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‘They get young people into smoking’: Doctors hesitant to prescribe vaping

Melbourne GP Mukesh Haikerwal, a former national AMA President, said he would not be prescribing nicotine vaping products to his patients.

“They actually get young people into smoking, rather than helping them get off it,” Dr Haikerwal said. “Some people say it’s better than smoking itself – well, it might be, but only just. And the dangers are really quite profound.”

The TGA’s interim decision said doctors were “well placed to support smoking cessation and advise on how to reduce the risks associated with nicotine use” and that the requirement for a prescription meant they could “fully assess a patient’s need for a product containing nicotine.”

It comes after Federal Health Minister Greg Hunt backflipped on a plan to impose a $200,000 fine on Australians who import liquid nicotine after a backbench revolt, with the importation ban scheduled to begin on July 1 delayed for six months pending the TGA consultation.

If the proposed new rules are approved by the TGA, it would allow Border Force to begin seizing liquid nicotine imported without a prescription.

The Royal Australian College of General Practitioners’ supports the use of nicotine-based e-cigarettes as a potential second-line aid for people who want to quit smoking, but only after other options have failed.

Professor Nicholas Zwar, chair of the RACGP’s expert advisory group on e-cigarettes, said doctors would face a difficult task in trying to assess whether patients seeking a prescription “are generally wanting to use them for cessation or if they have another motivation.”

Uncertainty about “what we’re prescribing” and a lack of evidence about the products’ safety and efficacy could also raise professional liability concerns, he said. “It’s not like a nicotine patch, where there is data about the product’s safety.”

No e-cigarette manufacturer has applied to have their product approved by the TGA as a cessation aid, with vaping companies preferring for their wares to be treated as consumer products, subject to softer regulation.

Dr Khorshid said if the TGA’s final decision was to approve e-cigarettes, the AMA would support a time limit on doctors’ ability to prescribe the products, to ensure that long-term nicotine use was not supported.

“The aim has got to be to get the patient off the nicotine addiction,” he said.

“Having a doctor prescribe a potentially harmful poison to a patient long-term is just not what this was all about.”

Dr Haikerwal said GPs looking to help patients quit smoking had other options to explore before even contemplating vaping products, with gums, patches and tablets working best when combined with coaching.

“The most important thing is calling the Quitline,” he said.

Dr Haikerwal is a board member with Cancer Victoria, which like all of the nation’s peak cancer bodies opposes nicotine vaping.

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The TGA said the requirement for a prescription would “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’s interim decision is open for consultation until November 6, with a final decision due mid-December.

Any changes would be rolled out in April or June next year.

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