The complexities of vaping reforms were highlighted at a recent Consumers Health Forum of Australia webinar, underscoring the importance of consumers being closely engaged in related processes, including the development of consumer friendly and targeted messaging on legal, safety and access issues.
Marie McInerney reports on the webinar discussions for the Croakey Conference News Service. See her X/Twitter thread, and watch the webinar here.
Marie McInerney writes:
Australian governments must do more to involve people who vape in the roll out and evaluation of complex, world-leading vaping reforms, Australia’s peak consumers body said this week ahead of further changes in where and how adults can access approved therapeutic vaping devices.
Consumers Health Forum of Australia (CHF) Chief Executive Officer Dr Elizabeth Deveny said feedback from consumers, including at a national webinar hosted by CHF last week, showed many were confused, worried and frustrated by multiple regulatory changes, which will also vary state to state.
She said federal and state governments should be consulting with consumers and providing tailored information and supports to people who vape, especially to Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse (CALD) backgrounds, and those with neurodiversity and/or mental health issues.
These groups represent a very different cohort to the Federal Government’s main focus in anti-vaping measures, which is to urgently halt rising rates of vaping by young people, she said.
“We keep hearing from people that they either didn’t know there was reform going on, because they can still buy vapes pretty much everywhere, but they don’t really understand what’s happened, and what the next steps are,” Deveny told Croakey after the webinar, urging governments to apply the adage of ‘nothing about us without us’ to the reforms.
“How do we make sure consumers can easily understand what’s legal, what’s safe and what they should be doing? And then, how will we evaluate how the change works for them?” she asked.
“Will we be able to see whether some of these people go to illegal sources of nicotine and back to cigarettes? How are we going to track that?”
The #UnderstandingVapingReforms webinar, the latest in a series of #CHFTalks covered by the Croakey Conference News Service, outlined the vaping reforms introduced in recent years and the impact of black and so-called grey markets (unofficial but not completely illegal markets).
The discussion also considererd what the reforms will mean for GPs and pharmacists amid ongoing concerns about the safety and efficacy of vaping as a smoking cessation tool and uncertainty about long-term health risks for users.
Public health menace
Already hailed as a world leader in tobacco control for plain packaging legislation, Australia hit international headlines again this year when Health Minister Mark Butler introduced a full ban on recreational vaping, restricting sales of vapes to pharmacies, effective from 1 July.
The former Coalition Government had tightened access in 2021 but, as Mandy Edlington from the Therapeutic Goods Administration (TGA) told the webinar, suppliers, importers, and manufacturers managed to subvert regulatory controls by simply not labeling their devices as containing nicotine.
Butler’s reforms began with an import ban on disposable vapes on 1 January 2024 and ramped up mid-year. Vapes approved for sale are now subject to quality and product standards including plain packaging and maximum nicotine concentration levels. They are permitted to be sold only over the counter in pharmacies, and only in mint/menthol and tobacco flavours and, compared to the multiple flavours available previously, which ranged from bubblegum and banana through to cheesecake and coffee.
Butler has been blunt, saying vaping was a “public health menace”, that governments and communities across the world had been duped into thinking vapes were a therapeutic product to help long-term smokers quit, and warning that the gains Australia had made in tobacco “could be undone”.
He’s described vapes as a product targeted to children, “sold alongside lollies and chocolate bars”, with nine out of 10 vape stores in Australia deliberately set up within walking distance of schools – overall, a “tool used by Big Tobacco to hook a new generation on nicotine”.
However, to get the legislation through the Senate, the Government agreed to amendments negotiated by the Greens, who had criticised the Government’s planned reforms on ‘prohibition’ grounds, saying they “risked criminalising people for possessing vapes for personal use”.
As a result of the amendments, from 1 October, people who are 18 years or over will be able to obtain vapes containing 20 mg/mL or less nicotine directly from pharmacists without a prescription, subject to strict conditions and compliance with state and territory laws.
But that’s if the pharmacy stocks them.
The Pharmacy Guild of Australia has expressed “strong opposition” to the change negotiated by the Greens, saying many pharmacists will not want to stock and dispense products “that are unregulated, untested, unproven”.
“We basically don’t have the evidence to show that they’re safe and effective for us to supply to people,” said National Pharmacies Chief Pharmacist Bec Rogers.
Competing tensions
Emily Manning, a 19-year-old vaper who was the consumer representative at the CHF webinar, said she believed many young people “are very conscious of the health risks of vaping” and therefore interested in being able to access products that are regulated for safety and quality.
If a therapeutic vape costs around the same as retail vapes but is “better for you, I think that would actually be something really attractive for a lot of young people”, she said.
But Manning warned that issues of price, ease of access and flavours will be crucial in whether young people opt to get vapes through pharmacies or turn to black markets for vapes and/or tobacco.
Another challenge will be around “easing people” into the new regulated environment, including whether they have access to non-judgmental treatment from doctors, nurses and pharmacists, particularly if they are not ready straight away to quit vaping, she said.
The webinar also heard concerns from other participants who posted in the chat that vapers “have been forgotten” in the course of legislation changes. Some said they had been forced back to tobacco and were being unfairly treated, given adults can still buy alcohol and cigarettes in retail markets – points that have also been raised by the powerful vaping lobby.
Deveny conceded it is tricky for a consumer body to be able to differentiate between genuine individual consumer concerns and polished vested interests, but said that difficulty is “true for us generally”, with many vested interests at play in consumer health issues, including those of doctors and pharmacists.
“We see these commercial influences across health broadly,” she said. “It does make it more difficult to know if there’s a vested interest but that doesn’t automatically negate the issue – just because there’s a commercial interest doesn’t mean the concerns aren’t shared by consumers,” she said.
Alarming association
Providing the medical perspective at the webinar, Dr Nicholas Zwar, a GP and medical educator, highlighted new research underscoring concerns about rising rates of vaping in Australia and vaping’s potential to provide a gateway to smoking for young people.
Published last week in the Australian and New Zealand Journal of Public Health, the retrospective cohort analysis by researchers from the University of Sydney, Griffith University and Cancer Council NSW indicated that vaping markedly increases the risk of subsequent tobacco smoking among 12 to 17-year-olds.
As Butler pointed out this week at a media event on vaping, it showed also that, “outrageously, a 12-year-old who vapes is 29 times more likely to try cigarettes as a 12-year-old who does not vape”.
Zwar, who is Chair of the Royal Australian College of GPs (RACGP) expert advisory group on smoking cessation, cautioned that the research showed an association, not cause and effect.
“But that’s an alarming association,” he told the webinar.
In a move he said has proven influential to national policy, Zwar said the RACGP had in 2020 given “conditional” support to the use of vaping to help adults who want to quit smoking, if they had tried to quit smoking via other therapies and failed, and noting that nicotine vaping products “are not registered therapeutic goods in Australia and therefore their safety, efficacy and quality have not been established”.
The RACGP believes the evidence to date makes it “reasonable” to have a discussion with patients and prescribe vapes in the right circumstances, but Zwar cautioned that “we don’t know about long term health effects”, pointing out that it took 20 to 30 years to develop evidence of smoking’s toxicity.
“There’s nowhere in the world that’s done a full medicines approval process which tests for efficacy, safety, quality, all those things,” he said, referring to concerns about brain development, gum disease, mental health, increased blood pressure and possible effects on the heart.
“So that’s an area of uncertainty. They’re unapproved products and that’s true anywhere around the world.”
Importantly, Zwar said there is no obligation on a doctor or nurse practitioner to prescribe therapeutic vapes, “and many have chosen not to do so” due to that uncertainty, concerns about medico legal risks and because they prefer to encourage smokers to first try nicotine replacement therapies that have “much more established evidence of safety”.
That also applies to pharmacists, said Chris Campbell, General Manager for Policy and Program Delivery at the Pharmaceutical Society of Australia (PSA).
Campbell was keen to reassure consumers that they should be able to expect respectful treatment in pharmacies, which are required by the profession’s code of ethics to provide a “culturally safe, stigma free” environment.
But he acknowledged that some pharmacists may not want to stock therapeutic vaping consultations or may prefer to first recommend nicotine replacement therapy.
On the changes that will be effective from 1 October, he emphasised it still would be unlawful to supply a vape for recreational use, and that pharmacists will be required to ask for certain information before they can dispense therapeutic vapes, including proof of ID.
“Please know this is not a pharmacist trying to meddle or ask too many questions that are personal, it’s a legal requirement for them to have a consultation,” Campbell said.
Campbell also acknowledged cost issues, saying there is currently no federally funded program like the Medical Benefits Scheme (MBS) to support out of pocket costs for a pharmacy vaping consultation. As a result, a pharmacist may refer the vaper to a bulk billing general practitioner for that consultation.
Given it will be illegal for pharmacies to advertise access to vapes, one of the best ways for consumers to find out is to “have a great relationship with your pharmacist”, Campbell said, though he acknowledged that many people don’t have such a relationship.
(Croakey has asked the PSA for more details on availability and costs.)
Deveny is calling for governments to involve consumers around these sorts of issues: developing consumer friendly and targeted messaging on legal, safety and access issues, highlighting challenges, and understanding the unintended and/or perverse consequences of reform, including that strict controls of vapes may lead people back to smoking or into black markets.
“This is complex legislative and regulatory reform, which is being implemented differently, jurisdiction by jurisdiction,” she said.
The overarching intent, to have fewer people exposed to vaping, is laudable, but that will play out differently for different populations. It’s one thing to say we don’t want 10-year-olds vaping, but the same approach may not be appropriate for a 40-year-old who uses vaping as a way to manage their nicotine addiction, she said.
Further reading: ‘Pssst … doctors can still prescribe higher-concentrated nicotine vapes in Australia‘: Emeritus Professor Simon Chapman
Watch the webinar
See Croakey’s archive of articles on vaping
