Australia’s drugs regulator is investigating several telehealth platforms that offer prescriptions only for nicotine vaping products, which experts warn could compromise patient care.
The Therapeutic Goods Administration (TGA) confirmed it was assessing the vaping prescription telehealth sites medicalnicotine.com.au, myduke.com.au, quitmate.com.au and a site related to quitmate, medmate.com.au.
“Although these services are not illegal, advertising them could, depending on the context, amount to encouraging patients to request a particular prescription medicine and may therefore amount to unlawful advertising of that prescription medicine,” a TGA spokesperson said.
“We do not provide information on active investigations.”
MyDuke provides patients with a nicotine vaping product script that can be used only at the MyDuke online pharmacy. The pharmacy offers patients Veev vape products, which are owned by the tobacco company Philip Morris International. The company did not respond when asked whether it also stocked any other brands.
As Guardian Australia reported last year, PMI made a deal with some Australian pharmacies to supply its Veev products below cost, offering them at an 80% margin on condition they sign a supply agreement with the tobacco giant.
MyDuke is owned by MEPH Pharmacy Ltd, which was previously fined $39,960 for unlawful advertising of nicotine vaping products.
Patients who use medicalnicotine.com.au are provided with an online script which must be used at the online pharmacy QuickRx (now known as Quitmed). When Guardian Australia used the service in late February, patients were directed to enter their email address, tick a box declaring they were over the age of 16, and were then directed to a credit card payment page. After paying $40 to receive a script for a six-month supply of vapes, and filling in a short questionnaire, they were sent the script.
The entire process takes just a few minutes.
After laws introduced on 1 March, vapes are now available to Australians only with a prescription.
In a February email from medicalnicotine.com.au acknowledging “March 1 looms ever closer,” the platform told customers “there are already some excellent online pharmacy options for ordering products, with delivery anywhere in Australia within days”.
The president of the Royal Australian College of General Practitioners (RAGCP), Dr Nicole Higgins, said patients should be able to use their prescription at any pharmacy of their choosing.
“To all people using nicotine products, I encourage you to have a chat to your GP about quitting,” she said.
“We can talk through a full range of options, rather than just pushing you towards one particular product or service. Remember too, GPs provide holistic care and will take full account of your circumstances and medical history.”
The Medical Board of Australia also has concerns about prescriptions that are offered without a consultation.
It says: “Prescribing or providing healthcare for a patient without a real-time direct consultation, whether in-person, via video or telephone, is not good practice and is not supported by the Board.”
A customer who left a review of the MyDuke prescribing service on the productreview.com.au website said she filled in the online form for a vape script on behalf of an NDIS client seeking help to quit smoking.
“Within 30 minutes of applying, we received an email from a doctor (no phone call) saying the prescription had been approved … never spoke with this doctor,” she wrote.
“No medical history taken, no discussion about weaning off cigarettes.” The reviewer wrote that when she tried to view the prescription online, she couldn’t open it.
“I called MyDuke Pharmacy and was told that you don’t get to have a copy of the prescription. Only THEIR pharmacy gets to see it because YOU CAN ONLY BUY FROM THEIR SHOP!” she wrote.
The Medmate website offers telehealth appointments for a range of conditions, but has partnered with the vaping telehealth platform Quitmate to provide all nicotine cessation consults and prescriptions.
The Quitmate website has been advertising heavily on social media platforms, with the ads highlighting “price hikes of cigarettes” and the “tobacco tax” to encourage people towards the prescription service.
A spokesperson for My Duke and My Duke Pharmacy said: “Doctors provide tens of thousands of telehealth consultations in Australia every day and smoking cessation is no different.
“We are unaware of any assessment by the regulator.”
Neither quitmate.com.au, medmate.com.au nor medicalnicotine.com.au responded to requests for comment.
A Pharmaceutical Society of Australia spokesperson said: “The PSA’s view remains firm in that it is not the role of health professionals, including pharmacists, to recommend unregulated products purporting to be therapeutic goods to patients.
“Nicotine vaping products are not a first-line option for smoking cessation,” they said.
“The body of scientific evidence points to registered Nicotine Replacement Therapy, and other prescription-only medicines as being the most effective way to quit, in combination with supports such as Quitline or health professional consultations.”
The chief executive of the Consumers Health Forum, Dr Elizabeth Deveny, said she was concerned a patient’s regular doctor might not know about telehealth prescriptions from online-only providers.
“If you’ve had this conversation with your health professional, and they haven’t been supportive of you trying vaping as a means of quitting, there may be good clinical reasons for that, and these may not be understood or not disclosed at the time of going to the telehealth vendor,” she said.
“We are concerned this model, ‘quickly go over here and get a service’ where you might pay upfront, means you get it quickly but without the same questions asked [as your own GP would ask].
“We’re not sure that model necessarily ticks all the boxes that we want to see in a safe, person-centred, high quality model of care.”
Do you know more? melissa.davey@theguardian.com
