Australia’s prescription-only model continues to make legal nicotine vapes difficult to access—blocking smokers who want to quit and vapers who need to stay off cigarettes. In this episode, meet Dr. Carolyn Beaumont as she reveals the challenges, controversies, and consequences of being one of the only doctors in the world prescribing nicotine in a country at war with vaping.
Featuring:
DR. CAROLYN BEAUMONT, MD
Australian General Practitioner/Family Physician
Transcription:
00:10
Brent Stafford: Hi, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV. Australia's war on vaping has reached new heights of absurdity. Despite overwhelming evidence that nicotine vapes are the single most effective tool to help smokers quit, the government has doubled down on its draconian prescription-only model, forcing millions of Australians to rely on the black market for access to safer alternatives. Joining us today for a deep dive into the issue is Dr. Carolyn Beaumont, a courageous Australian physician on the front lines of tobacco harm reduction. As one of the few doctors willing to prescribe nicotine for smoking cessation, Dr. Beaumont has faced relentless scrutiny from media and regulators, forcing her to fight not only for her patients, but also for her right to practice medicine. Dr. Beaumont, thanks for joining us today on RegWatch.
01:07
Carolyn Beaumont: Brent, thank you absolutely delighted to be invited to the program well thank you very much dr beaumont you weren't always involved in tobacco harm reduction what first got you interested in this field yeah it was uh because back in 2020 and there just seemed to be a bit of a meeting of various circumstances so One of them was that I had just finished my GP training, finished my exams. For the first time in many years, I was able to explore other areas of interest. I'd always been fairly interested in maybe some of the more fringe medicine, things like medicinal cannabis, for example, but had never, of course, come across vaping. It was just a mystery to me. But it just then coincided with me reading through some various GP college articles and whatnot and I saw something by this stranger Dr Colin Mendelsohn and I haven't heard of him and there was something about vape regulations and scripts needed for overseas importation I thought what's this about yeah so I just had a read of the article um And also keep in mind that back then there wasn't all the media beta about it. So there was neither good nor bad really known about it. So I was coming to it from a very neutral space. I was just curious. And after I read his article, I just realised, oh, this is something I never considered about smokers and they've been using something else successfully for years and now that they're going to have to go through all these hurdles to get a prescription and from what Colin was saying, there are hardly any prescribers in Australia. So look, one thing led to another, got on the phone, spoke to Colin, introduced myself and being the wonderful, warm, generous person he is, he just was so happy to teach me so many things.
03:04
Brent Stafford: Dr. Beaumont, as you know, Australia has some of the harshest restrictions on vaping in the world. Could you encapsulate the plight of vaping in Australia and the challenges vapers face?
03:16
Carolyn Beaumont: So back then, so 2020... Up until then, I think for several years, there had technically been a requirement that the person needed a prescription to import vapes from overseas because they weren't legally sold in Australia. If they contained nicotine, all the accessories were available in Australia, but not the actual nicotine. So there was this technical law, but in 2020, that then tightened up between federal and state. So then it could be enforced again. So there were very few prescribers. There was a government website. If you wanted to be a prescriber, you just had to be listed and authorised. And there were seven prescribers. And of those, a few doctors didn't really prescribe nationally, just to their own private patients. There was a particular clinic with a handful of doctors. There was Colin and then myself. So there were just... Less than 10 of us really doing the work of what should be, you know, Australia's workforce of some 30,000 GPs.
04:24
Brent Stafford: That's amazing. So tell me a little bit about what the challenge is then that these patients, I guess, is it okay to call them patients?
04:33
Carolyn Beaumont: Yes, yes. Look, you know, various people use different words. I mean, you know, I sort of think of them in some ways consumers or customers, but on the other hand, patients, because there are a lot of unmet medical needs. So short look, I think just for ease, consistency will save patients.
04:48
Brent Stafford: So what kind of challenges do they face? I mean, let me first just ask, I mean, how much worse is it now than it was in 2020? I mean, or are the challenges the same?
04:59
Carolyn Beaumont: No, it's worse now and the challenges are more and the key reason is because the personal importation has stopped really. I mean, look, I've always been fully supportive of any moves to regulate the field, of course. And it's so important that we have that distinction between black market vapes and the regulated, much higher quality vapes. So I've never been opposed to that. But unfortunately, stopping the personal importation has created such an access issue. Firstly, people just don't know how they can access them. You know, pharmacies aren't allowed to advertise that they stock fake products as a prescriber. You know, I'm not allowed to overtly say. I mean, certainly my approach is approach the person as a whole and address all their needs. And if that may or may not involve a fake prescription, if appropriate, that's sort of part of it. But people just can't access the information. They tend to go into Reddit forums, and then there's just the various online prescribers start to become known.
06:11
Brent Stafford: So the online prescribing, that's a big thing there?
06:16
Carolyn Beaumont: Yes, yes. So even just over the last few years that I've been prescribing, there have been more and more pop-up online clinics. And I guess where I've always come from is that I put my name and my face out there and people know exactly who they're dealing with. They're dealing with Dr. Carol Beaumont, whereas there are now a lot of other pop-up clinics. They're usually associated with the online pharmacy that supplies the vape and the person can get a script. They won't even know who the doctor is. Often the script never gets seen by the patient. It just goes to the back end, to the pharmacy. It's very rare that they even... will speak to a doctor. If they do, it might be a two minute, you know, just read off a script type of consult.
07:03
Brent Stafford: Dr. Beaumont, let me ask you, these actions, which, you know, I call punitive, they're all about protecting the children, are they not?
07:12
Carolyn Beaumont: It's always going to be a complex issue. And of course, Anyone who is sensible and sane wants the best outcomes for the next generation. Absolutely. But unfortunately, the vape laws as they stand have simply made the black market stronger, stronger, more powerful, more expensive. And what it's doing is actually normalizing to kids now. what the vapes are black market products so what i fear is that today's teenagers who are vaping and you know certainly some of them are going to continue on with that into early adults maybe later although no is black market fakes they really won't know about how to access good quality vapes because it's so difficult to find that information and that to me is really sad um And it's not saying that I then want teenagers to then vape, whether it's, you know, legal regulated ones or not. But it's such a shame that the worst possible example of vapes, the black market disposables, are what kids are knowing and using and associating with and getting addicted to. That's a tragedy. And we could and should do so much better.
08:28
Brent Stafford: So tell us then about disposables in Australia. How available are they? Like, can you go to a corner store or gas station and find disposables?
08:39
Carolyn Beaumont: anywhere, absolutely anywhere, totally rife, especially in the metro areas. It does become a bit different when you get to the fairly remote communities in Australia, which are hundreds of kilometres from other towns. They really just have cigarettes. Even accessing Blackbuck is difficult. But in terms of metro areas, absolutely everywhere. It's become more and more blatant. It's It's ridiculous. Some tobacconists and other shops that used to have the word vapes on it, all they've done is put a bit of tape over it. So they're everywhere. And they've basically tripled in price in the past year.
09:19
Brent Stafford: If disposables are available everywhere, doesn't that just make a farce of the ban and all these restrictions and prescription only?
09:27
Carolyn Beaumont: I believe it does. I mean, the black market has just become stronger, more expensive. Look, I know there's certainly a lot of government funding that's going into stopping things at the border, and that's great. Obviously, we need a lot more. But certainly, there's just no slowing down of the availability of black market disposables. Whereas on the other hand, the access and availability of You know, the regulated products, it's just very unknown. It's very hard to find that information.
10:08
Brent Stafford: So, Dr. Beaumont, you've built a reputation as one of the few doctors in Australia actively prescribing nicotine. Can you explain what your role entails and how your practice has evolved?
10:20
Carolyn Beaumont: Look, it has certainly evolved over a few years out of necessity and just the way one's thoughts work. and bigger picture of this issue developed. My practice has therefore developed as well. But essentially my role has been to, well, firstly to engage the smoker. So they generally have had fairly negative experiences with health professionals in the past, whether it's their doctors or the pharmacist or others. They're actually very used to being judged, being not listened to, not being met where they are in their journey. So I find the first aspect is really just to engage them and say, look, I'm here to work with you, two people equal for your best health interest. And then from there, the conversation is really quite easy. I always encourage them to be very open with me about what they've used, about what their smoking history has been, what they've tried or, you know, they've generally tried everything, all the other MRTs. And some of them have worked for some reasons or at various times in their life, but they And I'm talking about more established, maybe middle-aged smokers. They just keep going back to smoking, and they hate it. They hate themselves for it. They never talk about wanting to smoke. They talk more about this necessity that they have to smoke, and they hate it. They hate that the cigarette controls them. So most of my patients over the past... few years they've done the hard work for me they had already transitioned to vaping anyway and their life had changed and their finances were better and their health was better and their self-esteem was better everything was better in their life um so a lot of it has been just for me being able to continue facilitating that so they can keep getting good quality products and they don't want to use black market products either
12:11
Brent Stafford: Dr. Beaumont, I don't believe there's anywhere else in the world where doctors are required to prescribe nicotine. Is there anything unusual about this setup in your view?
12:20
Carolyn Beaumont: Oh, well, yeah, absolutely. It's hardly unusual. And look, there's certainly nothing wrong with a government wanting to see, is there a better way to do things? That's how we progress. That's fine. And I know the intentions have been Very good. And the intentions have always been for the best public health interest. But, yeah, unfortunately, it just hasn't worked. And it is really because, well, doctors aren't aware of, really aren't aware of what vaping is all about at Doctors are human, we're susceptible to all the media hype that everyone else is. And the same with pharmacists as well. So while there's that whole resistance and barrier to doctors and pharmacists being able to prescribe and dispense, the script system just won't work.
13:19
Brent Stafford: When you first started prescribing nicotine, did you face resistance from your peers, other doctors and pharmacists?
13:27
Carolyn Beaumont: I didn't really seek out the forums that would but you get to speak to some extent. I mean, look, yes, there'd be some GP Facebook groups and overall they weren't terribly supportive, but even then some of them were and, you know, there'd be a little bit of commentary about my business. Even with that group, I'm finding in private a few doctors would reach out to me and say how much they supported what I did and someone just very interested wanted to chat further. But, look, we've got 30,000 GPs in Australia and, again, There's a very vocal minority who'll get online. So what I have found, though, is that just in one-on-one conversations with other doctors, I actually are interested. You know, we're doctors. We're taught to be unbiased to appraise the evidence. So I've had more positive discussions one-on-one, but it's very hard to have that reach to many doctors online.
14:25
Brent Stafford: So I have to ask you, Dr. Beaumont, what does a prescription for nicotine vape look like?
14:34
Carolyn Beaumont: It's always the big question from everyone else in Australia. How the hell do you prescribe a vape? Yeah, so I've mocked up this one, which as I've written, it is not a valid script. I've removed any identifying codes on it. So For example, you know, we simply work out, well, what would be their average use over a week? And this is a very common one, so 6, 3, 6, 12 mg. They'll say, yep, go through a bottle a week. So I simply make it up for a three-month supply. And that's it. And we can do the same thing with closed pods. So it might say something like, you know, nicotine closed pod for inhalation, 36 mg of milk. If we base it on, say, every juice of one pot a day, I then just scale it up to a three month supply. I can always put a repeat on that to make it a six month supply. I don't need to put flavors on it. I don't need to prescribe the actual devices. So it's just the nicotine content. So there's no brand needed, no flavors, no device accessories on the script.
15:38
Brent Stafford: So it's really essentially down to the drug.
15:42
Carolyn Beaumont: Yes, that's right.
15:44
Brent Stafford: So nicotine's a drug. I think we all know that. How dangerous is it?
15:47
Carolyn Beaumont: I guess, firstly, you need to define danger, don't you? And what are we comparing the danger to? So that's always a starting point. That's always where I've approached this field. What are we comparing the danger to? Everything's dangerous, you know. So for me, always keep in mind the smoking harms that we're comparing it to. So as we all know, it's not ultimately the nicotine that's causing the lung cancer, the cardiovascular disease or the other smoking harms. So we're uncoupling nicotine from tobacco. But yeah, so nicotine's not a benign molecule, of course. It's a stimulant and it increases blood pressure, although more of a short-term nature. If someone's got underlying heart arrhythmias, it could worsen that. You know, certainly I'm very concerned and interested in evidence regarding high nicotine use for teenagers on their brain development. You know, I'm I'm always open to all the evidence. So, yeah, look, it's not benign, but certainly there are many, many benefits to it and that's why people keep using it. So my philosophy really in life and not just tobacco harm reduction is life is messy, life is complicated. There's this perfect nirvana of, no drug use and we all exercise and we all eat unprocessed foods. But in reality, life is more messy than that. Humans have been seeking out nicotine forever and it's for a reason and they're going to keep doing so. So for me, it's saying, well, what is the safest way that people can access nicotine? It's not so much saying how dangerous is nicotine.
17:35
Brent Stafford: So Australia technically removed the prescription requirement for nicotine up to 20 mg, yet in practice, the system seems to not be working. So, you know, is it pretty much a de facto prescription model no matter what?
17:51
Carolyn Beaumont: It is, yes. So that was a... The decision by the government to remove the prescription requirement for free base equivalent up to 20 mg. And so that would be available over the counter from the pharmacist. It was a fairly last minute decision. It really took the pharmacy guild unawares as well. But the problem is that the pharmacists themselves have their very own strict code of conduct and there are a lot of requirements for them to be able to dispense over the counter. And that includes the pharmacist having to have a personalised discussion with each patient. And, you know, it would take at least 15 minutes to be able to do that properly. So that's just not tenable. There's no... very minimal if any government support of you know for pharmacists to be able to provide that sort of training on top of all the other work that they do so in reality um if someone comes in with a prescription the pharmacist doesn't have to go through all of that so essentially um The main pharmacists that are willing to dispense vapes are online pharmacies, and they're still fully legitimate pharmacies. There's just a handful of them, and they focus their area on vape products, mostly liquids rather than closed pods. So because they can't do that sort of individualized approach, then they need a script.
19:28
Brent Stafford: So, Dr. Beaumont, I mean, it's pretty clear that the pharmacists have been reluctant to participate in this program, but you just got some good news today.
19:36
Carolyn Beaumont: That's right. Very rare in Australia, probably anywhere, to get good news related to THR policy. But yes, I saw that one of the ex-vice presidents of the Pharmacy Guild said, She came out publicly and said that she will be stopping vapes and she cited it as being of harm reduction benefit, of public health benefit, that it was an important tool in smoking cessation. And that was incredibly refreshing. Of course, when you scroll down on the article and quite a few comments, none of them were supportive, unfortunately, and I guess people Fairly predictably, she was accused of just chasing the dollars. But I was heartened that at least there's a pharmacist and someone who has been involved with the Pharmacy Guild. So someone who has been in a position of leadership is actually coming out and saying, guys, let's just rethink this opposition here.
20:39
Brent Stafford: So, I mean, we hear that, you know, for years. We get the sense that, you know, tobacco control and public health don't like entrepreneurship or capitalism, maybe even as far as that. What do you think?
20:51
Carolyn Beaumont: But in terms of, I haven't noticed any particular sort of resistance to the fact that I've had an entrepreneurial approach to things. I think it's just more, is it a money grabbing exercise?
21:06
Brent Stafford: But isn't that interesting because it's the government that actually put the medical profession and the pharmacies right in the middle of this whole process. And so then to attack them for being involved in a transaction, to me, is supercilious.
21:23
Carolyn Beaumont: Yes. I mean, for me, you know, I'm human just like the rest of us. Obviously, I have you know, bills to pay. So, you know, I don't have the luxury of just being able to prescribe and do all of this for nothing. But for me, it's a matter of, well, how am I best going to use my medical skills and my, you know, my general philosophy of the most benefit I can provide to people? How am I going to use that? And I've decided, well, I'm going to do that through tobacco harm reduction rather than, you know, sitting in a suburban practice prescribing antibiotics. Nothing wrong with antibiotics.
22:03
Brent Stafford: Do you think that asking doctors to prescribe nicotine is a valid use of health care resources?
22:11
Carolyn Beaumont: Not at the moment, not the way the current system is, where there's just not a proper set of guidelines about how to prescribe. There are some guidelines there, but it's really very, very difficult. It's too much to expect doctors which are, you know, overwhelmingly non-smokers, non-vapors. It's a big ask to expect them to know the products, know liquids, know the different coils, just understand the field. And that's really what they're expected to do when they're being asked to prescribe. So... Someone like myself, I've had to seek out the information. And it's just through conversation after conversation with vapors, finding out what the products are. And you can't expect many GPs to do that.
23:03
Brent Stafford: Dr. Beaumont, tell us, is the media in Australia friendly to vaping?
23:09
Carolyn Beaumont: No. No, they're not. No. Whether it's The Guardian or any other newspaper, You know, obviously journalists have a crucial role in calling things out, questioning things, absolutely, and as they should. You know, the Guardian have asked quite a lot of probing questions about a few of the prescribing clinics, the other online clinics, and they've included me in that. Many of the questions are very legitimate and I've never been I would never shy away from good debate. I've got nothing to hide. I feel that they might have gone a bit far with continuing the focus in the past year just on me at the expense of continuing to explore many of the other pop-up clinics that are doing sort of these rubber stamp type scripts. But I also understand that it is because I'm more high profile. So there's really no other prescriber out there who has set up a national clinic for smoking cessation that includes these therapies, who's put their name and their face to it, who's then also speaking at the conferences and making it national, really with the exception of Dr. Colin Mendelsohn. And we all know how much he's been thrown under the bus over the years. So I do see, look, I do have the responsibility to be setting a high standard for what nicotine prescribing is. And I've always welcomed any discussion from journalists or others.
24:53
Brent Stafford: And I guess they, you know, they would bring up the point that, you know, a little more transparency, I think they ask of you. And there was some issues around some fundraising.
25:04
Carolyn Beaumont: Yes, that's right. Yes. Look, I'm here. I'm human. I think one thing we don't learn in medical school is how to set up your own business, in particular how to set up your own business in a fairly contentious area and then navigate all of the complexities that can come from that. So... I fully own and acknowledge that I've stumbled a bit, you know, over these four years, I think, you know, because my focus has always been on the patient on the best half. So patient focused and in my zeal and passion to make that as effective and wide reaching as possible. Yeah, I've made some missteps. Absolutely. And look, I applaud the Guardian for calling that out. And I have no problem at all with fixing things up. So, you know, I know one thing that they brought up was that I wasn't transparent with my funding. And I guess maybe in my naivety I just didn't really think the sort of work I did with my patients. They knew exactly who I was and they could see all the various, you know, conferences, things I'd been to and spoken at. So I didn't really. I just it didn't cross my mind as being necessary. But look, it was pointed out. And of course, absolutely happy to be fully transparent. That's on my website now.
26:23
Brent Stafford: Dr. Beaumont, you've placed a strong focus on helping teens transition from black market vapes to legal prescribed vapes. Tell us about that.
26:33
Carolyn Beaumont: We want them to stop vaping. We don't want teenagers to be we don't want more teenagers to be taking up nicotine than otherwise would advise smoking. But I think it's working with teenagers, you have to be very careful. They're very easy to disengage. And once you've disengaged a teenager, that's it. Conversation's over. So for me, I think that starting point of if they're really not open to the conversation at all, if their parents just drag them into a discussion with the doctor, I think it's realistic to say, well, okay, look, using these black market vapes you don't know what's in them we don't know what strength is really you really don't know what your nicotine intake is if as an interim step we can transition you to a pharmacy vape at least we know what we're dealing with so then they can actually measure and know how many milligrams of nicotine they are actually using over a day and then if you can measure it you can change it so once they're at that point you know we could change them to a medium strength closed pot. I wouldn't be using open system with teenagers. Of course, it's got to be much more limited and finite, but then you can go to the low dose one and then they can really start to understand their use. And then it can become about, okay, well, how much of this fake use is the hand mouth, the social action, and how much is the nicotine neat? And maybe can we replace that baseline nicotine need with a patch? and just start to address it that way. So I know there's been some criticism of me that I'm just wanting to get teenagers onto pharmacy rates. It's way more complex than that.
28:15
Brent Stafford: Dr. Beaumont, as you know, the 12th edition of the Global Forum on Nicotine, the annual conference on safer nicotine products, takes place again this year in Warsaw, Poland, from June 19 to 21, 2025. The conference theme is challenging perceptions. In your mind, what are some solutions to address the misunderstandings, misconceptions, and mischaracterizations that are holding back progress for safer nicotine products?
28:44
Carolyn Beaumont: I think a major area that's stopping progress is this perception that vapes are unregulated, that they're black market. And that's very, very damaging. It's stopping so many smokers from being open to the idea of changing to vapes, for example. There's a lot of perception, and you hear it all the time just in conversation with smokers and non-smokers. Oh, vapes, aren't they as bad as smoking? Or they might even say, oh, vapes, isn't that worse than smoking? So that's really concerning. So I think having a whole separation of black market vapes to regulated high quality vapes is so important. And if that can happen through much more support of health professionals in the pharmacy, then that's a good thing. I think we need to just continually bring it back to smoking harms. Again, I'm noticing in Australia a lot of advertising about stopping vaping but it never ever seems to also say don't start smoking and putting it in the context of smoking harm so we just have to keep coming back to the elephant in the room which is the death and disease caused by smoking and we all know how bad the figures are but for example it's in Australia one smoker every I think 28 minutes dies of smoking related death of space you know primarily lung cancer heart disease. The figures are just astronomical. In Australia, that rate was more than double the annual COVID death rate. And we closed down the country for COVID deaths. We rightly recognise that as being a massive, massive health crisis and it needed urgent attention. And it is something that is killing more than double that every day. And it has been for years and it's going to continue doing so. And it just gets forgotten. It just gets forgotten. And we need to bring that back hard and center to any discussion we're having.