Many GPs in Australia would be prepared to upskill to prescribe nicotine-containing e-cigarettes to help patients who smoke, as another form of replacement therapy, says Professor Nick Zwar, executive dean of the Faculty of Health Sciences and Medicine at Bond University.
This is because they want to help their patients, writes Doug Hendri in News GP, the news hub of the Royal Australian College of General Practitioners (RACGP).“There are patients that GPs see who have struggled for many years with trying to quit smoking and not being able to,” Zwar told the Select Committee on Tobacco Harm Reduction. ‘[A]n opportunity to assist them is something that doctors would like.’
At present, only a handful of GPs are able to prescribe nicotine-containing e-cigarettes – but that number is expected to soar if the government shifts to a proposed prescription-only model – according to NewsGP.
Speaking at the 19 November hearing, Zwar – who chaired the RACGP smoking cessation guidelines advisory group – said prescribing nicotine vaping “shouldn’t be open-ended” and should occur through discussions on aiming to taper and withdraw from nicotine use.
“We don’t know about long-term harms, and even the short-term harms are not that well described, because there haven’t been a huge number of studies,” he said, reported NewsGP. “Some of these harms, of course, may take quite a time.
“The time between initiating tobacco use and developing lung cancer might be 25 or 30 years, developing COPD is often 20-plus years. We won’t know for some time about the extent of the risk, hence a precautionary approach makes a lot of sense.”
The inquiry is examining how nicotine-containing vaping products should be regulated, as well as the international evidence base for their use.
Zwar said education support for GPs and other prescribers would be necessary to be able to outline risks and benefits. “[M]edico-legal risk is always present in medical encounters. This is somewhat different,” he said, according to NewsGP.
“We do not know as much about what we’ll actually be prescribing, because…it hasn’t been through a full assessment as a medicine. It’s notable that none of the vaping manufacturers around the world, as far as I’m aware, have put forward their products to be tested as medicines.
“[I]it would be better if a nicotine-containing e-cigarette had been assessed as a medicine and had a full assessment for its efficacy and safety and what it actually delivered in terms of not only nicotine, but what other molecules are delivered into the lung of the user’s body by the device. [I]t would be another form of nicotine replacement therapy [NRT].”
While nicotine vaping has become a consumer product in countries like the US and New Zealand, Australia – which has run a decades-long public health push against traditional cigarettes – has to date maintained more scepticism.
Professor John Wilson, President of the Royal Australasian College of Physicians, told the inquiry he has “great pessimism” that vaping is the answer to tobacco use.
“e-Cigarettes do need to be controlled, regulated and appropriately prescribed,’ he said, NewsGP reports. “If the contention is that this is a treatment for addiction, in that case put it in that basket and say, “Okay, it’s a treatment for addiction. Let’s register it that way and treat it that way”,” he said.
The committee also heard from a number of public health and smoking cessation experts, who warned against opening the door to vaping as a consumer product.
Read the full NewsGP article via the link below.
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