As chair of the Royal Australian College of General Practitioners smoking cessation guidelines group, I have watched with growing concern the increasing use of nicotine vaping products, including by young people who have never smoked.
Federal Health Minster Mark Butler referred recently to national data from July 2023 that reported one in six high school students had vaped in the past month. The rate is even higher (about one in four) in young adults. Most of these have experimented with vaping products, which have been deliberately designed to appeal to youth through the use of sweet flavours and colourful packaging, as well as promotion on social media.
Nicotine, a key element in vapes, is a highly addictive drug where repeated use causes changes in our brain’s reward pathways and alters parts of the brain involved in learning, stress, and self-control. This can make it very difficult to stop and, as a result, we are seeing a new generation of nicotine users. Some of these young vapers will progress to smoking tobacco.
Even if they do not take up smoking, there is a range of adverse health effects from vaping alone. Possibly most concerning for young people is the negative effect nicotine has on brain development. Given the health risks, everyone needs to address the vaping challenge. The problem is how.
Similar societies to Australia, including New Zealand, Britain, Canada and the US, have not found a solution. The issue is complicated because there is research showing nicotine vaping can help some smokers to quit.
As far back as 2019 the RACGP guidelines group recommended nicotine vaping products be considered as an option to assist smokers who had not been able to quit with approved medicines such as nicotine replacement therapy.
The RACGP recommendation is that the use of vapes only occurs after the risks are discussed and the patient understands that:
- the long-term health effects of vaping are not known
- there is no product available tested and approved to the standard of a medicine
- that the goal is short-term use and to support the person to become nicotine free.
The aim of regulation is to prevent general community access and uptake, described as “recreational vaping” by Minister Butler, but enable access for people who have not succeeded to quit smoking.
This was to be via a prescription-access only model where people wanting nicotine vapes would need to have a script from a doctor or nurse.
This proposed approach was a world first and was backed by more than 50 public health organisations. Other countries have been watching with interest.
However, in a last-minute deal with the Greens to ensure the legislation passes the Senate, the Federal Government abandoned the prescription-only approach and is going to allow nicotine vapes to be sold in pharmacies to people aged 18 years and over.
Those aged under 18 will continue to need a prescription.
The approach has drawn strong criticism from the Pharmacy Guild of Australia and the Pharmaceutical Society of Australia. The pharmacy access plan is proposed from October 1, but there are many questions on how it will work, including how assessment of the health need for the product can be made in the pharmacy, how smoking and nicotine cessation support can be provided, and how use of vapes will be monitored.
The change increases the risk the nicotine vaping market will become dominated by tobacco companies who also manufacture vaping products. So, while our government deserves credit for trying it remains to be seen if the new regulatory approach will work.
Despite all the work governments, the Therapeutic Goods Administration and health groups such as the RACGP have put in over the past four years, we will never know if prescription-only model would have been the most effective approach.
The approach has drawn strong criticism from the Pharmacy Guild of Australia and the Pharmaceutical Society of Australia. The pharmacy access plan is proposed from October 1, but there are many questions on how it will work, including how assessment of the health need for the product can be made in the pharmacy, how smoking and nicotine cessation support can be provided, and how use of vapes will be monitored.
The change increases the risk the nicotine vaping market will become dominated by tobacco companies who also manufacture vaping products. So, while our government deserves credit for trying it remains to be seen if the new regulatory approach will work.
Despite all the work governments, the Therapeutic Goods Administration and health groups such as the RACGP have put in over the past four years, we will never know if a prescription-only model would have been the most effective approach.
Professor Nick Zwar is the Executive Dean, Health, Sciences & Medicine at Bond University, and chair of the RACGP smoking cessation guidelines expert advisory group.
