Joanna: Hello and welcome. I'm Joanna Junak and this is GFN News on GFN TV. In today's program we talk with Dr. Carolyn Beaumont from Australia, a general practitioner and authorized prescriber of nicotine, who strongly advocate for healthier adenoties for smoking through her work in the tobacco harm reduction period. Thank you Carolyn, for joining us today. First, can you tell us what you do and what is your area of interest?
Carolyn: So what do I do? Well, I am a GP and I do that part time. But over the last three years more and more my area of interest has become in the field of tobacco harm reduction. So I started prescribing nicotine for ex smokers in Australia about three years ago and we need to prescribe in Australia because it is the prescription model and there are very few doctors who were doing that. So yeah, I learned everything from Dr. Colin Mendelsohn who I think is very well known and yeah, he's really been my mentor with all of this and it's gradually become sort of more and more a part of my life, I guess my passion about tobacco harm reduction and becoming an advocate for it. Now I've cut down my normal GP hours quite considerably and spending more time with this and also creating education programs. I've been rolling them out to some schools about issues of black market vaping last year and then this year looking at doing some more with doctor education as well and hopefully getting out to some high risk communities in Australia of heavy smokers and talking to them more about tobacco harm reduction. So, yeah, it just started as a little area of interest and it's really become a major part of my life as a doctor now.
Joanna: You focus on helping the people who need reduced risk products demolished, whatever they gender. Could you tell us more about the difficulties smokers face when trying to quit, especially if they don't have access to nicotine vapes?
Carolyn: Yes, there's so many difficulties and until I started working in this area I had no appreciation of it whatsoever because I'm a non smoker myself and we never really taught the complexities of this medical school. But I guess in terms of the big difficulties, firstly, it's generally something that they've started when they were a teenager, usually because of curiosity. Everyone else was doing it growing up with a smoking background, so they've just had years of exposure to it, first of all. And then it becomes habitual. It becomes part of their life, their social group, smoking environments are the norm for them, so that becomes a barrier to quitting. And then as much as they want to quit the, you know, that the realities of the how strong nicotine addiction is, you know, just become so, so hard to sort of get past them, I guess, for them. And, you know, they'll generally they'll have tried the nicotine replacement, therapies so they'll usually have given a good go with the pouches, got the gums, the inhalers the mists, those sorts of options. There's champagnex as well. And generally well, I see the patients where these things don't work, so I hear the bad stories about it. But the big reasons why these other options don't work are usually a mixture of side effects. So things like headache, nausea, bad taste, things like champagne can cause worsened mental health, really bad nightmares as well, or they just don't work as well, they just don't stop the cravings. So mixture of side effects not being effective, and also the cost can be quite prohibitive as well. So they'll often have tried. We've got in Australia the Quit Line, which is a government funded counseling service, and I know it certainly can be beneficial, but for all of the heavy adult smokers I see, it might be maybe a bit tokenistic. Sometimes they feel that they're being spoken down to or the person is reading off a script, or they might send them a fridge magnet, say chew gum. So sort of not terribly effective techniques often that they're offered. So yeah, then they just go back to smoking. And then the issue has been in Australia that if they access Vaping, it might be effective, but then they're using it illegally because unless they have a prescription, that becomes a problem and a lot of people don't want to run that risk, they'll be accessing black market products. So that's sort of the many barriers. I just would never have really been able to understand this. And I think the other barriers to stopping is that people use the nicotine to help medicate. So, for example, there's coexisting ADHD is not uncommon and they'll say the smoking helps them with that, but they find Vaping is even more effective at helping the ADHD, but also they'll use smoking as a way to not use other drugs, for example. Again, I've been quite interested to hear that they find Vaping is even better at that. So I'm not sure what's going on there, but they tend to say the smoking was helping with their ADHD or their drug use, but the Vaping is even more effective at that.
Joanna: You provide nicotine scripts for adult smokers. Can you tell us more about this project?
Carolyn: Yes, it's through Telehealth, so it's an online service. So it'll be people from all around Australia so that they book the consult with me and then they access a questionnaire. And that's quite comprehensive and I've developed that. I keep tweaking it as I learn more and more about the sorts of questions and subtleties of nicotine use that I want to find out and add more and more into that. So there'll be quite a drop down list, maybe, of what's improved in their life with Vaping and what would happen if they couldn't access Vaping legally, what would they do? So I'm getting quite a big data pull of responses now, which is really interesting, but yeah, essentially they go through that process. So I collect the information about their medical history, their level of smoking, level of addiction, what they've tried, why it has, why it hasn't worked, and then the majority are already vaping anyway, so they actually know what they want. Maybe 5% are brand new to it and need more guidance, which I can give guidance about the different types of products as well. But yeah, quite commonly they're officially new to Vaping, but they will have been using Saudi friends Vapes for a few months and so they know the brand. Yes, I give them a script. It's quite flexible. So sometimes they like to order monthly or three monthly, so I keep it flexible. I keep it as an up to sort of script so they can order up to a certain limit, so it's fairly generous so it gives them the capacity to make the choices themselves and then there'll be repeats on it so they don't have to come back and get another script for twelve months which can seem like quite a long time and there's always that balance between how much do I have review with them versus how much time do I as a single person have servicing many papers in Australia. So it seems to work having that balance where they maybe can order three months supply, have their repeats, and then we chat in twelve months and we have wonderful conversations even though it's usually virtually now I've been doing it for about three years sort of getting a really nice little cohort of people now, so it's quite a community.
Joanna: You've mentioned young people and their access to black market nicotine products. Can you tell us more about the education sessions you provide and why is so important?
Carolyn: Yes, well, I guess black market disposables are just absolutely rife in Australia, in large part because there are no approved products. Even the adults, the vast majority of adult vapors will be using black market products as well. But it's absolutely flooding schools and they're so easy to access. The concern to me it's not so much that it's going to turn a generation of youth into smokers because the data just does not suggest that at all. But the concern is that they're accessing very poor quality, poorly regulated, poor electrical, the electrical hazards in these devices are quite scary, so there's just nothing regulated about these products. The education program started more talking just about Vaping itself and the issues with vaping, but it started to focus more and more on the black market aspect of that because to me that's the bigger problem really. And I used to be a teacher many, many years ago, so I've always enjoyed working in schools, I love working with kids and yeah, I just saw this as an area that, hey, I can bring my two interests together. So it's just something that I trialed at my daughter's secondary school, much to her embarrassment, this mum up there, so I should run away and hide. But, yeah, I just started trialing it and the principal is really interested. Then I gave her parents information evening and then spoke to some year nine students and some of the year sevens. And, yeah, it's just been it's just been a sort of an evolving process. So I've probably presented to about six loop schools now. And I guess in terms of this year, I'm not sure how much I'll focus on that because I might need to get more education towards GPS and adults at high risk of smoking. But, yeah, we'll just sort of see what happens with these school programs. I think the other key reason why I've started doing it is because I think it's very important for anyone working in the THR field to be taking really seriously the issue of youth vaping, as well as get the importance of THR for adults. And in Australia, for example, most of the media is just full of bad news stories about vaping, that it's an issue with the youth and we never hear about the adult THR benefits. So my way of thinking was, well, okay, I'm active in the adult THR field, but let's get more of a media profile, let's be known a bit more for very actively educating youth, and then they might be more likely to listen also to my other message about adult THR. So I'm trying to do my bit to make the whole conversation, I guess, not about either youth vaping issues or adult THR, but part of a whole important spectrum which is about we need to have good, safe, regulated, approved products that adults can access easily, which will also help prevent a black market for youth. So that's my ideal.
Joanna: Thank you, Carolyn. That's all for today. Tune in next time on Gfntv or on our Gfntv podcast. You can also find transcriptions of each episode on the Gfntv website. Thanks for watching or listening. See you next time.