AUSTRALIAN GPS HAVE A LIMITED KNOWLEDGE about vaping and nicotine prescribing, are concerned about safety and effectiveness, have a poor understanding of the vaping regulations, and are reluctant to prescribe a product that is not approved by the medicines regulator, the TGA.
These were the findings of a detailed GP survey published today in BMC Public Health. The findings were broadly consistent with the views of overseas GPs found in a systematic review of 25 studies in 2022 by the same authors.
The study found that some GPs refused point blank to prescribe at all. Others were only willing to prescribe after all other possible treatment options had been exhausted.
The underlying issues identified were
Most GPs are poorly informed about vaping and lack the knowledge or confidence even to discuss the issue with smokers. Most want more information about safety and effectiveness, although this is now widely available.
GPs want practical advice on how to prescribe nicotine and how to manage subsequent treatment decisions such as stepping down the nicotine dosage.
Many GPs feel they are at risk when prescribing nicotine, a product that is not approved by the TGA like all other prescription medicines. If there was an adverse event, GPs are concerned that they could be responsible, without the protection normally associated with an approved drug.
Misinformation about vaping is common, such as concerns about a gateway effect and the belief that vaping “is merely switching from one tobacco product to another”.
Some GPs were resentful that they were expected to prescribe nicotine at all, asking ‘Why do we have to be the gatekeepers?’.
It is worth noting that this feedback was from the 13 GPs who agreed to participate in the study out of 246 invited. It is quite possible that this group was more interested in vaping than those who declined an interview, so the results may be even worse.
The results of this study will not surprise most Australian vapers, many of whom report being unable to get a prescription after visiting multiple GPs
Implications for Australia’s prescription-only model
The findings cast serious doubt on the future of Australia’s prescription-only model for vaping nicotine
Australia’s 1.7 million vapers are required to get regular prescriptions from GPs to access nicotine e-liquid and vape legally. However, less than 10% of users have a prescription, and most access supplies from the black market. Without prescriptions, the whole model collapses.
To be fair, GPs are subject to constant negative messaging and misinformation about vaping from health authorities, medical associations, health charities and the media.
Many GPs report not getting requests for nicotine prescriptions, so are not motivated to spend time learning about vaping. Appropriate training is quite extensive and time consuming.
So far very little quality education has been provided. GPs particularly lack training on prescribing and providing ongoing support for vaping. Further education is promised but if it is as ineffective as the training so far, it will insufficient in most cases.
The study highlights the folly of making vaping a medical treatment. Vapes are consumer products like cigarettes and should be readily available as adult consumer products from retail outlets. Smokers are not ‘sick’ and most do not need medical care to quit, especially with vaping.
GPs have very little to offer patients on vaping. The purpose of the medical model was for GPs to support the patient’s quit attempt with expert advice. However, most vapers know far more than GPs.
An additional issue is the current primary care crisis. General practice is overloaded, has become less affordable as bulk-billing rates fall and many patients are delaying care. Adding millions of unnecessary consultations each year for vaping is worse than stupid.
Mark Butler’s medical prescription model for vaping is in a death spiral. It has created a rampant black market controlled by criminal gangs. Australian smokers are not quitting and youth have easy access to illicit products. The crisis with GP prescribing may be the final nail in the coffin