Tue Apr 16

Pharmacists should be able to dispense nicotine vapes without a prescription. Here’s why

Written by: Coral Gartner, Director, NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, The University of Queensland

The Australian government is currently considering a bill ^[1] to implement the next stage of reforms to vaping regulation.

At present, vaping products that don’t contain nicotine can be sold in regular shops, such as convenience stores, like tobacco products are. To use vaping products that contain nicotine, people must have a prescription ^[2] from a doctor or a nurse practitioner, and get the prescription filled at a pharmacy.

However, many retailers have sold nicotine-containing vapes illegally ^[3] by pretending they don’t contain nicotine. Young people have found it easy to obtain them ^[4].

The current bill will address this issue by ending the sale of nicotine-free vaping products by general retail stores. But it’s not only teenagers who have accessed nicotine vaping products without a prescription. Most adults who vape, including those who use vaping products to quit smoking, don’t have a prescription ^[5] either.

In a new paper ^[6], we argue allowing pharmacists to dispense nicotine vapes without a prescription would be a practical way to ensure people who are using them to quit smoking can access them, while reducing the chance they’ll fall into young hands.

Why are people vaping without a prescription?

Research shows vaping can help people quit smoking ^[7] and may be more effective than other nicotine replacement therapies. For people who have not succeeded with other methods, using vapes to quit smoking ^[8] may be a reasonable option. Although certainly not risk-free, the health risks of vaping are likely to be much lower than those of smoking ^[9] because vapes emit far lower levels of harmful chemicals than cigarettes.

Some doctors will not prescribe ^[10] vaping products because they are not approved medicines. Others lack knowledge about their use for smoking cessation or find the reporting requirements for prescribing them too onerous. Prescribers must notify the Therapeutic Goods Administration ^[11] via an online form within 28 days of prescribing nicotine-containing vapes.

Online prescribing services ^[12] have emerged, which may fill this void. However, there are concerns about the quality of care because some online prescribers do not speak directly to the patient ^[13].

With fewer GPs bulk billing ^[14], there are also substantial patient costs involved in seeking a prescription for nicotine vapes.

Vaping regulation is currently being reformed in Australia. Oleggg/Shutterstock ^[15]

The current law risks criminalising people who vape nicotine without a prescription because possession without a prescription is illegal. The maximum penalties ^[16] vary from a fine of A$45,000 in Western Australia to two years in jail in the Australian Capital Territory or the Northern Territory.

The ACT minister for population health, Emma Davidson, is reportedly working on a bill ^[17] to remove the penalties for unauthorised personal possession of nicotine vapes in the ACT.

However, a simpler option would be to change the classification of nicotine vapes ^[18] from prescription-only (schedule 4) to pharmacist-only (schedule 3). This would allow pharmacists to supply nicotine vapes without a prescription.

Additional requirements could be added, such as banning advertising of vapes, and standards for providing in-pharmacy smoking cessation counselling alongside vaping product supply.

As well as removing penalties for possession without a prescription, other possible benefits would include reduced costs and greater access for patients. This model also retains health practitioner oversight of vaping product supply.

What other options are being discussed?

Some lobbyists are promoting the idea all vaping products should be regulated like tobacco ^[20]. This would allow vaping products, including those containing nicotine, to be sold by general retailers to people aged 18 and over with no health practitioner involvement.

While some political parties ^[21] support this model, most Australian health and medical organisations do not ^[22]. Regulating vapes like tobacco may seem like a reasonable option, but there are several factors to consider.

The widespread availability of tobacco makes quitting smoking difficult ^[23] and encourages youth to experiment with smoking ^[24]. Widespread retailing of vaping products is likely to have a similar effect for vaping.

We also know general retailers have sold vapes to children ^[25].

Nicotine vapes can help people quit smoking. Gyorgy Barna/Shutterstock ^[26]

Are pharmacists up to the task?

Pharmacists are governed by professional standards and the Australian Health Practitioner Regulation Agency ^[27]. Strong sanctions, including restrictions on practice, can occur for pharmacists who do not comply with professional standards and laws, such as illegal supply of medicines.

Pharmacists currently supply other pharmacist-only (schedule 3 ^[28]) medicines directly to the public. These include pseudoephedrine (cold and flu medicines), salbutamol (asthma puffers) and naloxone (for reversing an opioid overdose).

Some people may be concerned that without a prescription, certain customers may purchase nicotine vapes to supply to youth illegally. However, pharmacists have previously developed innovative ways to reduce diversion of medicines where this has become a problem.

For example, pseudoephedrine can be used to make methamphetamine. Real-time monitoring of sales of cold and flu medicines containing pseudoephedrine has reduced the diversion ^[29] of these medicines from pharmacies into methamphetamine production.

Further, after additional planned reforms ^[30] are implemented this year, the types of vaping products that pharmacies can supply – only tobacco, mint or menthol flavoured vapes sold in plain pharmaceutical packaging – will be less attractive to youth.

Pharmacists already play an important role in supplying smoking cessation nicotine products and services. They offer advice and counselling about the full range of assistance and medications available for quitting smoking.

Therefore, pharmacist-only supply of nicotine vaping products without a prescription would utilise the skills, knowledge and accessibility of pharmacists to support people who wish to use nicotine vapes to quit smoking, while preventing inappropriate sales to youth.