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Guidance for the use of nicotine vaping products for smoking cessation
This page contains practical guidance to assist prescribers with the prescribing of nicotine vaping products. This guidance can be used regardless of whether the prescription is to be dispensed by an Australian pharmacy or from an overseas retailer through the Personal Importation Scheme.
Clinical guidelines for prescribers
Prescribers should be familiar with the clinical advice provided in the Royal Australian College of General Practitioners (RACGP) Supporting smoking cessation: A guide for health professionals (RACGP Guidelines). The RACGP Guidelines stipulate that nicotine vaping products are not a first-line treatment for smoking cessation. The strongest evidence base for efficacy and safety is for currently approved pharmacological therapies combined with behavioural support. They also state that there is a lack of well conducted randomised controlled trials comparing nicotine vaping products with approved pharmacoptherapies, such as bupropion and varenicline.
For people who have unsuccessfully tried to stop smoking with approved pharmacotherapies, but are still motivated to stop smoking, nicotine vaping products may be a reasonable intervention. However, this needs to be preceded by an evidence-based, informed shared decision-making process.
Clinical efficacy evidence
Evidence of the potential efficacy of nicotine vaping products for smoking cessation is currently mixed, with more reliable, large-scale studies required (references are provided in our Guidance for Therapeutic Goods (Standard for Nicotine Vaping Products) (TGO 110) Order 2021 and related matters).
An updated Cochrane Review (published September 2021) compared the effects of nicotine vaping products with other ways of delivering nicotine, such as nicotine replacement therapies (NRTs) like patches and chewing gum, e-cigarettes without nicotine, and behavioural support only/no support. The review included 61 studies (16,759 participants), including 34 randomised controlled studies and 27 other studies. Seven studies were rated as having a low risk of bias, 42 at high risk of overall bias, and the remainder were of unclear risk. In relation to the quit rates:
- Four studies, involving 1924 participants, showed higher quit rates in people randomised to nicotine vaping products than those randomised to NRT (risk ratio RR = 1.53). This might lead to three additional people per 100 quitting smoking using nicotine vaping products compared to NRT. This was moderate-certainty evidence, limited by imprecision.
- Five studies, involving 1447 participants, showed higher quit rates in people randomised to nicotine vaping products than to e-cigarettes without nicotine (risk ratio RR = 1.94). This might lead to seven additional people per 100 quitting smoking using nicotine vaping products versus non-nicotine e-cigarettes. This was also moderate-certainty evidence, limited by imprecision.
- Six studies, involving 2886 participants, showed higher quit rates in people randomised to nicotine vaping products compared to those who received only behavioural support or no support (risk ratio RR = 2.61). This might lead to six additional people per 100 quitting smoking using nicotine vaping products versus behavioural support only/no support. This was very low-certainty evidence, due to issues with imprecision and bias risks.
The Cochrane Collaboration is an international non-profit organisation formed to organise medical research findings to facilitate evidence-based choices about health interventions. A Cochrane Review is a systematic review of research in health care and health policy.
A recent (August 2021) meta-analysis from the University of Queensland provided similar results. The study found that participants randomised to receive nicotine vaping products were 49% more likely to remain abstinent from smoking than those who received other NRTs (risk ratio RR = 1.49, 9 trials with 6080 participants). Those randomised to receive nicotine vaping products were 109% more likely to remain abstinent from smoking than those in control conditions where no nicotine was supplied (risk ratio RR = 2.08, 7 trials with 5674 participants). However, it concluded that more high quality studies are required to ascertain the effect of nicotine vaping products on smoking cessation due to risk of bias in the included studies.
Another recent (September 2021) meta-analysis from the Australian National University also demonstrated a small benefit in smoking cessation for freebase nicotine vaping products compared to approved NRT, in the clinical context and based on low certainty evidence. Significantly greater quit rates for participants randomised to freebase nicotine vaping product were found compared to no intervention or usual care; evidence was also of low certainty.
Practical information on nicotine vaping products
The following practical information and resources about nicotine vaping products are provided for prescribers and consumers in light of the mixed efficacy evidence.
This document contains practical information produced by a team from the University of Wollongong, based on their years of practical research on nicotine vaping products.
It is intended to respond to the question: ‘If I decide to prescribe a nicotine vaping product, what type of product(s) should I look at?’
There is information on the different kinds of nicotine vaping products and vaping devices available and suggestions on the starting point for new users (i.e. smokers not currently using nicotine vaping products).
This practical information is not based on clinical evidence.
This document contains practical flowcharts produced by a team from the University of Wollongong, based on their years of practical research on nicotine vaping products.
It is intended to assist prescribers who are considering prescribing nicotine vaping products for ‘new’ and ‘existing’ users.
It includes an overview and pictorial representations of different types of vaping device systems with suggestions on dosages.
This practical information is not based on clinical evidence.
Health practitioner resources from the United Kingdom and New Zealand
The following links are to resources for health practitioners from the United Kingdom (UK) and New Zealand (NZ).
It is important when reading these materials to be aware that, unlike in Australia, nicotine vaping products are available in the UK and NZ as consumer products (not medicines) without a prescription. The focus in those jurisdictions is on harm reduction. Nevertheless, nicotine vaping products are regularly used by health practitioners in the UK and NZ for smoking cessation programs.
United Kingdom resources
- E-cigarettes: a guide for healthcare professionals is a course developed by the National Centre for Smoking Cessation and Training (UK) to assist health and social care practitioners to support people wanting to use nicotine vaping products to stop smoking.
- Electronic cigarettes: A briefing for stop smoking services is a National Centre for Smoking Cessation and Training (UK) briefing to assist smokers wanting to use electronic cigarettes to help them stop smoking. Released in 2016, it provides evidence as well as practical information on the use of nicotine e-cigarettes for smoking cessation.
- Information for specialist stop-smoking services that are considering providing e-cigarette starter packs: recommendations from the Trial of Ecigarettes (sic) (TEC) is a National Centre for Smoking Cessation and Training (UK) briefing summarising the findings from the Trial of E-Cigarettes (TES) research that was carried out in stop smoking services in London, Leicester and East Sussex. It includes recommendations for stop smoking services on providing starter packs.
- Using e-cigarettes to stop smoking is a National Health Service (UK) briefing on the use of e-cigarettes to stop smoking.
- Combination nicotine replacement therapy (NRT) is a National Centre for Smoking Cessation and Training (UK) briefing on the efficacy of a combination NRT (e.g. patch plus a faster acting form such as gum, inhalator etc.) relative to a single NRT product.
- Vaping Facts includes several resources for new users (smokers).
- Vaping to Quit Smoking includes information for patients on other means to support their quest to stop smoking, whether vaping is an appropriate treatment and, if so, what product might be appropriate.
- Vaping vs other ways of quitting advises smokers on the different supports to stop smoking, including behavioural support and pharmacological therapies.
- Nicotine management and What vape liquid should I get? are two articles on nicotine management that include advice on nicotine free base versus nicotine salt products, including relative concentrations, and how to be ‘vape-free’.
Frequently Asked Questions
See the 'Prescribing nicotine vaping products' section of the Nicotine vaping products: Frequently Asked Questions for further information.
 Hartmann-Boyce J, McRobbie H, Butler A, Lindson N, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti N, Turner T, Fanshawe T, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews. 14 September 2021. URL: Electronic cigarettes for smoking cessation - Hartmann-Boyce, J - 2021 | Cochrane Library
 Chan G, Stjepanović D, Lim C, Sun T, Anandan A, Connor J, Gartner C, Hall W, Leung J. A systematic review of randomized controlled trials and network meta-analysis of e-cigarettes for smoking cessation. Addict. Behav. Aug 2021. Electronic publication 15 March 2021. URL: https://pubmed.ncbi.nlm.nih.gov/33798919/
 Yazidjoglou A, Ford L, Baenziger O, Brown S, Martin M, Zulfiqar T, Joshy G, Beckwith K, Banks E. Efficacy of e-cigarettes as aids to cessation of combustible tobacco smoking: updated evidence review. Final report prepared for the Australian Government Department of Health: online version, September 2021. URL: http://hdl.handle.net/1885/247864