Your Postcode Shouldn’t Decide How You Quit Smoking

Australia has placed therapeutic vaping inside the pharmacy system. But a legal pathway means little if the person who needs it cannot realistically reach it.

Two adults wake up in different Melbourne suburbs and make the same decision: they want to stop smoking.

Both have smoked for years. Both understand the risks. Both have tried before. This time, they want to speak to a pharmacist about whether a therapeutic vape might help them leave cigarettes behind.

Let us call them David and Sarah. They are fictional people, created to illustrate the practical questions raised by a real study. Their experiences are not reported cases, and neither represents every person living in their suburb.

David lives in a more affluent part of Melbourne’s south-east. He has a car, some money left after the bills and enough control over his working day to make a few calls. If his nearest pharmacy cannot help, he can try another. An unsuccessful trip is irritating, but manageable.

Sarah lives in a less advantaged outer suburb. She works shifts, uses public transport and has children to collect. She can make a call during a break, provided someone answers before she has to return to work. Visiting another pharmacy involves checking bus times, arranging the school pickup and deciding whether she can afford the extra journey.

They have the same intention. They face very different costs in acting on it.

That difference deserves a much larger place in Australia’s vaping debate.

A study by Isabella Papadopoulos and colleagues, published on 3 July 2026 in the Health Promotion Journal of Australia, audited 418 community pharmacies across the South East Public Health Unit catchment. Data were collected between May and July 2025. Of those pharmacies, 174 - 41.6% - reported supplying therapeutic vapes. Availability was higher in areas of greater socioeconomic advantage.

This was a regional study of supply and pharmacy practice. It did not establish that unequal access caused different quitting outcomes. Nor can its findings be treated as a current national pharmacy census.

What it does establish is enough to demand attention: access to this cessation option was uneven within the region studied.

The phrase “available from pharmacies” sounds reassuring. It evokes familiar premises, professional advice and a service embedded in the community. But it leaves a crucial question unanswered.

Available to whom?

Under Victoria’s rules, adults can obtain therapeutic vapes containing no more than 20 mg/mL nicotine without a prescription, subject to a pharmacist’s assessment. Ordinary retailers, including vape shops and tobacconists, cannot legally supply vaping products. That makes practical access to an authorised supplier central to whether an adult can use this pathway. health.vic.gov.au

A government can establish that pathway in law. It cannot assume that writing it into law makes it equally usable.

Return to David. Imagine his first pharmacy does not supply therapeutic vapes. He phones another, confirms that a pharmacist can discuss them and drives there after work. He still needs appropriate advice. He still needs to decide whether the available product suits him. Nothing guarantees that he will stop smoking.

But he has reached the point where he can make an informed choice.

Now imagine Sarah’s first pharmacy cannot supply them either. She has enough time to ask one hurried question before returning to her shift. Later, she searches for another supplier while preparing dinner. She finds a possible option, but cannot tell whether the product is in stock or whether she can complete the consultation at a time that fits her life.

Her problem is no longer simply choosing a cessation aid. It is organising access to the choice.

These scenarios are illustrative. The study did not measure David’s drive or Sarah’s bus journey. They expose the questions that a pharmacy audit alone cannot answer: how long does obtaining a product take, what does the whole process cost, and how often does someone abandon the attempt before receiving help?

A service can exist within a region and still be out of reach for a particular person.

Distance is only one part of that problem. Opening hours matter. Reliable information matters. The ability to make private calls matters. So does having enough money to absorb an unsuccessful trip.

For someone with flexible hours, a car and spare cash, a referral elsewhere may be a small inconvenience. For someone juggling casual work, caring responsibilities and a tight budget, the same referral can consume the only opportunity they had that week.

We should be careful about interpreting persistence as motivation. David’s ability to visit three pharmacies would not prove that he wanted to quit more than Sarah. It might simply prove that he could afford to keep searching.

That is where the familiar language of personal responsibility becomes inadequate. People are responsible for decisions, but the choices they can realistically act on depend partly on how services are organised.

If a policy requires adults to use a particular supply system, government has a responsibility to examine whether that system reaches them.

The researchers’ interviews identified several barriers to provision, including perceived low demand, limited shelf space and concerns about the evidence. They also identified time pressures and a lack of remuneration for counselling. These findings suggest that access depends on the conditions under which pharmacies operate as well as the legal permission to supply.

That should prevent this discussion from becoming an attack on individual pharmacists.

A pharmacist may be managing prescriptions, vaccinations, staff shortages and a queue of patients. Meaningful cessation advice takes time. If government expects pharmacies to deliver that service, it needs to consider training, workload and funding alongside regulation.

Professional involvement can offer something valuable: an opportunity to discuss smoking, previous quit attempts and available treatment options. The question is whether the system consistently makes that opportunity accessible.

There is also a problem with treating low demand as a complete explanation for limited supply.

Demand expressed at a pharmacy counter is not necessarily the same as need in the surrounding community. Some adults may not know the service exists. Some may have stopped asking after previous refusals. Others may be unable to visit during suitable hours.

Those are possible explanations, not findings established by this audit. They deserve investigation precisely because a quiet counter cannot tell us how many people never reached it.

An access evaluation should therefore begin before the successful transaction.

It should follow the person who asks, the person who is referred elsewhere and the person who gives up searching. It should examine whether people obtain useful support, choose another cessation method, continue smoking or seek products through another route.

We cannot presume those outcomes. We need to measure them.

The questions I would put to the researchers are straightforward. How closely does pharmacy supply align with local need? What would a patient-level study add to the map? Could travel time, total cost, and unsuccessful attempts reveal barriers that a simple supply measure misses? And how should we test whether those barriers affect quitting?

The questions for government are more uncomfortable.

What level of practical access was expected when the pharmacy model was introduced? How is that access being monitored? What happens when supply is weaker in less advantaged communities? Who is responsible for closing the gap?

A national framework does not automatically deliver equal opportunity. Even where the legal rules are the same, their practical effects can differ sharply.

Online pharmacy services may help some adults. Victorian guidance provides for online supply with identity checks and appropriate procedures. But the existence of that option does not establish that it resolves every access barrier; delivery time, cost and the ability to navigate the service still need consideration. health.vic.gov.au

Similarly, the existence of other cessation treatments does not make this particular access question disappear. An adult may prefer another method, and good advice should help them consider it. But if therapeutic vaping is offered as a lawful cessation option, its accessibility deserves scrutiny on its own terms.

Otherwise, the response to someone who cannot obtain the option they sought becomes an administrative shrug: try something else.

That is a poor substitute for understanding why the pathway failed them.

The July study should prompt a practical review of how access is delivered. Reliable information about suppliers would help reduce fruitless searches. Support for pharmacists could make counselling easier to provide. Targeted action could focus on communities where gaps are identified. These are proposals to evaluate, rather than outcomes the study has already demonstrated.

Above all, evaluation should connect supply with people’s experiences and, eventually, their smoking outcomes.

Counting participating pharmacies is useful. Understanding whether an adult can obtain suitable help within the limits of their everyday life is more useful still.

Imagine Sarah finally finds a pharmacy she can reach. She gets advice, considers her options and chooses a way forward. That is the opportunity the system should make possible. Whether she succeeds in quitting remains an empirical question, influenced by many things beyond access alone.

But she should not have to demonstrate exceptional logistical skill before she is allowed to try.

Australia’s public-health debate often asks whether adults should have access to therapeutic vapes. The policy already provides a conditional answer. We now need to examine what that answer means outside the legislation.

Does it mean a realistic opportunity to seek help? Or does it mean an option that becomes easier to use as income, mobility and control over working hours increase?

The Melbourne findings do not settle every argument about the pharmacy model. They make complacency harder to defend.

A person’s determination to stop smoking should not be tested by how many unsuccessful journeys they can afford. Their willingness to seek help should not be judged by whether they can rearrange a shift or find someone to collect the children.

Your postcode should not decide how much effort it takes to reach a way out of smoking.

And when a government chooses the doorway, it has a responsibility to find out who can actually get through it.