Risk/Benefit Evaluation of NVP's

The Government has asked the Australian GP community to preside over the introduction of NVPs as a new unapproved medicine. This will start at significant scale from October 2021.

There are no obvious precedents in medicine for what is likely to prove a challenge for GPs, even while it represents a unique opportunity to utilise NVPs in treating one of the most intractable health problems of our times.

A clear picture on the safety and efficacy of NVPs is not available because the evidence around both has derived from:

• Markets in which products are regulated as consumer goods;
• Heterogeneous product typology, due to rapid innovation since the technology’s introduction, and little, if any, regulatory oversight in its early history; and
• Regulatory contexts that differ between countries, with disagreements amongst the global research community as to what should even count as evidence ^[1].

In short, the literature does not provide a clear path towards satisfactory answers.

Nevertheless, there are fundamental areas in which consensus exists, which can guide judicious clinical decision making, ensuring a focus on patient safety.

Understanding nicotine delivery

• The nicotine concentration of any e-liquid offers limited predictive power as to the delivery of nicotine to a user.
• The amount of e-liquid that is turned into an aerosol for a given puff depends on the device, and principally the power at which it operates.
• In this way, a low concentration liquid can deliver very high levels of nicotine per puff, exceeding that of cigarettes.