In July this year, the Government revised the laws aimed at stopping illicit sales of vaping products, while enhancing safety standards and streamlining access for prescribed vapes.
All vapes may now only be dispensed in person through physical pharmacies. However, from 1 October, pharmacists may supply low concentration vapes (20 mg/mL or lower) as S3 medicines without a script.
This note considers how the supply of S3 vapes at pharmacies will impact prescribers.
What are the impacts of the new legislation?
Over the three years since the therapeutic access framework was introduced, patients have struggled to find prescribers.
The Government’s regulatory changes aim to address that issue by directing patients who are interested in therapeutic vaping to pharmacists in the first instance, rather than prescribers.
This change utilises the established ‘patient-centred care approach’ (psa.org.au), where pharmacists act as the bridge between patients and prescribers to:
- Direct patients to appropriate prescribers, and then
- Provide supply and ongoing support during the course of the patient’s abstinence journey.
Further, S3 supply of vapes has been introduced to allow short term supply of a low concentration product, for less dependent patients, or for such time as patients can arrange to see a prescriber.
What to expect from 1 October
- Increased enquiries for OTC vapes in pharmacies, leading to more referrals to prescribers of therapeutic vapes.
- Pharmacies, including major banners, supplying S3 vapes to increase in late 2024 | early 2025 as proper systems and training are put in place.
- People seeking access to therapeutic vapes will continue to seek a consultation with medical and nurse practitioners for assessment.
- Pharmacists prescribing S3 vapes, or who determine that higher concentration vapes are appropriate, must refer patients to prescribers.
- Pharmacies will likely look to establish relationships with prescribers who they can direct interested patients to.
Why 1 October doesn’t mean wholesale changes for prescribing vapes
Allowing supply of S3 vapes wasn’t in the original reforms and pharmacy bodies, including the Pharmacy Guild and PSA, have expressed concerns.
The PSA has now issued comprehensive guidance (psa.org.au), but there are a number of unique requirements to supply S3 vapes that will take pharmacies time to incorporate them into their supply procedures.
Overarching any pharmacy’s decision whether to supply S3 vapes, TAS and WA have indicated they will prevent S3 supply of therapeutic vapes altogether, with South Australia likely to follow. There has been no suggestion that NSW, QLD and VIC will prohibit S3 supply, but there will be better clarity in the coming weeks.
Prescribers continue to play a critical role in access to therapeutic vapes
Pharmacists supplying S3 vapes are required to direct patients to a prescriber and a smoking cessation service, such as Quitline.
Further, under the PSA Guidance, pharmacists are required to ensure any patient supplied S3 vapes must be assessed by a prescriber after 12 weeks of supply, before continuing supply.
Prescribers have a broader range of cessation tools available, including higher concentration vapes, and are better positioned to help establish clear cessation plans for patients.
The pharmacist’s role is to work in collaboration with prescribers, not as a replacement for them.
Update to RACGP guidance likely to follow PSA updates
PSA guidance reaffirms that nicotine dependence is a chronic condition.
Vaping products may be a useful cessation tool because of its ability to act as a complete smoking substitution, substantially reproducing the pharmacological, pharmacokinetic, sensory and behavioural characteristics of cigarettes.
The RACGP has stated that it intends to update its guidance on smoking cessation and the use of therapeutic vapes, including guidance on attempting abstinence in patients successfully stabilised away from combustible cigarettes.
PSA guidance may be indicative in terms of initial dosing guidance.
Why S3 vapes will not be suitable for most patients
Consistent with prescribing over the last three years, low-concentration (20 mg/mL or less) vapes are unlikely to be effective for most smokers, as higher concentrations are typically required for successful cessation.
| PSA initial dosing guidelines |
| For patients who smoke less than 10 cigarettes per day AND have their first puff more than 30 minutes after waking | Nicotine salt concentration of 18-30 mg/mL |
| For other more dependent patients: | Nicotine salt concentration of >30 mg/mL |
Prescribers have a broader range of cessation tools available to meet the needs of smoking patients, including higher concentration vapes.
Prescribing vaping products is not for all prescribers
However, with the Government estimating more than 450,000 Australians are likely to seek assessments for therapeutic vapes, it is something that all clinics should consider.
Immediate next steps
- Identify a prescriber within your clinic or at a trusted nearby clinic to refer interested patients to; and
- Speak to pharmacies where you have established relationships to understand whether they are supplying therapeutic vapes.
