Pharmacist Information Hub
How to assess patients and supply S3 vapes
Patients seeking information about therapeutic vaping
With patients now directed to pharmacists for advice on the use of therapeutic vapes, many will have questions as they consider whether it is appropriate for them.
Liber has prepared a patient handout that answers many of these common questions to reduce the time that pharmacists need to spend on general, and oft repeated questions.
Patient enquiry hand-out
A handy 2-sided DL explainer to assist you with ongoing patient enquiries – 'What you need to know about therapeutic vaping'
How to assess patients seeking access to therapeutic vapes
When a patient approaches a pharmacist about therapeutic vapes, four questions will allow the pharmacist to determine whether proceeding with a consultation for S3 supply or referring the patient to a medical practitioner for assessment is appropriate for them.
1
“Do you smoke, vape (illicit market) or dual-use (both smokes and vapes)?”
If the patient does not fall into one of these categories, there is generally no reason to supply S3 vapes.
2
“Have you tried to quit before and if so, how?”
Establishes whether the patient should consider alternative first-line therapies and will guide the pharmacist as to the patient’s motivations to attempt abstinence.
Then, determine the patient’s level of nicotine dependence using the same baseline assessment as used by the RACGP1 for NRT:
3
“How many cigarettes do you smoke per day?”
4
“How long after you wake before your first cigarette / puff of a vape?”
Initial dosing guidance based on nicotine dependence
Based upon the guidance from the PSA and RACGP guidelines, the table below will assist the pharmacist in establishing initial dosing based on the patient’s nicotine dependence.
Lower dependence patient
Smokes 10 or fewer cigarettes per day
AND
First smokes > 30 minutes after waking
Up to one Nicovape® Q20 (2mL) cartridge per day should support patients with lower dependence
Up to 28 Nicovape® Q20 (2mL) cartridges for four weeks’ supply
When supplying S3 vapes, the priority is to ensure that patients are sufficiently dosed to stop smoking and avoid relapse. If a patient requires more than one Nicovape® Q20 per day for therapeutic relief, use combination therapy and refer to a prescriber for Nicovape® Q35 or Q50.
Higher dependence patient
Smokes 10 or more cigarettes per day
AND
First smokes < 30 minutes after waking
Only available on prescription. Refer patient to a specialist prescriber
Up to one Nicovape® Q35 or Q50 (2mL) cartridge per day should support patients with higher dependence
Up to 28 Nicovape® Q20 (2mL) cartridges may be supplied as an interim until patient can see a specialist prescriber
Complicating factors
Before supplying S3 vapes, pharmacists must consider whether the patient has complicating factors:
Establishing informed consent
As therapeutic vapes are supplied as unapproved therapeutic goods, it is necessary to (i) inform the patient about the nature of any S3 vaping product being supplied and any potential risks, and (ii) document the patient’s informed consent.
The PSA’s guidelines recommend that the patient should be advised of the following:
Counselling the patient on how to use vapes effectively
When a pharmacist supplies an S3 vape, they should advise the patient of the following:
They should use the vape only when they crave nicotine, as often as required to remain completely cigarette or illicit vape-free
A key advantage of using a vape is that they can have a single puff when they need it to satisfy their cravings for nicotine
Patients should try to have no more than 15 puffs per hour, resulting in approximately a single Nicovape® Q Cartridge per day
Referring the patient to cessation services or specialist prescribers
Where a pharmacist chooses to supply S3 vapes, the regulations oblige them to direct patients towards a smoking cessation support service and/or a specialist prescriber.
This is a crucial stipulation that de-risks the pharmacist by ensuring patients can access a full range of support in using vapes therapeutically.
Specialist prescribers can fully assess a patient’s cessation needs, establish a cessation strategy and consider prescribing a range of treatments, including higher concentration vapes, which pharmacies will continue to dispense.
Specialist prescribers can be accessed via:
- Your local network of GP clinics; or
- Online telehealth services.
Liber:Activate
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Filing an SAS-C notification
When supplying an S3 vape, the pharmacist must ensure that an SAS-C notification is reported within 28 days.
Request a pharmacy pack
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Liber:Activate
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Important links
Therapeutic Goods Administration
Pharmaceutical Society of Australia
References
- PSA Professional Practice Standard 1: https://www.psa.org.au/practice-support-industry/pps/
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iNRT Healthcare is operated by Liber Pharmaceuticals for the purpose of furthering healthcare education regarding Nicotine Vaping Products (NVPs) within the Australian medical framework. Liber has no affiliation with the tobacco industry, their affiliates, or any organisations or individuals engaged in lobbying on their behalf.
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