Want to quit smoking? How about liquid nicotine

The debate over whether e-cigarettes are a cure or a curse just got a little more complicated

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The debate over whether e-cigarettes are a cure or a curse just got a little more complicated

A Sydney-based company has quietly begun online sales of liquid nicotine to help patients quit smoking, using a regulation exemption that allows the controlled substance to be dispensed on prescription for therapeutic purposes.

While growing numbers of Australians have been buying liquid nicotine online from overseas under the Therapeutic Goods Administration’s personal importation rules, Nicopharm is the first provider of a locally compounded solution.

Nicotine, a Schedule 7 dangerous poison, was also classed as a Schedule 4 substance when used in therapeutic dosage forms, Teresa Nicoletti, external legal counsel for Nicopharm, told The Medical Republic.

“What that means is, as long as a doctor issues a prescription and says I want you to compound liquid nicotine for my patient, then Nicopharm can lawfully compound that product into its finished dosage form and issue it to the patient on receipt of their prescription,” she said.

The TGA has no oversight of the product, and patients can secure prescriptions via Nicopharm’s website after stating their intent to quit smoking and completing a medical questionnaire which is reviewed by a doctor.

The company could not advertise the S4 solution directly to consumers, however, and it aimed to involve medical professionals in the process, Dr Scott Chapman, a director and part-owner of Nicopharm, told TMR.

“The idea is that GPs or other doctors can also send in prescriptions or give patients prescriptions so they can access liquid nicotine through us as well,” Dr Chapman said.

“It’s not an exclusively online system, but to make it as simple for patients as possible while staying within the boundaries of what we think is reasonable, we tried to come up with a model that would work.”

The company said it wanted to give patients access to liquid nicotine in Australia as a stop-smoking aid and a harm-reduction agent.

“I think this is a really useful thing for patients,” Dr Chapman, who practices in Sydney as an infectious diseases physician, said. “For chronic smokers, if we can get them onto electronic cigarettes we are reducing a lot of harm if they can’t quit by other means.”

Since launching a few months ago, patient numbers have been small, closer to 30 or 40 than 100, he said.

But potential demand is huge. The UK market is said to comprise seven million people, who can buy liquid nicotine freely over the counter, and the cost of the Australian product is low, at $20 to $40 for a few months’ supply.

Debate in Australia over e-cigarettes as a smoking cessation tool is still very polarised between ardent vapers, who want UK-style open slather access, and sceptics with concerns about potential perils.

Dr Chapman agreed some regulations should remain in place.

“I think we are striking the right balance between access and regulation at this point in time. As the evidence evolves over the next few years, maybe this will change… We need to see how this works and how it works within the community,” he said.

In a recent MJA article, Professor Mike Daube and others argue too little is known of the long-term effects of vaping and it is difficult to find evidence that e-cigarettes are better than conventional means in helping smokers quit.

Professor Daube said he had serious reservations about what he had seen of Nicopharm and had found it difficult to find information about its products.

But smoking cessation specialist Dr Colin Mendelsohn welcomed the venture and said vaping should be encouraged as a low-risk intervention.

“There are many smokers who are unwilling or unable to give up with conventional treatments. This is an alternative which, in my experience, has been very effective for many patients,” he said.

“I think most people will end up doing it on their own, just like they try to quit smoking on their own. But overseas experience shows quitting by vaping is most successful if it’s combined with behavioural counselling and other medications.”