10 reasons why the new pharmacy vape model will fail

Posted on July 24, 2024 By Colin

FROM 1 OCTOBER 2024, vapes and e-liquids (with or without nicotine) will be classified as Schedule 3 medicines and will be legally available without a prescription only from pharmacies.

In a real-world episode of the comedy series Utopia, Mark Butler's Vaping Reform legislation was finalised in a last-minute backroom deal with the Greens, without any consultation with the pharmacy profession. Experts acknowledge communication was badly bungled.

Here are 10 reasons why the pharmacy model will inevitably fail, probably not before too long.

1. Pharmacists are rebelling

Pharmacists are angry they were not consulted. The Pharmacy Guild issued a media release stating it “strongly opposes this proposal”. The TerryWhite Chemmart, Priceline, National Pharmacies, Blooms and Pharmacy 777 pharmacy chains and thousands of individual pharmacies have expressed their opposition.

The Pharmaceutical Society of Australia (PSA) is not supportive of the plan but is willing to engage further.

How many of Australia’s 6,000 pharmacies will stock supplies and will it be enough for the 1.7 million vapers? Cigarettes are sold at up to 40,000 retail outlets at all hours of the day and night, including at petrol stations, tobacconists, pubs, liquor outlets, gift shops, convenience stores, and supermarkets.

2. Vapes are not approved medicines

Vapes are “unapproved” medicines. None have gone through the TGA’s rigorous medicines approval process and are not listed on the Australian Register of Therapeutic Goods (ARTG). All other S3 medicines are approved and are on the ARTG.

Many pharmacists believe that selling unapproved products puts them at-risk. If there was a side-effect, they would not have the same legal protection as they do for approved products. There is concern professional insurance premiums will rise.

3. Misperceptions about vaping

Vaping is poorly understood by the public, and pharmacists appear to have the same misunderstandings. For example, the Pharmacy Guild incorrectly wrote recently that vaping causes “cancer, lung-scarring and nicotine addiction” and that “There is limited evidence to support the use of vaping products for smoking cessation and nicotine dependence.” Also here.

Pharmacists are reluctant to sell products they believe may be unsafe or ineffective.

4. No reimbursement for a substantial workload

For each purchase, the pharmacist (not the pharmacy assistant) must personally have a detailed “therapeutic consultation” with the customer, for which there is no reimbursement. For every purchase, they must

• Verify that the product is for a ‘therapeutic use’ i.e. smoking cessation or nicotine dependence
• Check ID to confirm age
• Inform the customer that the product is an “unapproved” therapeutic product
• Give appropriate advice on dose and frequency and interactions with other medicines
• Get informed consent
• Provide advice on alternative quitting aids and supports
• Provide the contact details for smoking cessation support services
• Supply the vape in accordance with good pharmacy practice
• Notify the TGA via the SAS C notification system for each purchase
• Personally hand the products to the customer
• Notify the TGA of any adverse effects and defects

Ironically, the government also gets no revenue from this plan as Schedule 3 medicines are not eligible for GST.

5. A lack of training and protocols

Few pharmacists and staff are trained in vaping. The PSA has developed smoking cessation guidelines for pharmacists and will develop best-practice guidelines for vapes. However, for many pharmacists there are just too many unanswered questions about the regulations and the products.

Very few pharmacists will be able to provide detailed counselling if needed, product advice and ongoing support and troubleshooting.

6. Pharmacy sales will be minimal

Pharmacy products will be unappealing and expensive and few vapers will purchase them.

• Flavours are restricted to tobacco, menthol and mint
• Nicotine is capped at 20mg/mL freebase equivalent
• The range of e-liquid and hardware at each pharmacy will be small. Many vapers just want to use the specific product (device, flavour, nicotine level etc) that helped them quit
• Only one month’s supply can be purchased at a time

Vapers are uncomfortable having to speak to pharmacists who know far less than they do about vaping. None want to be lectured and judged on a monthly basis.

It is hard to avoid the conclusions that many vapers will head straight for the vape black market or return to smoking. Comments by vapers here, and here and here.

7. Demand and shelf-space

There is very little interest in filling up shelves with a wide-range of stock that may not be used. Most community pharmacies have had very few enquiries about vaping and see very little demand.

Under the current laws, pharmacies cannot advertise that they stock vapes.

8. The black market will adapt

Most vapers will continue to purchase supplies from the black market, which will go underground and continue to thrive. The black market will supply flavours and higher nicotine concentrations and broaden its offering of products.

9. Pharmacists are angry with Mark Butler

Community pharmacy is struggling. After the 60-day dispensing debacle, the $1 script discount and other challenges, pharmacists are not keen to do Mr Butler any favours. Some are refusing to cooperate in protest at the poor treatment of the pharmacy industry.

10. Other concerns

Organised crime groups have a low threshold for firebombing and extortion of vape and tobacco retailers. Sofar there have been 87 vape and tobacco shops firebombed, three contract killings and widespread extortion. Will pharmacies be the next target? Is it worth taking the risk?

There is a risk of customers buying from multiple pharmacies and on-selling vapes to underage users (diversion), driving up youth vaping. There are also concerns about hostility from angry vapers who are opposed to the pharmacy model, especially if the pharmacist chooses not to dispense to that customer.

What should be done?

My prediction is that the pharmacist-only model will last no more than  12 months.

Australia should follow the New Zealand model as soon as possible. Vapes are sold as adult consumer products from licensed retail outlets with strict age verification. This would make vapes more attractive, accessible and affordable for adult smokers. It would  reduce access for young people, generate tax revenue, reduce the black market and ensure products were fully regulated.