Expect a clamour of vaping script requests

4 minute read

The Department of Health says GPs should expect an influx of 450,000 new patients, but it’s crickets so far.

The federal government’s new vaping reforms may mean 450,000 new people seek vaping prescriptions each year and cost the public over $52 million a year in GP and pharmacy visits, says a recently released Department of Health and Aged Care analysis.

As of the beginning of this year, the federal government is enforcing the final stages of its crackdown against vaping by banning the importation of all disposable, single-use vapes.

From 1 March, the importation of any vape apart from those meeting TGA standards for prescription will be banned.

The only vapes legally available will be sold at pharmacies and prescribed by a health professional.

All medical practitioners and nurses will be able to prescribe vapes through the Special Access Scheme (SAS C).

Currently, only 70,000 of Australia’s 1.3 million vapers use a prescription.

The world-leading crackdown, primarily aimed at stemming youth vaping, hinges on successfully quashing illicit imports and ensuring the prescription vaping pathway is accessible to those who need it.

But the newly released DoHAC analysis suggested that young people may instead turn to tobacco and fuel the black market if the new pathway is too fiddly.

The analysis also flagged that patients seeking vaping scripts would continue to face barriers to GP access that already plague many Australians, such as high gap fees, poor regional access and low bulk-billing rates.

Patients may also be faced with costs of up to $150 for a refillable vape, totaling $67.5 million a year on vaping products nationwide on top of an estimated $52.1 million on biannual GP visits and monthly pharmacy visits, the analysis suggested.

Speaking to The Medical Republic, chair of the RACGP’s smoking cessation guidelines’ expert advisory group Professor Nick Zwar said that the numbers produced by DoHAC were “only estimates” and that previous reforms, such as those rolled out in October 2021, had not resulted in a large influx of GP appointments for vape prescriptions.

While this could be because those regulations were “not sufficiently effective”, it may also be that many found other ways of managing their nicotine addictions, such as counselling, said Professor Zwar.

But even if there was a jump in vape-related appointments, it shouldn’t be “cause for alarm”, he added.

“General practice is stretched, but this [additional work] is not vast compared to the amount of work general practice does every day, especially when you consider spreading it right across the more than 30,000 GPs in the country,” he said.

Speaking to TMR, RACGP president Nicole Higgins concurred, adding that vapes would “another tool in the toolbox” for GPs addressing nicotine addiction and would be “business as usual”.

Professor Zwar noted that while some GPs would be keen to utilise vaping as a cessation tool, some may be less inclined, meaning practices will need to discuss how best to manage requests.

According to Professor Zwar, from a regulatory perspective, prescribing vapes to adults is “reasonably straightforward”.

GPs can assess a person’s level of nicotine addiction using a number of simple tools with a strong evidence-base for smoking cessation that have been adapted for vaping cessation, said Professor Zwar.

“One simple one is time to first vape [each day],” he said.

“If someone vapes within a few minutes of waking, they’re likely to be nicotine dependent.

“There’s also the HONC (hooked on nicotine), which is another slightly more detailed way of assessing vaping related nicotine dependence.”

The HONC can be accessed through the RACGP’s updated smoking cessation guidelines.

According to Professor Zwar, under the authorised prescriber pathway, prescribers can now apply to become a prescriber for any patient aged down to 16.

But the age limit for the SAS C pathway remains unclear, added Professor Zwar.

GPs can also discuss other non-pharmacological approaches or smoking cessation pharmacotherapy like nicotine-replacement therapies with their patients, said Professor Zwar.

The DoHAC’s analysis ultimately concluded that the harsh crackdown on import and sale and prescription-only vaping was the best way to cut youth vaping and risks could be mitigated by improved education campaigns and stringent border enforcement.

But the success of the reforms will rely on the RACGP ensuring GPs are willing to prescribe vapes, the analysis outlined.

“I think that [the reform] has a lot of positives for both reducing young people’s nicotine dependence, but also, the waste caused by single-use vapes,” concluded Professor Zwar.

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