Perfect shouldn’t be the enemy of good: AMA

6 minute read

Despite amendments to anti-vaping legislation to appease the previously ‘inscrutable’ Greens, the association and RACGP remain firmly on-side. The Guild, however, is not best pleased.

Yesterday, the Labor government agreed to amend its anti-vaping bill to allow e-cigarettes to be sold over the counter at pharmacies, amid concerns over the prohibitive costs of the prescription-only model raised by the Greens. 

The amended bill, which will be presented to the Senate this week, would allow vapes to be sold in pharmacies to adults as Schedule 3 medicines from 1 October. 

“This is a very common therapeutic pathway that allows certain medicines, like the morning after pill, pseudoephedrine and various asthma medicines, to be obtained through a discussion with a fully qualified pharmacist,” the Minster for Health and Aged Care Mark Butler told media today.  

Should the bill pass in the Senate, which it is expected to do after passing through parliament yesterday with the support of the Greens, there would be a transition period from 1 July until 1 October during which patients would require a prescription from a GP to access a vape. 

Speaking on the recent amendments to the reform, AMA president Professor Steve Robson said the association remained on-side, as the end goal – to keep vapes out of the hands of children – was maintained in the amended bill. 

“We don’t want perfect to be the enemy of good here,” Professor Robson told The Medical Republic, noting that the Greens had been “inscrutable” in their position on the original legislation before it was seen in parliament. 

“We always need to put at the forefront what are we trying to achieve: we’re trying to head off the public health catastrophe of a whole generation of Australians dependent on recreational vapes, which are a public health disaster. 

“I admit, the [prescription-only] legislation was controversial, because it was so incredibly strong and it was unique globally. 

“But we’re also political realists and we understand that sometimes to get legislation over the line, compromise is required. 

“Our position is that if the spirit of what we’re trying to achieve is still respected in the legislation in its final form, then we think it’s better than no legislation and no change.” 

Professor Robson said he recognised the need for vapes in the smoking cessation space and championed the bill for moving vaping into the “therapeutic paradigm”. 

“At the end of the day, is the legislation perfect? Well, no, few things are,” he said.  

“But is it good? We think it is good and we think at the end of the day, it changes the paradigm from a romp and free-for-all, which it is at the moment.” 

RACGP president Dr Nicole Higgins echoed the AMA’s position on the perfectly imperfect bill. 

“This is a pragmatic compromise,” Dr Higgins told TMR

“It’s not ideal, it’s not perfect, but having this bill defeated and having vapes in every corner store, easily accessible to our kids and taxed was never going to be okay. 

“The reality is that nicotine replacement therapies are already sold through pharmacies and building [into the legislation] that the pharmacist must counsel the consumer about quitting moves [vaping] to a health space versus a retail local corner shop.” 

It seems the Pharmacy Guild is far from pleased with the new amendments, labelling the new bill “insulting” and suggesting it turned pharmacists into “tobacconists or garbologists”. 

Mr Butler insinuated the hypocrisy of the outcry, as did Dr Higgins. 

“Pharmacies have been selling vapes for some considerable time and it was always proposed that they would continue to sell vapes under the reforms that government has put together,” Mr Butler told media. 

Dr Higgins said that counselling was an important part of the health journey, one which GPs already performed. 

“The Pharmacy Guild don’t want to be considered tobacconists and yet they’re willing to dispense vapes that have been prescribed by a GP. 

“[Pharmacists] can’t have it both ways: if they want to be supporting people’s health journeys, they also need to help them quit smoking and quit vaping, not just treat UTIs.” 

According to Mr Butler, the “pharmacist-only” model had been under consideration for some time and was discussed at the Senate Committee hearing, which the Guild opted not to attend. 

“This is a significant amendment that we will be proposing to the Senate, but one that very much keeps faith with the original intention of our reforms, which are to wipe out the recreational vaping market, to wipe this out from retail settings and to return this product to its original intention,” he said. 

Should the third wave of the federal government’s anti-vaping and tobacco reforms pass, vapes would still be illegal outside pharmacies and only TGA-compliant, plain packaged vapes in menthol, tobacco and mint flavours would be available for purchase at pharmacies. 

“The TGA has issued very clear standards for the type of vape that will be able to be sold in Australia as a therapeutic product,” said Mr Butler. 

“It will have a prescribed nicotine content, it has prescribed content on chemicals, it is designed to be pharmaceutically-styled in packaging, not presented as a recreational product that is attractive to kids.” 

However, some academics have raised concerns over the “watered down” legislation. 

“Mark Butler’s leadership in the vaping arena has been commendable and it’s so disappointing to see that, due to lack of support for vaping reform, his proposed legislation has now been watered down,” said Professor of health promotion and public health at Curtin University Jonine Jancey. 

“It seems that an opportunity to prioritise community health has been lost!” 

Professor Brian Oliver, who leads the respiratory molecular pathogenesis group at UTS and the Woolcock Institute, said the amendments were an “illogical step backwards”. 

“The lack of a prescription now puts the responsibility on a pharmacist to decide who should be able to be dispensed a vape,” he said. 

“The argument made was that a visit to a GP, who may or may not bulk bill, was cost prohibitive, but someone will have to now cover the cost of the pharmacist’s time.  

“I’m sure if I can see the gap in the market someone else has already thought of the idea: vape only pharmacies.” 

NHMRC fellow and program lead of ‘Smoking, Vaping and Mental Health’ at USyd Associate Professor Emily Stockings said the new bill opened the door for continued supply to young people. 

“When accessing smoking cessation treatment, discussion with a trained health professional and provision of brief advice is the gold standard, and it remains to be seen if this is going to be feasible in busy community pharmacies.” 

Mr Butler called on all Senators to back the amended bill, which now has public support from the AMA, the Cancer Council, the RACGP and the Public Health Association of Australia. 

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