping has gone up alarmingly,’ Professor Zwar said.
 
‘Increasingly, young people and their parents and schools are asking for help.’
 
Updates to the guidelines have already been drafted, with targeted consultation to follow according to Professor Zwar, who hopes much of the work will be complete midway through December.
 
Once the new prescribing arrangement comes into place, he believes the change will be felt in general practices around the country, with more presentations likely from younger people.
 
However, Professor Zwar says it is unclear when the impact will be greatest due to uncertainty about the effect of the import ban.
 
‘It will depend a bit on how many illegal nicotine vapes are already in the country and how long that supply lasts before people have difficulty buying the disposable ones in particular, which are the ones that most young people use,’ he said.
 
‘No one knows how long that will be, but it may be a few months, maybe less.
 
‘It needs to be on all GPs’ radar.
 
‘Some time in the first quarter of next year, they will see more young people and their parents coming in, asking for help.
 
‘People who vape and may never have even realised that what they’re doing is actually illegal will be coming in asking about therapeutic vapes as well.
 
‘GPs [are] going to have to navigate how they support people who are nicotine dependent, and transition them to be nicotine free.’
 
RACGP President Dr Nicole Higgins said the college has been working closely with the Therapeutic Goods Administration (TGA) to develop an approach that works for GPs and patients. 
 
‘The expansion of prescribing to more practitioners and lessening the administrative burden of nicotine vapes for smoking cessation will help us to support our patients,’ she said.
 
‘This is really important – the last thing we want is people returning to smoking, or young people who have never smoked to start.
 
‘Your GP understands nicotine addiction is a serious thing to experience, and is there to support you, without judgement.’ 
 
Dr Higgins said patients’ health should be the priority.
 
‘We’ll hear a lot of rhetoric about freedom and choice,’ she said.
 
‘Being hooked on nicotine means the choice to smoke or vape, or not, has been taken away from you.’
 
But while Professor Zwar welcomes the Government measures, the timelines are challenging.
 
‘We do understand the regulatory complexity [for the] Government, TGA and the need to get all states and territories on board,’ he said.
 
‘But it does feel a bit like October 2021, when we’ve come under pressure to get the nicotine vaping for smoking cessation module done in a very short time.
 
‘This is even shorter.’
 
Minister Butler said laws will be put forward to shut down the domestic manufacture, advertising, supply and possession of non-therapeutic and disposable single use vapes ‘to ensure comprehensive controls on vapes across all levels of the supply chain’.
 
He also announced that product standards will be tightened next year, with moves to limit flavours, reduce nicotine concentrations and introduce pharmaceutical packaging requirements.
 
Professor Zwar flagged that more updates to the guidelines will be introduced later once those changes are confirmed.
 
He also hopes the TGA exercises caution about reducing the nicotine concentrations too far.
 
‘Getting this across is really hard, because people conflate things,’ he said. ‘There is understandable concern about young people using high concentration things and getting hopelessly addicted.
 
‘[But] if they’re on prescription, a higher concentration is needed for some people to manage their nicotine dependency and then grade down and then off.
 
‘Some kids are waking up in the night to puff.
 
‘They will need a reasonable strength medical vaping product to manage their symptoms, their dependence, and stopping them from getting withdrawal.
 
‘Then it could be titrated down.’
 
According to the Minister Butler’s announcement, health and police ministers from all states agreed to a new national enforcement framework, overseen by a multi-agency National Vaping Working Group, to put in place the changes.
 
‘All Australian governments are committed to working together to stop the disturbing growth in vaping among our young people,’ the Federal Health Minister said.
 
‘We’re taking tough action because this is a major public health issue.
 
‘The great majority of vapes contain nicotine and children are becoming addicted. Vaping is a gateway to smoking and smoking remains the leading preventable cause of death and disease in Australia.’
 
An extra $25 million is going to the Australian Border Force, as well as $56.9 million to the TGA, to help enforce the changes.

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