Important new regulations for buying nicotine e-liquid begin on 1 October 2021. This blog is a simple summary of what every vaper needs to know.

You must have a prescription from an Australian doctor to import nicotine e-liquid legally from overseas after that date. Importing it without a script attracts a fine of up to $222,000!

You can also purchase nicotine e-liquid from some Australian pharmacies but will also need a prescription.

Importing nicotine

1. Visit your GP for a nicotine prescription

Explain to your GP that you have been unable to quit smoking with the methods you have tried and that vaping is keeping you off the cigarettes.

If your doctor is unwilling to provide a nicotine prescription, you can get a second opinion from one of the doctors listed on the ATHRA website here.  Most provide consultations by phone or video call. There is a fee for the telehealth consultation (typically about $90) and in most cases you can get a $39.10 rebate from Medicare.

The doctor will decide how much e-liquid you can have, but usually the prescription is for 3 months’ of your usual supply and 3 repeats to last a year in total. Any registered doctor can write a prescription for importing nicotine. Prescriptions are valid for up to 12 months.

2. Send the retailer a copy of your prescription

Upload or email the script to the overseas retailer every time you  order nicotine e-liquid. A copy must be included with every order sent to you.

If a script is not included and your delivery is intercepted by the Australian Border Force, you will be asked to provide a prescription. If you do not have one, the goods will be destroyed and you may be fined.

Remember that doctors cannot backdate prescriptions, so the script must be written before making your order.

3. E-liquids must comply with the new Standards

Confirm with the retailer that the e-liquid complies with the Australian standards which commence on 1 October (Standard for Nicotine Vaping Products, TGO 110). The requirements for imported nicotine are:

The products should also have compliant labelling and packaging but this is not compulsory.

4. Keep a copy of the prescription on your smartphone

You may be asked if you have a valid prescription for nicotine if you are vaping in public. It is an offence to possess nicotine liquid without a prescription and there are serious penalties and even jail terms in some states.

Pharmacy purchases

You can now purchase nicotine e-liquid from some participating Australian pharmacies and online pharmacies. Pharmacies can supply commercial e-liquid products but the range will be limited. Some compounding pharmacies will make nicotine liquid to order.

1. Find a participating pharmacy

Ask your local pharmacy if they can get supplies of your favourite product from a pharmacy wholesaler for you. They can also import products directly from overseas for sale. Compounding pharmacies can also prepare nicotine e-liquid from the basic ingredients.

If your pharmacy can’t help, there will be others that can, but not many. Some will take online or email orders and will arrange delivery. I will provide a list of participating pharmacies before 1 October.

Information for pharmacists is available here.

2. Visit your GP

Your GP needs to be an Approved Prescriber (AP) for nicotine to write prescriptions for pharmacy purchase. Ask if your GP has registered to be an AP before your visit. GPs can register here quickly and easily.

The Therapeutic Goods Administration will be providing a list of Approved Prescribers on its website from 1 October to help you find one if needed.

3. Go to the pharmacy

If the pharmacy stocks the product you want, take your prescription to the pharmacy so the product can be dispensed.

If ordering from an online Australian pharmacy, email your script or upload it on their website. The order will be posted to you when ready.

All products supplied by Australian pharmacies must comply with the new Standards.

4. Keep a copy on your smartphone

Keep an image of your prescription on your mobile phone in case an authority asks for it. It is an offence to possess nicotine liquid without a prescription in Australia and there are serious penalties and even jail terms in some states.

Further information

Nicotine vaping products: information for consumers. Therapeutic Goods Administration 3 September 2021

Nine media (Sydney Morning Herald and The Age) recently published a disturbing expose of  rampant vaping by Australian teenagers. It was a horror story of addiction, nicotine poisoning, lung and brain damage.

It must have generated lots of clicks and advertising dollars. However, the article was misleading and unbalanced and only told part of the story. It was based on anecdotal reports and dubious claims of harm.

Emeritus Professor Simon Chapman said his granddaughter told him she knows kids who are vaping ‘because you can get lemonade’ flavour. This anecdote is presented as rock-solid evidence of a youth epidemic. However, he has repeatedly dismissed the stories of millions of former smokers who have quit with vaping as ‘just anecdotes’. Apparently his anecdotes are compelling evidence.

How common is youth vaping really?

Official government figures show that underage vaping is rare in Australia, and frequent vaping is very rare. Less than two per cent of Australian teenagers vaped in 2019 and more than 90% had never tried vaping. News reports suggest vaping has increased since then but we have no data to confirm that, just ‘anecdotal’ reports.

What the article didn’t say is that almost all young people who vape regularly are already smokers before they tried vaping.

They also forgot to mention that most vaping is infrequent and short-term and one in three young vapers do it only once or twice.

Furthermore, vaping probably diverts some would-be smokers from going on to smoking (as explained below). Vaping is not harmless but it is very much the lesser of two evils.

“all the school kids have nicotine addictions”

Really? The evidence tells a different story. Nicotine dependence is rare in young non-smokers who experiment with vaping. Studies have consistently shown that vaping is significantly less addictive than smoking.

One woman in her twenties reported vaping to quit smoking, but ‘my nicotine addiction is worse than ever.’ This is very unusual but she is far better off vaping than continuing to smoke.

Former smokers who vape have simply transferred their nicotine dependence to a much safer alternative. This can only be a good thing.

Professor Peters, “kids are turning up to school sickbay vomiting from nicotine poisoning”

Really? What Professor Peters means is that some kids vaped too much, vomited and then recovered fully. This is unpleasant but harmless and may stop them from experimenting again.

Professor Peters, “nicotine exposure creates neuropsychological harms in children”

Professor Peters plays the fake brain-damage-card to demonise vaping further. He forgot to mention that this has only been shown to occur in adolescent rodents in laboratory tests. These tests often use unrealistic nicotine doses in artificial settings and rodents are more sensitive to nicotine than humans. There is no evidence so far that nicotine harms the human brain in adolescence.

Is vaping harmful to adolescents?

Kids should not vape, smoke, binge drink, use illicit drugs or have unsafe sex, but we all know that some will take these risks, no matter what adults tell them.

Vaping is not risk-free (nothing is!). It exposes adolescents to low levels of some toxic chemicals and there is some evidence that it may worsen asthma and cause cough and cause lung irritation in non-smokers. There is a low risk of becoming dependent on nicotine.

However, significant harms are unlikely, even if use continues for some years.

Nearly all lasting harmful effects from smoking can be avoided by quitting before the age of thirty-five years. As vaping is far less risky than smoking, any permanent harm is likely to be delayed even longer and would be much less. There may be long-term harms we don’t know about yet but they are almost certain to be much less than smoking.

Does vaping lead to smoking?

One of the favourite myths about vaping is that it causes teens to take up smoking. However, just because vaping precedes smoking for some teens does not mean that vaping caused the subsequent smoking (the ‘gateway theory’).

The most likely explanation for why vaping and smoking go together is that young people who experiment with vaping are more prone to taking risks generally. This is known as having a ‘common liability’ for risk taking.

According to the New Zealand Ministry of Health,

‘Some people worry that vaping might be a ‘gateway’ to smoking for young people, but there is no clear evidence for this. Smoking among young people is continuing to decline and most young people who vape are smokers or ex-smokers.’

It is quite possible that vaping may lead some young non-smokers to experiment with smoking and an even smaller number may go on to become regular smokers. However, the overall effect is likely to be very small indeed.

Vaping is diverting young people from smoking

The overall evidence suggests that vaping is diverting young people away from smoking and reduces the risk of an adolescent becoming a smoker.

A study of US high school students found that those who tried vaping first (before smoking) were LESS likely to be smokers later than those who tried smoking first.

Increasingly, studies are finding that some young people who would have smoked are taking up vaping instead, and not turning to smoking. This helps to explain why youth smoking declined so rapidly in the United States and United Kingdom after vaping became popular.

Despite all the hysteria about youth vaping, it may well lead to improved public health. It causes little harm to young people and appears to be reducing the uptake of smoking, Australia’s biggest preventable killer.

If Professors Chapman and Peters are so concerned about youth vaping, it would be more helpful to campaign to enforce the current laws which ban their sale. This carefully orchestrated panic about youth vaping is becoming tiresome.

Further reading

Mendelsohn CP, Hall W. Does the gateway theory justify a ban on nicotine vaping in Australia. International Journal of Drug Policy 2020

The world’s leading expert on nicotine has published an authoritative report on nicotine and vaping. It is a must-read for all vapers.

Professor Neal Benowitz is Emeritus Professor of Medicine at the Center for Tobacco Control Research and Education, University of California San Francisco. His work on nicotine over the last 40 years has been the go-to reference and is always considered and reliable.

Some of the key comments in the review are listed below, but I recommend all vapers read the paper carefully. It is available here.

“If smokers used ENDS to quit smoking, even if they continued to use ENDS, we expect that there would be an enormous benefit to public health.”

Nicotine

 Safety of vaping

Reference

Benowitz NL et al. Clinical Pharmacology of Electronic Nicotine Delivery Systems (ENDS). American College of Clinical Phrmacology, 2021

Sensible vaping regulations are in force from today in New Zealand under the Smokefree Environments and Regulated Products Act. They are a stark reminder of how far Australia is falling behind best practice and the rest of the western world.

While Greg Hunt insists on nicotine prescriptions and pharmacy-only sales, New Zealand adults can buy nicotine e-liquid as a consumer product from a wide range of retail outlets.

The laws strike a good balance between ensuring that safe, good-quality products are readily available for adult smokers while minimising appeal and access to young people.

The laws are not perfect but are a great start. According to the Associate Health Minister, Dr Ayesha Verrall, they will help achieve a ‘healthier future for Aoetearoa’ and ‘represent an exciting and significant step towards our Smokefree Aotearoa 2025 goal’.

In Australia, nicotine e-liquid is regulated like tobacco. However, the NZ government understands that vaping is a safer alternative to smoking and allows retailers to provide the following messages

The good

The guidelines ensure that all products meet high safety and quality standards. Nicotine, PG and VG must be pharmaceutical-grade and all liquids must be tested in an accredited laboratory before sale. Manufacturers must notify health authorities that a product has met the safety and quality standards before it can be sold.

Importantly, reasonable nicotine limits have been set at

There are also requirements for labelling, instructions for handling and correct use, safety warnings and bans on certain toxic chemicals. Containers should be no more than 120 ml and must be protected against breakage, leakage, spilling and have child-resistant closures.

Safety standards have also been set for vaping devices including battery and electrical safety and consistent nicotine delivery. Devices such as ‘mechanical mods’ with no electrical protection are banned.

Protection for young people includes a minimum age of sale of 18 years, no vaping in cars with children and a ban on cartoons or toys on packages.

The not-so-good

Vape shops can sell a wide range of flavours, but other retail outlets can only sell tobacco, mint or menthol. Limiting access to flavours may puts vapers at risk of relapse to smoking if they can’t access the product that works for them.

Advertising is banned. However, carefully regulated advertising of vaping products raises awareness of vaping as a safer alternative to smoking and has an anti-smoking effect. Advertising targeted at adult smokers encouraging them to switch could reduce smoking rates.

Come on Australia!

The NZ regulations put Australia to shame. They are based on the evidence rather than politics and ideology. They are a model for good public health policy on vaping and will save lives.

Australia’s requirement for nicotine prescriptions is complex, expensive and unnecessary and makes it harder to access vaping products than cigarettes. Is that really what Greg Hunt wants.?

Resources

Smokefree Environments and Regulated Products Act

Media release 10 August 2021

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:

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.

Penalties

Importing nicotine without a valid prescription carries a penalty of up to $222,000 under the Customs Act, p644 (222 penalty units, $1,000 each). The penalties for importing or possessing nicotine without a prescription are totally disproportionate to the risk involved.

State and territory penalties for possession without a prescription are up to $32,000 and  2 years jail time! A prescription is not required to possess nicotine e-liquid in South Australia but will be required after 1 October 2021.

STATE PENALTY PRISON TERM LEGISLATION
ACT $32,000 max or prison or both 2 years Medicines, Poisons and Therapeutic Goods Act 2008,  4.1.3, 36
Western Australia $30,000 Medicines and Poisons Act 2014, 2.16.2 and 115
Victoria $1,817 Drugs, Poisons and Controlled Substances Regulations 2017
South Australia $10,000 max TBC >1 Oct21 Controlled Substances Act 1984, 4.22
Northern Territory $15,700 max or prison 12 months Medicines, Poisons and Therapeutic Goods Act , 2.2, Div 3, 44.2
Queensland $27,570 max Medicines and Poisons Act 2019 , 2.1.1.34
New South Wales $2,200 max or prison or both 6 months Poisons and Therapeutic Goods Act 1966, No 31, 16
Tasmania $8,650 or prison Up to 2 years Poisons Act 1971, Part 3, Division 1, Clause 36

It is a good idea to keep a copy of the prescription on your smartphone in case an authority asks to verify it.

Resources

Nicotine vaping products and vaping devices. Guidance for the Therapeutic Goods (Standard for Nicotine Vaping Products) (TGO 110) Order 2021 and related matters. July 2021

Standards for nicotine e-liquids
Therapeutic Goods (Standard for Nicotine Vaping Products) (TGO) Order 2021

Explanatory statement for TGO 110

Nicotine e-cigarette laws are changing. TGA 5 July 2021


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