Pharmacist-only supply of nicotine vaping products: proposing an alternative regulatory model for Australia

Regulation of nicotine vaping products (NVPs) is an ongoing challenge across the world. Australia currently has a globally unique NVP regulatory model that requires a medical prescription to purchase and use NVPs, with further restrictions in progress in response to evidence of widespread illicit NVP sales. Against this background, we examine the new measures and consider a modification of the model to pharmacist-only supply as an option for increasing access to NVPs for smoking cessation, while retaining health practitioner oversight of supply. We describe the strengths and challenges of implementing a pharmacist-only NVP supply option in Australia. Compared with the current prescription-only model, pharmacist-only supply could increase access to a lower exposure nicotine product in a highly regulated therapeutic context while addressing youth access and purchasing for non-therapeutic use, reduce demand for illicit products for smoking cessation purposes and avoid overburdening medical services with consultations to obtain NVP prescriptions. This approach can also accommodate current government goals such as eliminating NVP advertising, youth-focused branding and supply from grocery and convenience stores.

The impact of pseudoephedrine regulation at Australian pharmacies through Project Stop: A narrative review

ISSUES

Project Stop, a real-time monitoring program for pseudoephedrine-containing medicines, was initiated in 2005 by the Pharmacy Guild of Australia in collaboration with police in the state of Queensland. The program implemented an online database to record pseudoephedrine purchases (and attempted purchases) to prevent large-scale diversion to methamphetamine production.

APPROACH

This narrative review aims to understand the overall impact of Project Stop, what evidence exists for this kind of intervention in Australia, and what lessons can be learned from its introduction. Systematic database searches were conducted in Embase, PubMed, Web of Science and Google Scholar, with 20 relevant sources selected for inclusion.

KEY FINDINGS

Project Stop successfully prevented some pseudoephedrine from being diverted from pharmacies to methamphetamine production. The intervention has been most effective in jurisdictions that made the program mandatory. Project Stop was also associated with a temporary decline in clandestine laboratory seizures in Queensland, changes in methamphetamine production methods and reduced voluntary treatment admissions for methamphetamine use. Implementation was not associated with an appreciable effect on secondary indicators, such as methamphetamine production and harmful use.

IMPLICATIONS

Future applications of a Project Stop model must ensure ongoing impact evaluation, assessment of its effect on individual's drug-related behaviour and combine it with policies that address drug use as a health issue.

CONCLUSION

Project Stop has been narrowly successful in terms of reducing pseudoephedrine diversion and demonstrates the potential for third-party policing practices directed at the consumer level, in collaboration with healthcare practitioners, rather than only regulating precursor wholesalers.

What isn't public health?

By recognizing the structural causes of health and illness, public health has often been associated with values of compassion and solidarity, and a relational understanding of human agency. Rather than supporting the consistent integration and application of these insights, however, public health is now sometimes invoked more as a rhetorical move, used to construct issues as simple questions of neoliberal scientistic rationalism. Public health practitioners must reckon, therefore, with how the field can be discursively deployed in the public square, for multiple divergent political ends. If public health is always positioned as a value-neutral and detached scientific approach to addressing complex subjects, from drug use to pandemics, it not only fails to connect with the arguments of its critics, but further divorces what was once called the public health 'movement' from the strong and progressive political and theoretical positions it was founded upon and should advocate for today.

‘Making Ground’: An Ethnography of ‘Living With’ Harmful Methamphetamine Use and the Plurality of Recovery

The trajectories of people attempting to reduce harmful methamphetamine use are frequently understood within a binary framework of transitioning between states of health and disease. This framework can often be reinforced by service interactions informed by these dominant narratives of recovery and addiction. In this paper, we draw on a critical interactionist analysis of ethnographic fieldwork conducted with people who use methamphetamine, to examine how their experiences could undermine this binary, observing the ways participants experienced growth, change, and progress, without necessarily maintaining abstinence. These findings support a more diverse understanding of drug use trajectories, and we explore the concept of ‘living with drug use’, similar to how people live with other chronic conditions by finding ‘health in illness’. Participant experiences are also interpreted within the context of counter public health, arguing for the recognition and integration of values and goals which are divergent from the implicit aims of public health practice.

The Blind Men and the Elephant: Meta-Ethnography 30 Years On

In the 30 years since its introduction, meta-ethnography has become a critical tool for synthesizing qualitative health research and providing a holistic understanding of complex health and social phenomena. Meta-ethnography has also been adapted to integrate a wider range of research methodologies, expanded to include a detailed taxonomy of research methods, and has led to the development of multiple other methods of synthesis. In this article, we describe the development of meta-ethnography, its unique research approaches, the innovations that have occurred since its inception, and potential future directions for the method. These include the need for consensus around the role of systematic database searches and critical appraisal, and a clearer path to action for clinicians interpreting qualitative research. Understanding and updating methods such as meta-ethnography will ensure that the exponentially developing field of qualitative research continues to have a meaningful and cumulative impact on complex issues of health and well-being.

Wearable near-infrared optical probe for continuous monitoring during breast cancer neoadjuvant chemotherapy infusions

We present a new continuous-wave wearable diffuse optical probe aimed at investigating the hemodynamic response of locally advanced breast cancer patients during neoadjuvant chemotherapy infusions. The system consists of a flexible printed circuit board that supports an array of six dual wavelength surface-mount LED and photodiode pairs. The probe is encased in a soft silicone housing that conforms to natural breast shape. Probe performance was evaluated using tissue-simulating phantoms and in vivo normal volunteer measurements. High SNR (71 dB), low source-detector crosstalk ( ? 60 ?? dB ), high measurement precision (0.17%), and good thermal stability (0.22% V rms / ° C ) were achieved in phantom studies. A cuff occlusion experiment was performed on the forearm of a healthy volunteer to demonstrate the ability to track rapid hemodynamic changes. Proof-of-principle normal volunteer measurements were taken to demonstrate the ability to collect continuous in vivo breast measurements. This wearable probe is a first of its kind tool to explore prognostic hemodynamic changes during chemotherapy in breast cancer patients.

On Impostorship, Cultural Suicide, and Other Dangers: How Nurses Learn Critical Thinking

Critical thinking is an important idea whose time seems to have come for nursing education. However, as a newly fashionable buzzword, it is in danger of being uncritically accepted, of being regarded as the panacea for all problems of nursing practice. This article goes behind the positive rhetoric of critical thinking to explore how this process manifests itself in the lives of nursing practitioners, nurse managers, administrators, and educators. Drawing on nurses' own stories of what happened as they challenged conventional professional or organizational assumptions and as they explored alternative perspectives on nursing practice, a picture of critical thinking "from the inside" emerges. Themes of impostorship, cultural suicide, lost innocence, roadrunning, and community emerge as defining features of the critical thinking process. It becomes clear that critical thinking is a strongly emotional as well as cognitive process, and that it carries considerable political dangers for its protagonists.