It is undoubted that the regulation of nicotine e-cigarette products (NVPs) is a challenging task for many countries. In order to implement regulation effectively, a trade-off must be made: on the one hand, the potential risks of NVPs for young people must be scrutinized in order to protect them from potential harms; on the other hand, the potential positive effects of NVPs as a cessation aid must not be overlooked, providing new options for adults who wish to quit smoking.
Can e-cigarettes be prescribed?
One strategy is to limit the distribution of NVPs to adult smokers who are prescribed them. This would ensure that NVPs are used in a legal, controlled environment while maximizing their potential as a smoking cessation tool that can have a positive impact on public health.
Is vaping only available by prescription in Australia?
Australia has set an example in the regulation of nicotine e-cigarette products (NVPs). As the country with the strictest tobacco and e-cigarette policies in the developed world, Australia is the world-wide first country to implement a prescription model for e-cigarette products, making it the only country in the world to have a prescription model for e-cigarette products. Since October 2021, Australia has adopted an innovative initiative that allows compliant NVPs to be obtained through a medical prescription without the need for a cumbersome approval process for them to be considered therapeutic products.
Australia's e-cigarette regulatory policy for 2024:
Reforms to the e-cigarette will be phased in by 2024 to strengthen controls on the importation, manufacture and supply of e-cigarettes with the aim to protect Australians from the dangers of e-cigarettes and nicotine dependence, ensuring that prescription patients can access e-cigarettes from pharmacies. From 2024, the importation of disposable e-cigarettes and other e-cigarettes will be prohibited unless certain conditions are met:
(1) Disposable e-cigarettes that do not contain nicotine or therapeutic claims may be supplied by retailers, subject to compliance with local laws. (2)Nicotine-containing disposable e-cigarettes that meet the requirements of the TGA can be legally supplied in Australian pharmacies on prescription.
At the same time, the Individual Entry Program is closed, prohibiting the order of e-cigarettes from overseas. Nicotine replacement therapy does not require a prescription and can be purchased from pharmacies and retail outlets.
In addition, Australia’s tax system for smokers is quite strict, with the tax rate being among the highest of its kind and increasing steadily at a rate of 5 percent per year. This tax strategy has not only significantly increased government revenues, but has also curbed the consumption of tobacco and e-cigarettes, effectively reducing the health problems caused by smoking.
These policies have also gained the support of some medical experts, who consider it an effective means of reducing and eventually eliminating smoking and e-cigarette use.
On the European continent, the United Kingdom also faces the challenge of effectively and reasonably regulating e-cigarette products. The productive policies adopted in Australia unquestionable serve as a worthy model on this issue. The UK’s Labour Party has made it clear that if it wins the general election, it will follow the Australian regulation model to regulate e-cigarette products.
However, despite the well-intentioned policies contributed to reducing the consumption of cigarettes and e-cigarettes through increased taxes and restrictions, these measures have accidentally awakened a thriving black market trade. With the tightening of restrictions, the black market has become more lucrative and expanded in size, creating new society problems.
In the current environment, law enforcement agencies bear great pressure and challenges to effectively curb black market activities. The Australian Border Force is already struggling to deal with the challenges of the illicit drug market, making it even more difficult to juggle the illegal trade in products such as e-cigarettes. Though some progress have made against black marketeers and illicit products, these operations are often short-lived victories as black market activity quickly recovers and expands, rendering law enforcement efforts moot.
The existence of a black market not only creates a problem of systemic violence, but more seriously, a flood of inferior and adulterated products into the market. These products usually do not undergo rigorous quality testing, and pose serious health risks and even more harmful than legal tobacco products. Besides, retailers in black market are not bound by restrictions on sales to minors, making e-cigarettes more readily available to young people, further exacerbating the public health problem.
In addition, consumers are at risk of criminalization. Some innocent people have been involved in altercations with the police and arrested for possession of products, raising public concerns about excessive law enforcement and infringement of individual rights. At the same time, the black market trade has also led to a significant loss of tax revenue, which has taken a huge toll on the state’s coffers. The Department of Revenue estimates that the loss of tax revenue due to black market transactions will be as high as $2.3 billion in 2021-2022.
It is evident that the current tobacco and e-cigarette policies have had serious side effects, transforming a legal and relatively peaceful market into an increasingly dangerous and out-of-control situation. Strengthen legislative reform, multi-agency collaboration, and build up a nationally consistent policy platform can improve the situation.
What do Australians think about prescribing models for e-cigarette products?
A paper published in the NCBI Journal exploring the prescribing model for nicotine e-cigarette products presents a detailed list of key self-reported arguments made by the top 20 e-cigarette users who consulted with the TGA about the introduction of a prescribing model for nicotine e-cigarettes in Australia. These arguments cover a number of areas as outlined below:
1. Users were concerned that they might revert to traditional smoking once the prescription model was implemented.
2. Some users felt that the move infringed on individual freedom of choice.
3. Many are concerned that visiting a doctor for a prescription will become difficult, time-consuming and inconvenient.
4. It will fueled the spread of of black market trading of e-cigarettes, which may lead to the circulation of illegal products.
5. There are concerns that smokers will find it difficult to quit smoking or those who have quit smoking will return to smoking again.
6. Users believe that consulting a doctor for a prescription increases the burden on the health care system and consumes taxpayer funds.
7. Concerns that prescription models may cause more people to become ill or even die.
8. Implementation of prescription models may increase the financial burden on consumers.
9. Young people may turn to traditional cigarettes because of prescription restrictions.
10. Other smoking cessation products may be ostracized because of the prescription model.
11. Users believe that prescription models may increase curiosity about e-cigarettes among young people and thus increase their use.
12. The prescription model may place an additional burden on the health care system due to concerns about people returning to smoking.
13. The model may damage the existing e-cigarette industry.
14. Smoking rates are predicted to rise as a result of the prescription model.
15. The prescription model may put more pressure on the judicial and law enforcement systems.
16. Users made positive statements about e-cigarettes and their benefits.
17. Electronic cigarettes are considered to have potential health benefits.
18. Considered e-cigarettes to be an effective smoking cessation aid.
19. Emphasize the affordability and cost-effectiveness of e-cigarettes compared to traditional cigarettes.
20. Argue that e-cigarettes can make the process of quitting smoking easier.
From the first 20 arguments we can find that most people are still inclined to have a less favorable attitude toward the prescription model policy for e-cigarette products. Most people are worried that e-cigarette users will switch to cigarettes, the emergence of a black market for e-cigarettes, as well as the fear of limited freedom of choice and inconvenient prescriptions, and so on.
Data reference source:
Jongenelis, Michelle I et al. “Perceptions of a prescription model for accessing nicotine vaping products: an examination of submissions made by self-reported e-cigarette users to an Australian consultation.” Health promotion international vol. 38,4 (2023): daad080. doi:10.1093/heapro/daad080
Collected and published by ANTBAR
