Nicotine prescriptions. What you need to know

FROM 1 OCTOBER 2021, Aussie vapers who import nicotine without a prescription will risk a penalty of up to $222,000 and a possible criminal record under new TGA regulations.

If you are a vaper, visit your GP and explain how vaping has helped you quit and the benefits to your health. Vaping nicotine is now recognised as a legitimate, quitting aid by the Royal Australian College of General Practitioners for smokers who are unable to quit with other treatments. It is legal and approved for GPs to support vaping and write nicotine prescriptions if appropriate.

What if my doctor won’t prescribe nicotine?

If your GP does not know how to write a prescription, politely suggest they visit the ATHRA website and log in to the Health Professional section for more information.

Many doctors have been discouraged from prescribing nicotine by the Australian Medical Association and other medical bodies and most do not have the time to research the evidence themselves. You may wish to get an opinion from another doctor.

There is a list of Australian GPs online who have an interest in helping you quit smoking, are well informed about vaping and can provide a nicotine prescription if it is appropriate. The list is at www.athra.org.au/doctors.

Prescriptions are valid for 12 months and nicotine liquid is not covered by the Pharmaceutical Benefits Scheme (PBS).

Telehealth consultations

Medicare rebates are now available for a telehealth (video or phone) consultations for smoking or vaping from a GP who is not your own doctor. The rebate for a consultation up to 20 minutes is $39.10. If over 20 minutes, the rebate is $75.75. If you are on a health care card, the Medicare rebate is only payable if you are bulk-billed and is paid directly to the doctor.

3 ways to legally access nicotine e-liquid

1. Importation from overseas

If you have a prescription, you can import up to 3 months’ supply of nicotine e-liquid from overseas suppliers for personal use to quit smoking or prevent relapse under the Personal Importation Scheme. Most vapers order from New Zealand or China.

It is important to send a copy of your prescription to the supplier to return with your order. If a prescription is not provided your order will be destroyed by the Border Force and you may face severe penalties under the Customs Act 1901 (see page 644).

The TGA has established new safety and quality standards for nicotine e-liquid [Therapeutic Goods (Standard for Nicotine Vaping Products) (TGO) Order 2021] commencing 1 October 2021. Products imported under the Personal Importation Scheme:

• Must not contain other ‘active’ ingredients other than nicotine, such as caffeine, THC, stimulants or vitamins
• Must not contain acetoin, benzaldehyde, cinnamaldehyde, diacetyl, diethylene glycol, ethylene glycol, pentane-2,3-dione, vitamin E acetate, which are potentially harmful
• Maximum nicotine concentration of 100mg/mL
• Nicotine to be within 10% of concentration stated on the label

2. Commercial products from Australian pharmacies

Since May 2021, Australian chemist shops and online pharmacies have been able to sell commercial nicotine e-liquids (bottled or in pods or cartomisers) if you have a prescription and your doctor is an Authorised Prescriber.  Doctors must apply to the TGA to become an Approved Prescriber.

You will need to inform your doctor which product, brand and flavour you require and find out if an Australian pharmacy can provide it.

It remains to be seen how many pharmacies will participate. The Pharmacy Guild of Australia has previously stated, ‘The Guild does not support the sale of personal vaporisers in pharmacies, regardless of whether or not they contain nicotine’.

It is likely there will be a limited range of products available. Pharmacy markups are likely to be significant and may be prohibitive. It is not clear yet if nicotine e-liquid will be on pharmacy shelves or if it needs to be ordered from a wholesaler when the script is presented.

If you choose this option, make sure the doctor is an Authorised Prescriber before your visit to get a prescription.

3. Compounding pharmacies

Registered ‘compounding pharmacies’ can prepare customised nicotine e-liquid from the individual ingredients when provided with a prescription from an Authorised Prescriber.  Tell the doctor what flavour, PG:VG ratio and nicotine concentration you require so it can be included on the prescription.

Ask the compounding pharmacy if they prepare nicotine e-liquids, what flavours are available and if they keep supplies in-house.