Australia’s Therapeutic Goods Administration (TGA) has reclassified nicotine as a prescription-only medication, rather than a dangerous poison, in an interim decision announced last week. The decision, if made final, will mean that certain nicotine products—including e-cigarettes, e-juice, heat-not-burn tobacco products, chewing tobacco and snuff—can only be obtained with a doctor's prescription.
The change in legislation aims to clear up confusion as to whether nicotine products should be treated as dangerous poisons or therapeutic goods that serve a medicinal purpose. Current state and territory laws classify vapes and e-cigarettes as prescription medicines if intended for therapeutic use—such as for quitting smoking—and dangerous poisons if intended for non-therapeutic use.
Under the new scheduling, a doctor or medical practitioner will be able to issue a prescription for vape products if they think it will help a patient quit smoking. Those products will likely be sold through community pharmacies and Australian online retailers, while the importation of products from online sellers overseas will be banned.
“The requirement for a prescription will also prevent the rapid growth of youth uptake in vaping seen in Australia and overseas, and a potential pathway to cigarette smoking by young people,” the TGA said in a statement. “Between 2015 and 2019, e-cigarette use by young people increased by 72 percent in the US, 150 percent in Canada and 96 percent in Australia.”
But while some health experts have commended the TGA’s decision to regulate the sale of nicotine products, noting that it will likely curb the number of young people who are taking up smoking via vapes and e-cigarettes, others have raised concerns over the proposed rescheduling.
"The most dangerous form of using nicotine is from smoking tobacco, not from vaping nicotine using e-cigarette. Requiring prescription for nicotine vaping products while letting traditional tobacco products be widely available does not make any sense,” said Dr Gary Chan from the University of Queensland’s Centre for Youth Substance Abuse Research. “In the debate of e-cigarette policy, it is essential to remember that it is the harmful chemicals from burning cigarettes that kill, not the nicotine per se.
“From a public health perspective, a more reasonable policy is to ban combustible cigarettes while giving smokers easy access to nicotine vaping to relieve craving."
Associate Professor Kristin Carson-Chahhoud from the University of South Australia Cancer Research Institute meanwhile pointed out that more studies are needed in order to clarify the therapeutic efficacy of e-cigarettes, and to weigh the pros against the cons.
“Australia needs to continue to focus on evidence-based policies, which includes ongoing review about long-term impacts of e-cigarettes and whether they do help with quitting,” she said. “[The] reality is the evidence is not there yet to support e-cigarettes as a quitting aid but evidence-based gold standard care that we know is effective is getting overlooked.
“We cannot have a regulatory framework that exposes a new generation of Australians to a nicotine addiction, as we see happening in New Zealand and Canada.”
The interim decision will be open for public consultation until 6 November 2020, with a final decision expected in mid-December. If passed, the changes will be implemented on either April 1 or June 1, 2021.
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