Will Australia's tightened prescription system reduce nicotine vaping among young people?

Background: Australia introduced a prescription only policy for e-cigarettes in 2011 to prevent uptake among youth while allowing smokers to access e-cigarettes for cessation. This is one of the restrictive forms of regulation for e-cigarettes recommended by the World Health Organisation.

Aims: To assess whether the policy has prevented e-cigarette youth uptake and facilitated smokers' access to e-cigarettes for cessation; and to examine a proposed toughening of the policy.

Methods: An analysis of survey and administrative data on e-cigarette use and smoking and a critical analysis of the contents of submissions to parliamentary inquiries into the policy.

Results: E-cigarette use among youth and young adults has increased steeply since 2016 but very few of these products have been obtained through the prescription system, because medical authorities discourage their use. A policy change in 2021 to increase the prescription of e-cigarettes has not reduced e-cigarette use among youth and only marginally increased rates of prescribing. Australian policy makers have nonetheless tightened the prescription system by banning any use of e-cigarettes unless prescribed by a doctor and dispensed by a pharmacist.

Implications: Australia's tightened prescription policy for e-cigarettes may reduce adolescent vaping but at the risk of reducing smokers' access to e-cigarettes and increasing the size of the illicit market for combustible cigarettes and e-cigarettes. A more effective policy would allow vapes to be sold as consumer products by licensed tobacconists under regulations that require prior product approval, plain packaging, bans on their promotion and enforced age restrictions on purchases.