Vaping

Question 1

Vaping:
Vape devices and e-liquid form

Answer 1

Closed: - single use
Open: - manually fill and re-fill with e-liquid

e-liquid:

Free-base
-if concentration >20mg/mL causes throat irritation

Salt
-less throat irritation
-higher levels of nicotine can be inhaled relative to free-base (possible greater propensity for addiction)
-as a result the volume of e-liquid consumption is less reducing exposure

Question 2

Vaping:
Prescribing and recommendations

Answer 2

Nicotine concentrations:
-maximum of 100mg/mL (concentrations usually calculated in g/mL)

Flavours limited mint, menthol, tobacco

RACGP recommendation
-if have failed to quit smoking with conventional first line therapy then vaping in combination with behavioural therapy is recommended with moderate certainty

<16yo = Special Access Scheme (SAS) B; single patient only

≥16yo = SAS C
-online
-immediate
-form for each patient
-submit within 28 days
-copy needed in notes
-pharmacist can submit the form on behalf of prescriber

Clinical Documentation

Current use:
Cigarettes-
Nicotine Vape Products-
Modified hooked on Nicotine Checklist (M-HONC) [≥1 = not in control of vaping] =

Single tobacco cigarette delivers approximately 2mg of nicotine.

Initiating dosage recommendations:
Less dependent = up to 50mg/day (salts ≤30mg/mL, free- base ≤12mg/mL)
High dependence = up to 75mg/day (salts >30mg/mL, free-base ≥18mg/mL)

Reason for vaping prescription:
Unsuccessful smoking cessation with first line nicotine replacement therapy

Consented to nicotine e-liquid
Discussed possible side effects including:
-death if ingested (5mg/kg)
-harm to brain development in adolescence
-nicotine dependence
-throat irritation, cough, headache
-unknown chronic lung disease implications
-interaction with other medication

DO NOT use unapproved flavours, vitamin E, THC/CBD products not designed for device due to increased risk of harm and/or death.

Acknowledged that understood and accepted the side effects above.

Consent document signed - see documents.

TGA SAS form B submitted
OR
TGA SAS form C submitted

If repeat consult:
Adverse effects reported -
No. of tobacco products being used per day -

Plan:
-All non prescribed NVP nicotine and combustable tobacco encouraged to be ceased
-consider weaning or transition to NRT in 12 weeks
-aiming for duration of NVP up to 12 months maximum
-Quitting support that are NVP specific: SmokeSCREEN video game, “This is Quitting” text messaging program

Script details
Brand/Product
Device - Closed/Open
Nicotine mg/mL
Daily dose
QuantityRepeats