Peter Guthrey FPS
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[post_content] => Although somewhat kept on the down low, nicotine inhalators – manufactured by the likes of Pfizer and Kenvue – have been discontinued. Are Pharmacist Only vapes the next best option?
Deepali Gupta, an advanced cardiac pharmacist at Queensland Health and co-chair of the Statewide Smoking Cessation Working Group, first heard rumblings in mid-2024 that nicotine inhalators would be discontinued.
‘This started off with some reports from overseas,’ she said. ‘The reason for discontinuation was because the resin required to make the mouthpieces can’t be sourced.’
This news affects a significant subset of patients with mental ill health, many of whom have higher rates of smoking and who currently rely on inhalators as part of their nicotine replacement therapy.
Nicorette inhaler discontinued in Australia, Pharmacies that sell non prescribed vapes in Melbourne?
byu/Angrygoat87 inquittingsmoking
‘At Queensland Health, nicotine inhalators are on the list of approved medicines for mental health and acute behaviour management patients,’ Ms Gupta said. ‘So as soon as we heard there’s a possibility they may be discontinued, we were concerned that it would affect patient care in the mental health unit.’
After confirming with the manufacturer at the time that there was sufficient stock of nicotine inhalators for at least 12 months, Ms Gupta and team were relieved.
‘We were also advised that Kenvue would be seeking out another supplier for the resin for manufacturing of mouthpieces, which was the main reason why they were at risk of being discontinued,’ she said.
‘Then [earlier this year] we received a notice through a community pharmacist that nicotine inhalators are discontinued. And that the pharmacy group is displaying posters in their pharmacies for their clients.’
Despite reaching out to the manufacturer multiple times, no feedback was received. ‘There is also nothing on the Therapeutics Goods Administration’s website about this discontinuation,’ she added.
Why are smoking rates higher in those with mental ill health?
Among Australians aged 18 years and over, smoking rates have been steadily declining – sitting at 11.1% in 2022–23.
‘[But in my experience] if you go to a mental health ward, around 50% of people are current smokers,’ Ms Gupta said.
The reasons for this are multifactorial. Higher smoking rates are often observed in communities experiencing social and economic disadvantage, including some Aboriginal and Torres Strait Islander communities, where complex social and emotional wellbeing factors play a role.
‘[And] people who are suffering from [poor] mental health may be living in low socioeconomic situations,’ she said.
What makes nicotine inhalators more appealing?
When it comes to smoking cessation, nicotine inhalators are the preferred nicotine replacement therapy (NRT) option among patients with mental ill health, Ms Gupta said.
Explaining the precise chewing technique required to release nicotine from gum can be challenging for someone experiencing acute mental illness. Likewise, conveying that nicotine lozenges must be held in the mouth for an extended period to ensure absorption rather than being wasted in the digestive tract poses a similar difficulty.
Some patients may also experience discomfort or anxiety about having a patch on their skin and may remove it prematurely, Ms Gupta said.
‘And sprays have a very strong taste, which can put them off completely,’ she added.
Nicotine inhalators, on the other hand, are much easier for patients to adapt to.
‘They are already used to the hand-to-mouth method from smoking, and the inhalator only needs to be set up once,’ Ms Gupta said. ‘You just tell them to suck on it whenever they feel they need to smoke. That works really well to keep mental health clientele calm.’
Should vapes be used as a substitute?
Ms Gupta recently turned to a close community pharmacist friend to ask, ‘What’s the situation with nicotine inhalators?’ Confirming they haven’t been available for many months, the pharmacist suggested that vapes are in stock and can be supplied over the counter. Hearing this from a senior pharmacist with decades of experience and a patient-first ethos alarmed Ms Gupta.
‘Some people may argue that vapes can be used as NRT, however, we know the amount of nicotine supplied through vapes is significantly higher. This feeds into the nicotine addiction rather than using lower levels and targeting nicotine withdrawal,’ she said. ‘If they are looking for NRT, we should be using the TGA-approved medications.’
Understanding that nicotine dependence varies per patient is key – particularly among patients with mental ill health, who often experience high levels of dependence and
derive symptomatic relief from nicotine. Vapes may not be therapeutically appropriate for this patient population, and are also not permitted in the same spaces as smoking – including in hospitals. So for these patients, it’s crucial to have as many options available as possible.
For example, those who have high dependence may need up to three nicotine patches. Patients should also be initiated on combination NRT, similar to how pain relief is approached.
‘You need something for the whole day and then a quick-acting [therapy] for the breakthrough,’ Ms Gupta said.
In Ms Gupta’s view, NRT is not being optimally utilised prior to a step-up therapy with varenicline and bupropion. But a targeted approach works best.
‘Some people don't want to [try] patches or gum and prefer to go straight onto tablets, so varenicline is a great option for them. Others don't want to take more medicines and are worried about adverse effects, so it's best to start them on NRT,’ she said. ‘It’s important to individualise treatment to see what your patient wants.’
For more information, refer to PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
[post_title] => Nicotine inhalators discontinued: are vapes an alternative?
[post_excerpt] => Although somewhat kept on the down low, nicotine inhalators have been discontinued. Are Pharmacist Only vapes the next best option?
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[post_content] => Mark Chantachak MPS has worked as a locum in many places in Australia. And
he’s learned a thing or two along the way.
What set you towards becoming a regular locum?
Over a decade ago, when there was an oversupply of pharmacists in Australia, I ended up working in a few casual roles.
Then an old friend referred me to a locum agency back in 2012. After enlisting with them, I suddenly started getting a lot of phone calls for jobs – from one-day postings to longer-term offerings for weeks or months at a time, and even permanent part-time roles. From there, the opportunities only grew.
Now I’ve enlisted with three to four agencies, and I also gain work through social media platforms. One of the best things about locuming is the flexibility.
You can dictate your own working schedule, choose when and where you work, and take a vacation whenever you feel like it. You can also kill two birds with one stone: working and travelling. I like to think of it as a working vacation. And on countryside locum stints, there’s no need to battle heavy traffic to get to work. You can even walk if you want to.
Where in Australia have you worked as a locum?
You wouldn’t believe the list of the places I’ve been to: Corowa, Parkes, West Wyalong, Orange, Boggabri and Dareton in New South Wales; Heyfield, Donald, Nhill, Horsham, Rainbow, Jeparit, Bendigo, Warragul, Drouin, Morwell, Swan Hill, Bairnsdale, Ballarat, Lakes Entrance, Sale, Moe and Seymour in Victoria; Cairns and Atherton in Queensland; and Broome in Western Australia – to name just a few!
Every destination offers its own perks. As tourist towns, Broome, Cairns and Atherton have a lot of activities to offer. In these spots, you also get to meet the international workers during social activities, such as language, Latin dancing and poker nights. I liked Broome for its friendly staff who educated me on the making of TikTok videos. Another highlight was the camel riding. But my most rewarding stay would have to be in Heyfield, where I experienced both personal and professional growth. My social skills vastly improved through meeting so many people at football, tennis, touch football, and basketball games.
During my time there, I also had the pleasure of participating in the World’s Greatest Shave, where I coloured and shaved my head, with the whole town rallying to raise funds for cancer research. I had a friend who survived leukaemia.
What are the ideal ingredients for a successful locum posting?
Keeping up with continuing professional development and education is important for staying current with practice. Personality is also important. In my opinion, you have to be a people person to be a good locum, because, as your workplace is always changing, you need to continually get on well with new staff and patients.
You also have to love road trips. Some drives to locum stints can be quite long, so you have to love travelling to new, different towns – sometimes in the middle of nowhere.
Flexibility is also key; you need to be able to adapt to new procedures quickly. Different teams work in different ways, so you have to be able to adjust to how they work. And then there’s the need for speed. You have to pick things up quickly and complete tasks at a rapid pace.
Confidence, empathy and the ability to identify conflicts early – so you can iron out any issue between staff – will also set you on the right path.
Where would you like to be in 5 years?
Continuing to work and travel around Australia, but exclusively in rural and regional areas. There’s a lot of countryside I still want to explore.
I could honestly see myself carrying on this working lifestyle into my retirement years. And perhaps one day, when I have a family, I’ll have them in tow on my locum adventures.
Any advice for ECPs?
Attend all the conferences and seminars you can. As well as continuing your professional development, they are also great for networking with fellow pharmacists, interns and students – which opens up both friendship and job opportunities.
I also encourage involvement in community activities during placements. Explore all the locational possibilities, and weigh up the pros and cons of each destination.
[post_title] => Locum life in rural and regional Australia
[post_excerpt] => Mark Chantachak MPS has worked as a locum in many places in Australia. And
he’s learned a thing or two along the way.
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[post_content] => The biggest pharmacy organisations in Australia have put out a joint statement to advance autonomous pharmacist prescribing.
The Joint Pharmacy Organisations’ Paper for Endorsed Pharmacist Prescribers, authored by PSA, the Pharmacy Guild of Australia and Advanced Pharmacy Australia, recommends that the Pharmacy Board of Australia introduce an endorsement for pharmacists to be able to prescribe autonomously within a self-determined scope of practice.
The proposed endorsement will enable pharmacists to use the full extent of their training for patient care. Pharmacists will be able to assume appropriate prescribing responsibilities within their scope across settings – improving access, safety and continuity of care, particularly where health care services are stretched.
Why endorse pharmacist prescribing?
The current fragmentation of prescribing authority between states and territories is leading to inequities in patient access and inconsistencies in professional recognition.
Endorsement would allow the Pharmacy Board of Australia to formally recognise pharmacists who meet specific education and competence standards as Endorsed Pharmacist Prescribers.
Will the endorsement support harmonisation?
Should endorsement be introduced, it’s proposed that uniform national standards be established, ensuring that all endorsed pharmacists are recognised to practise within their qualified scope.
The uniform national standards for pharmacist prescribing will potentially be achieved through a registration system under the Pharmacy Board of Australia, supported by the Health Professionals Prescribing Pathway. This framework provides a consistent, competency-based approach to prescribing that applies across all states and territories, ensuring all pharmacists across Australia are held to the same regulatory, educational and professional standards – creating a unified, transparent standard for safe and effective prescribing practice.
[caption id="attachment_30798" align="alignright" width="225"]
PSA Vice President Professor Mark Naunton MPS[/caption]
This will promote workforce mobility, allowing pharmacists to move freely between jurisdictions without re-credentialing.
‘A nationally consistent approach via registration endorsement through the Board for pharmacist prescribers is vital to ensure access to health care services is equitable for all Australian patients, and that pharmacists are able to work to their full scope of practice regardless of which setting they work in – community, hospital, general practice, or a residential aged care home,’ said PSA Vice President Professor Mark Naunton MPS.
How can pharmacists define their individual scope of practice?
A Decision-Making Framework for Scope of Practice will need to be developed by the Board alongside the endorsement to help pharmacists determine whether a particular prescribing activity falls within their competence and authority.
The proposed Framework should provide structured guidance for pharmacists to self-assess, document and justify their scope of practice in relation to prescribing activities. Pharmacists will be required to evaluate their competence, setting, patient needs and available resources before undertaking prescribing responsibilities.
‘The framework will ensure pharmacists prescribe autonomously but responsibly because they will be guided by their education and training, pharmacy practice standard, scope of practice, professional development, and collaboration with health care teams,’ Prof Naunton said.
How will pharmacists become Endorsed Pharmacist Prescribers?
The paper recommends that to gain endorsement, registered pharmacists must successfully complete an Australian Pharmacy Council (APC) accredited and Pharmacy Board of Australia approved course that aligns with the National Prescribing Competency Framework.
It’s proposed that pharmacists demonstrate the full range of competencies outlined in the Framework, including:
‘We’ve seen various pilot programs in action, in states like Queensland, New South Wales and Victoria. The goal is now establishing a consistent, national approach to pharmacist prescribing.' Professor Mark Naunton MPSQueensland’s pilot for chronic disease management has shown improved access in rural and remote areas, with positive outcomes for patients with chronic conditions. And hospital-based programs such as Partnered Pharmacist Medication Charting and Partnered Pharmacist Medication Prescribing have achieved up to 94% reductions in medicines errors, with shorter hospital stays for patients. ‘We’ve seen various pilot programs in action, in states like Queensland, New South Wales and Victoria. The goal is now establishing a consistent, national approach to pharmacist prescribing,’ Prof Naunton said.
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[post_content] => With glucagon-like peptide-1 receptor agonists (GLP-1 RAs) back and some basal insulins disappearing, pharmacists face a new wave of complexity in diabetes management.
Diabetes management has been significantly disrupted in recent years, from ongoing shortages of (GLP-1 RAs) to the discontinuation of several insulin formulations.
But with medicines like semaglutide (Ozempic) back on the market and the impending discontinuation of another long-acting basal insulin analogue – there are further complexities to navigate.
Here, Australian Pharmacist explores how the sector is tackling these issues.
Ozempic return leads to medicine double-ups
Medicine shortages of popular diabetes medicines have eased this year, including the official removal of Ozempic from the Therapeutic Goods Administration’s medicine shortages list in July.
But throughout the shortage period, it became common for patients to receive multiple prescriptions for whichever medicine was available at the time, said Kirrily Chambers MPS, Advanced Practice Pharmacist and credentialled diabetes educator during the National Medicines Symposium 2025, held last week.
For example, when Ozempic was out of stock, Ms Chambers said patients were often issued a prescription for sitagliptin (Januvia) in addition to their usual semaglutide.
‘When there have been issues with not being able to get [the medicine], people will often pick up both scripts when it comes back on the market,’ she said.
‘A patient might collect a 6-month prescription for Januvia. Then, when they present to the pharmacy, the pharmacist says, “Mrs Jones, your Ozempic is back – would you like one?” The patient says, “Yes, please,” forgetting the GP or specialist had advised using Januvia only while Ozempic was unavailable.’
If pharmacists encounter this situation, they should contact the GP or specialist to confirm the prescribing was intended.
‘We're now ringing to say, “Hey, did you really mean to put this person on multiple things? Because 6 months ago, they weren't on all these medications”,’ she said. ‘This is part of deprescribing to keep people safe, so that they're not bouncing into hospital.’
Regular Diabetes MedsChecks and medicines reconciliation, or a Home Medicines Review where appropriate, is critical to help the person living with diabetes understand the therapeutic approach. Any issues or duplications identified should then be communicated to the multidisciplinary team.
Discontinuations leave some patients without options
In the last few years, numerous diabetes medicines have faced discontinuation, including several insulin formulations and the GLP-1 RA liraglutide(Saxenda). There have also been device discontinuations, which can make diabetes care more difficult for older patients, said Associate Professor Margaret McGill AM, nurse manager and associate director at Royal Prince Alfred Hospital’s Diabetes Centre.
‘We know that people are living longer … and that age is the biggest predictor of type 2 diabetes,’ she said. ‘So we now see many referrals of people in their 80s and 90s – and some of these people need to go on insulin.’
Often, older patients don’t have the dexterity to navigate some of the newer devices, including putting a cartridge into a reusable pen.
‘When we lose the simple devices … it’s really impactful,’ A/Prof McGill told Symposium delegates.
Distinguished Professor David Simmons, the Chief Medical Officer, Diabetes Australia, has tried to ensure there are replacements for some of these devices.
‘Protaphane [is] one that we're trying to do, and it's quite challenging,’ he said.
‘If you're working with people [who have], for example, gestational diabetes, and they only have a limited number of weeks to actually understand what they're doing, some of the quicker learning devices are superior to learning how to put a cartridge into a pen.’
But the device discontinuation causing the most concern, however, is insulin detemir (Levemir) – which is set to be discontinued by December 2026.
Some patients who can tolerate a once daily dose of insulin could go on glargine, Prof Simmons said. However, the individual risks must be calculated for each patient.
‘For those who need Levemir twice daily so it can cover them during the day and night, there's a big risk when we go to once a day,’ he said.
‘During the day, they will be at risk of hypos – perhaps when they're driving if they haven't got a sensor on, or if the sensor is not working. If they then reduce their dose and their glucose goes up, they're going to be more hyperglycaemic at night – which will directly lead to long-term complications.’
While Diabetes Australia is looking into management strategies, the only current solution for these patients is an insulin pump.
‘There’s nothing else that's going to replace it for those individuals, and they may not be able to afford a pump,’ Prof Simmons said. ‘So we're certainly concerned about that. And GPs and pharmacists need to be very much aware that this is what's coming.’
Finding the right therapeutic approach
When considering new medicines for patients that are appropriate for diabetes, they must be selected for a person through a complex algorithm, said Dr Gary Deed, Chair of the Diabetes Specific Interest group at the Royal Australian College of General Practitioners.
‘[You] have to think, “do [they] have high blood pressure, lipid problems, kidney disease, metabolic-associated fatty liver disease? And how then, do I adapt that framework to the choices of medications and then negotiate with [the patient]?’ he said.
‘[You need a] well-trained, systematic approach and a very clear perspective of what that person is, not just physically, but also emotionally, and how they live.’
Renza Scibilia, a diabetes advocate who has lived with type 1 diabetes for 27 years, said that there’s a broad spectrum of people living with diabetes, and their understanding of the diabetes landscape may vary, including:
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[post_content] => Questions about spacers are abundant in community pharmacy. AP answers some of the trickiest ones pharmacists face.
Aren’t spacers just for kids?’ This is a common misconception pharmacists hear. People of all ages should use a spacer whenever they use a pressurised metered dose inhaler (pMDI).1 Spacers slow down aerosol spray, improve lung delivery and reduce oropharyngeal adverse effects like irritation, hoarseness or oral thrush from inhaled corticosteroids (ICS).1,2
They’re also useful for anyone who struggles with coordination or breath timing. When used correctly with a spacer, a pMDI delivers medicine as effectively as a nebuliser, and is often more efficient and convenient.2
Which spacers are better?
Spacers can be made of plastic or cardboard. Collapsible spacers are more compact for the patient to carry. Cardboard spacers fold flat for easy storage. Some spacers have additional features e.g. anti-static spacers improve delivery of active ingredient by preventing medicine from sticking to the walls.4
Some spacers have an inhalation indicator that moves when the patient inhales and whistles if they inhale too fast.4 Spacers with one-way valves stop exhalation into the chamber, helping keep the medicine inside and making delivery more effective.4
Anti-bacterial spacers are embedded with materials e.g. silver ion to inhibit bacteria growth. Choice of spacer depends on age, treatment, budget, dexterity and lifestyle. It should suit the patient, be easy to put together and be compatible with their inhaler.2,3 The Spacers for pMDIs Chart helps identify spacer options. Visit www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/charts
Do all inhalers fit into a spacer?
Not always. Some spacers have a rigid or fixed connection end. Those pMDIs with circular mouthpieces may require spacers with a flexible rubber/silicone opening that can form a seal around the mouthpiece. If in doubt, test the fit in the pharmacy and demonstrate with the patient’s own device.
Which devices don’t need spacers?
Breath-actuated inhalers, such as Accuhaler, Autohaler, Breezhaler, Ellipta, Respimat, Spiromax, and Turbuhaler are not spacer-compatible.5
Who needs to use a mask with a spacer?
A tightly fitting face mask is used for anyone who may find it harder to take a breath in through their mouth or cannot seal their lips tightly around the mouthpiece of an inhaler or spacer.2
What’s the big takeaway?
Spacers aren’t just for kids. For adults, they support technique and mean better medicine delivery with fewer adverse effects. Pharmacists play a key role in helping patients, especially adults, understand why using a spacer with pMDI is recommended.
References
- Lung Foundation Australia. Spacer and puffer inhaler device technique fact sheet. 2025. At: https://lungfoundation.com.au/support-resources/resource-hub/spacer-and-puffer-inhaler-device-technique-fact-sheet/
- National Asthma Council Australia. Spacer use and care fact sheet. 2025. At: www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/factsheets/spacer-use-and-care
- Respiratory Therapeutic Guidelines. Inhalational drug delivery devices Melbourne: Therapeutic Guidelines; 2020 (amended 2025). At: https://app.tg.org.au/viewTopic?etgAccess=true&guidelinePage=Respiratory&topicfile=inhalational-drug-delivery-devices&guidelinename=Respiratory&sectionId=toc_d1e208#toc_d1e208
- National Asthma Council Australia. AeroChamber Plus* Flow-Vu* Spacers for pMDIs Information Paper. 2025. At: www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/information-paper/aerochamber-plus-flow-vu-spacers-pmdi
- Asthma Australia. Devices and Techniques. 2025. At: www.asthma.org.au/devices-techniques/puffer-and-spacer/
[post_title] => Why all patients should be using a spacer
[post_excerpt] => Questions about spacers are abundant in community pharmacy. AP answers some of the trickiest ones pharmacists face.
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[post_content] => Although somewhat kept on the down low, nicotine inhalators – manufactured by the likes of Pfizer and Kenvue – have been discontinued. Are Pharmacist Only vapes the next best option?
Deepali Gupta, an advanced cardiac pharmacist at Queensland Health and co-chair of the Statewide Smoking Cessation Working Group, first heard rumblings in mid-2024 that nicotine inhalators would be discontinued.
‘This started off with some reports from overseas,’ she said. ‘The reason for discontinuation was because the resin required to make the mouthpieces can’t be sourced.’
This news affects a significant subset of patients with mental ill health, many of whom have higher rates of smoking and who currently rely on inhalators as part of their nicotine replacement therapy.
Nicorette inhaler discontinued in Australia, Pharmacies that sell non prescribed vapes in Melbourne?
byu/Angrygoat87 inquittingsmoking
‘At Queensland Health, nicotine inhalators are on the list of approved medicines for mental health and acute behaviour management patients,’ Ms Gupta said. ‘So as soon as we heard there’s a possibility they may be discontinued, we were concerned that it would affect patient care in the mental health unit.’
After confirming with the manufacturer at the time that there was sufficient stock of nicotine inhalators for at least 12 months, Ms Gupta and team were relieved.
‘We were also advised that Kenvue would be seeking out another supplier for the resin for manufacturing of mouthpieces, which was the main reason why they were at risk of being discontinued,’ she said.
‘Then [earlier this year] we received a notice through a community pharmacist that nicotine inhalators are discontinued. And that the pharmacy group is displaying posters in their pharmacies for their clients.’
Despite reaching out to the manufacturer multiple times, no feedback was received. ‘There is also nothing on the Therapeutics Goods Administration’s website about this discontinuation,’ she added.
Why are smoking rates higher in those with mental ill health?
Among Australians aged 18 years and over, smoking rates have been steadily declining – sitting at 11.1% in 2022–23.
‘[But in my experience] if you go to a mental health ward, around 50% of people are current smokers,’ Ms Gupta said.
The reasons for this are multifactorial. Higher smoking rates are often observed in communities experiencing social and economic disadvantage, including some Aboriginal and Torres Strait Islander communities, where complex social and emotional wellbeing factors play a role.
‘[And] people who are suffering from [poor] mental health may be living in low socioeconomic situations,’ she said.
What makes nicotine inhalators more appealing?
When it comes to smoking cessation, nicotine inhalators are the preferred nicotine replacement therapy (NRT) option among patients with mental ill health, Ms Gupta said.
Explaining the precise chewing technique required to release nicotine from gum can be challenging for someone experiencing acute mental illness. Likewise, conveying that nicotine lozenges must be held in the mouth for an extended period to ensure absorption rather than being wasted in the digestive tract poses a similar difficulty.
Some patients may also experience discomfort or anxiety about having a patch on their skin and may remove it prematurely, Ms Gupta said.
‘And sprays have a very strong taste, which can put them off completely,’ she added.
Nicotine inhalators, on the other hand, are much easier for patients to adapt to.
‘They are already used to the hand-to-mouth method from smoking, and the inhalator only needs to be set up once,’ Ms Gupta said. ‘You just tell them to suck on it whenever they feel they need to smoke. That works really well to keep mental health clientele calm.’
Should vapes be used as a substitute?
Ms Gupta recently turned to a close community pharmacist friend to ask, ‘What’s the situation with nicotine inhalators?’ Confirming they haven’t been available for many months, the pharmacist suggested that vapes are in stock and can be supplied over the counter. Hearing this from a senior pharmacist with decades of experience and a patient-first ethos alarmed Ms Gupta.
‘Some people may argue that vapes can be used as NRT, however, we know the amount of nicotine supplied through vapes is significantly higher. This feeds into the nicotine addiction rather than using lower levels and targeting nicotine withdrawal,’ she said. ‘If they are looking for NRT, we should be using the TGA-approved medications.’
Understanding that nicotine dependence varies per patient is key – particularly among patients with mental ill health, who often experience high levels of dependence and
derive symptomatic relief from nicotine. Vapes may not be therapeutically appropriate for this patient population, and are also not permitted in the same spaces as smoking – including in hospitals. So for these patients, it’s crucial to have as many options available as possible.
For example, those who have high dependence may need up to three nicotine patches. Patients should also be initiated on combination NRT, similar to how pain relief is approached.
‘You need something for the whole day and then a quick-acting [therapy] for the breakthrough,’ Ms Gupta said.
In Ms Gupta’s view, NRT is not being optimally utilised prior to a step-up therapy with varenicline and bupropion. But a targeted approach works best.
‘Some people don't want to [try] patches or gum and prefer to go straight onto tablets, so varenicline is a great option for them. Others don't want to take more medicines and are worried about adverse effects, so it's best to start them on NRT,’ she said. ‘It’s important to individualise treatment to see what your patient wants.’
For more information, refer to PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
[post_title] => Nicotine inhalators discontinued: are vapes an alternative?
[post_excerpt] => Although somewhat kept on the down low, nicotine inhalators have been discontinued. Are Pharmacist Only vapes the next best option?
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[post_content] => Mark Chantachak MPS has worked as a locum in many places in Australia. And
he’s learned a thing or two along the way.
What set you towards becoming a regular locum?
Over a decade ago, when there was an oversupply of pharmacists in Australia, I ended up working in a few casual roles.
Then an old friend referred me to a locum agency back in 2012. After enlisting with them, I suddenly started getting a lot of phone calls for jobs – from one-day postings to longer-term offerings for weeks or months at a time, and even permanent part-time roles. From there, the opportunities only grew.
Now I’ve enlisted with three to four agencies, and I also gain work through social media platforms. One of the best things about locuming is the flexibility.
You can dictate your own working schedule, choose when and where you work, and take a vacation whenever you feel like it. You can also kill two birds with one stone: working and travelling. I like to think of it as a working vacation. And on countryside locum stints, there’s no need to battle heavy traffic to get to work. You can even walk if you want to.
Where in Australia have you worked as a locum?
You wouldn’t believe the list of the places I’ve been to: Corowa, Parkes, West Wyalong, Orange, Boggabri and Dareton in New South Wales; Heyfield, Donald, Nhill, Horsham, Rainbow, Jeparit, Bendigo, Warragul, Drouin, Morwell, Swan Hill, Bairnsdale, Ballarat, Lakes Entrance, Sale, Moe and Seymour in Victoria; Cairns and Atherton in Queensland; and Broome in Western Australia – to name just a few!
Every destination offers its own perks. As tourist towns, Broome, Cairns and Atherton have a lot of activities to offer. In these spots, you also get to meet the international workers during social activities, such as language, Latin dancing and poker nights. I liked Broome for its friendly staff who educated me on the making of TikTok videos. Another highlight was the camel riding. But my most rewarding stay would have to be in Heyfield, where I experienced both personal and professional growth. My social skills vastly improved through meeting so many people at football, tennis, touch football, and basketball games.
During my time there, I also had the pleasure of participating in the World’s Greatest Shave, where I coloured and shaved my head, with the whole town rallying to raise funds for cancer research. I had a friend who survived leukaemia.
What are the ideal ingredients for a successful locum posting?
Keeping up with continuing professional development and education is important for staying current with practice. Personality is also important. In my opinion, you have to be a people person to be a good locum, because, as your workplace is always changing, you need to continually get on well with new staff and patients.
You also have to love road trips. Some drives to locum stints can be quite long, so you have to love travelling to new, different towns – sometimes in the middle of nowhere.
Flexibility is also key; you need to be able to adapt to new procedures quickly. Different teams work in different ways, so you have to be able to adjust to how they work. And then there’s the need for speed. You have to pick things up quickly and complete tasks at a rapid pace.
Confidence, empathy and the ability to identify conflicts early – so you can iron out any issue between staff – will also set you on the right path.
Where would you like to be in 5 years?
Continuing to work and travel around Australia, but exclusively in rural and regional areas. There’s a lot of countryside I still want to explore.
I could honestly see myself carrying on this working lifestyle into my retirement years. And perhaps one day, when I have a family, I’ll have them in tow on my locum adventures.
Any advice for ECPs?
Attend all the conferences and seminars you can. As well as continuing your professional development, they are also great for networking with fellow pharmacists, interns and students – which opens up both friendship and job opportunities.
I also encourage involvement in community activities during placements. Explore all the locational possibilities, and weigh up the pros and cons of each destination.
[post_title] => Locum life in rural and regional Australia
[post_excerpt] => Mark Chantachak MPS has worked as a locum in many places in Australia. And
he’s learned a thing or two along the way.
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[post_content] => The biggest pharmacy organisations in Australia have put out a joint statement to advance autonomous pharmacist prescribing.
The Joint Pharmacy Organisations’ Paper for Endorsed Pharmacist Prescribers, authored by PSA, the Pharmacy Guild of Australia and Advanced Pharmacy Australia, recommends that the Pharmacy Board of Australia introduce an endorsement for pharmacists to be able to prescribe autonomously within a self-determined scope of practice.
The proposed endorsement will enable pharmacists to use the full extent of their training for patient care. Pharmacists will be able to assume appropriate prescribing responsibilities within their scope across settings – improving access, safety and continuity of care, particularly where health care services are stretched.
Why endorse pharmacist prescribing?
The current fragmentation of prescribing authority between states and territories is leading to inequities in patient access and inconsistencies in professional recognition.
Endorsement would allow the Pharmacy Board of Australia to formally recognise pharmacists who meet specific education and competence standards as Endorsed Pharmacist Prescribers.
Will the endorsement support harmonisation?
Should endorsement be introduced, it’s proposed that uniform national standards be established, ensuring that all endorsed pharmacists are recognised to practise within their qualified scope.
The uniform national standards for pharmacist prescribing will potentially be achieved through a registration system under the Pharmacy Board of Australia, supported by the Health Professionals Prescribing Pathway. This framework provides a consistent, competency-based approach to prescribing that applies across all states and territories, ensuring all pharmacists across Australia are held to the same regulatory, educational and professional standards – creating a unified, transparent standard for safe and effective prescribing practice.
[caption id="attachment_30798" align="alignright" width="225"] PSA Vice President Professor Mark Naunton MPS[/caption]
This will promote workforce mobility, allowing pharmacists to move freely between jurisdictions without re-credentialing.
‘A nationally consistent approach via registration endorsement through the Board for pharmacist prescribers is vital to ensure access to health care services is equitable for all Australian patients, and that pharmacists are able to work to their full scope of practice regardless of which setting they work in – community, hospital, general practice, or a residential aged care home,’ said PSA Vice President Professor Mark Naunton MPS.
How can pharmacists define their individual scope of practice?
A Decision-Making Framework for Scope of Practice will need to be developed by the Board alongside the endorsement to help pharmacists determine whether a particular prescribing activity falls within their competence and authority.
The proposed Framework should provide structured guidance for pharmacists to self-assess, document and justify their scope of practice in relation to prescribing activities. Pharmacists will be required to evaluate their competence, setting, patient needs and available resources before undertaking prescribing responsibilities.
‘The framework will ensure pharmacists prescribe autonomously but responsibly because they will be guided by their education and training, pharmacy practice standard, scope of practice, professional development, and collaboration with health care teams,’ Prof Naunton said.
How will pharmacists become Endorsed Pharmacist Prescribers?
The paper recommends that to gain endorsement, registered pharmacists must successfully complete an Australian Pharmacy Council (APC) accredited and Pharmacy Board of Australia approved course that aligns with the National Prescribing Competency Framework.
It’s proposed that pharmacists demonstrate the full range of competencies outlined in the Framework, including:
‘We’ve seen various pilot programs in action, in states like Queensland, New South Wales and Victoria. The goal is now establishing a consistent, national approach to pharmacist prescribing.' Professor Mark Naunton MPSQueensland’s pilot for chronic disease management has shown improved access in rural and remote areas, with positive outcomes for patients with chronic conditions. And hospital-based programs such as Partnered Pharmacist Medication Charting and Partnered Pharmacist Medication Prescribing have achieved up to 94% reductions in medicines errors, with shorter hospital stays for patients. ‘We’ve seen various pilot programs in action, in states like Queensland, New South Wales and Victoria. The goal is now establishing a consistent, national approach to pharmacist prescribing,’ Prof Naunton said.
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[post_content] => With glucagon-like peptide-1 receptor agonists (GLP-1 RAs) back and some basal insulins disappearing, pharmacists face a new wave of complexity in diabetes management.
Diabetes management has been significantly disrupted in recent years, from ongoing shortages of (GLP-1 RAs) to the discontinuation of several insulin formulations.
But with medicines like semaglutide (Ozempic) back on the market and the impending discontinuation of another long-acting basal insulin analogue – there are further complexities to navigate.
Here, Australian Pharmacist explores how the sector is tackling these issues.
Ozempic return leads to medicine double-ups
Medicine shortages of popular diabetes medicines have eased this year, including the official removal of Ozempic from the Therapeutic Goods Administration’s medicine shortages list in July.
But throughout the shortage period, it became common for patients to receive multiple prescriptions for whichever medicine was available at the time, said Kirrily Chambers MPS, Advanced Practice Pharmacist and credentialled diabetes educator during the National Medicines Symposium 2025, held last week.
For example, when Ozempic was out of stock, Ms Chambers said patients were often issued a prescription for sitagliptin (Januvia) in addition to their usual semaglutide.
‘When there have been issues with not being able to get [the medicine], people will often pick up both scripts when it comes back on the market,’ she said.
‘A patient might collect a 6-month prescription for Januvia. Then, when they present to the pharmacy, the pharmacist says, “Mrs Jones, your Ozempic is back – would you like one?” The patient says, “Yes, please,” forgetting the GP or specialist had advised using Januvia only while Ozempic was unavailable.’
If pharmacists encounter this situation, they should contact the GP or specialist to confirm the prescribing was intended.
‘We're now ringing to say, “Hey, did you really mean to put this person on multiple things? Because 6 months ago, they weren't on all these medications”,’ she said. ‘This is part of deprescribing to keep people safe, so that they're not bouncing into hospital.’
Regular Diabetes MedsChecks and medicines reconciliation, or a Home Medicines Review where appropriate, is critical to help the person living with diabetes understand the therapeutic approach. Any issues or duplications identified should then be communicated to the multidisciplinary team.
Discontinuations leave some patients without options
In the last few years, numerous diabetes medicines have faced discontinuation, including several insulin formulations and the GLP-1 RA liraglutide(Saxenda). There have also been device discontinuations, which can make diabetes care more difficult for older patients, said Associate Professor Margaret McGill AM, nurse manager and associate director at Royal Prince Alfred Hospital’s Diabetes Centre.
‘We know that people are living longer … and that age is the biggest predictor of type 2 diabetes,’ she said. ‘So we now see many referrals of people in their 80s and 90s – and some of these people need to go on insulin.’
Often, older patients don’t have the dexterity to navigate some of the newer devices, including putting a cartridge into a reusable pen.
‘When we lose the simple devices … it’s really impactful,’ A/Prof McGill told Symposium delegates.
Distinguished Professor David Simmons, the Chief Medical Officer, Diabetes Australia, has tried to ensure there are replacements for some of these devices.
‘Protaphane [is] one that we're trying to do, and it's quite challenging,’ he said.
‘If you're working with people [who have], for example, gestational diabetes, and they only have a limited number of weeks to actually understand what they're doing, some of the quicker learning devices are superior to learning how to put a cartridge into a pen.’
But the device discontinuation causing the most concern, however, is insulin detemir (Levemir) – which is set to be discontinued by December 2026.
Some patients who can tolerate a once daily dose of insulin could go on glargine, Prof Simmons said. However, the individual risks must be calculated for each patient.
‘For those who need Levemir twice daily so it can cover them during the day and night, there's a big risk when we go to once a day,’ he said.
‘During the day, they will be at risk of hypos – perhaps when they're driving if they haven't got a sensor on, or if the sensor is not working. If they then reduce their dose and their glucose goes up, they're going to be more hyperglycaemic at night – which will directly lead to long-term complications.’
While Diabetes Australia is looking into management strategies, the only current solution for these patients is an insulin pump.
‘There’s nothing else that's going to replace it for those individuals, and they may not be able to afford a pump,’ Prof Simmons said. ‘So we're certainly concerned about that. And GPs and pharmacists need to be very much aware that this is what's coming.’
Finding the right therapeutic approach
When considering new medicines for patients that are appropriate for diabetes, they must be selected for a person through a complex algorithm, said Dr Gary Deed, Chair of the Diabetes Specific Interest group at the Royal Australian College of General Practitioners.
‘[You] have to think, “do [they] have high blood pressure, lipid problems, kidney disease, metabolic-associated fatty liver disease? And how then, do I adapt that framework to the choices of medications and then negotiate with [the patient]?’ he said.
‘[You need a] well-trained, systematic approach and a very clear perspective of what that person is, not just physically, but also emotionally, and how they live.’
Renza Scibilia, a diabetes advocate who has lived with type 1 diabetes for 27 years, said that there’s a broad spectrum of people living with diabetes, and their understanding of the diabetes landscape may vary, including:
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[post_content] => Questions about spacers are abundant in community pharmacy. AP answers some of the trickiest ones pharmacists face.
Aren’t spacers just for kids?’ This is a common misconception pharmacists hear. People of all ages should use a spacer whenever they use a pressurised metered dose inhaler (pMDI).1 Spacers slow down aerosol spray, improve lung delivery and reduce oropharyngeal adverse effects like irritation, hoarseness or oral thrush from inhaled corticosteroids (ICS).1,2
They’re also useful for anyone who struggles with coordination or breath timing. When used correctly with a spacer, a pMDI delivers medicine as effectively as a nebuliser, and is often more efficient and convenient.2
Which spacers are better?
Spacers can be made of plastic or cardboard. Collapsible spacers are more compact for the patient to carry. Cardboard spacers fold flat for easy storage. Some spacers have additional features e.g. anti-static spacers improve delivery of active ingredient by preventing medicine from sticking to the walls.4
Some spacers have an inhalation indicator that moves when the patient inhales and whistles if they inhale too fast.4 Spacers with one-way valves stop exhalation into the chamber, helping keep the medicine inside and making delivery more effective.4
Anti-bacterial spacers are embedded with materials e.g. silver ion to inhibit bacteria growth. Choice of spacer depends on age, treatment, budget, dexterity and lifestyle. It should suit the patient, be easy to put together and be compatible with their inhaler.2,3 The Spacers for pMDIs Chart helps identify spacer options. Visit www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/charts
Do all inhalers fit into a spacer?
Not always. Some spacers have a rigid or fixed connection end. Those pMDIs with circular mouthpieces may require spacers with a flexible rubber/silicone opening that can form a seal around the mouthpiece. If in doubt, test the fit in the pharmacy and demonstrate with the patient’s own device.
Which devices don’t need spacers?
Breath-actuated inhalers, such as Accuhaler, Autohaler, Breezhaler, Ellipta, Respimat, Spiromax, and Turbuhaler are not spacer-compatible.5
Who needs to use a mask with a spacer?
A tightly fitting face mask is used for anyone who may find it harder to take a breath in through their mouth or cannot seal their lips tightly around the mouthpiece of an inhaler or spacer.2
What’s the big takeaway?
Spacers aren’t just for kids. For adults, they support technique and mean better medicine delivery with fewer adverse effects. Pharmacists play a key role in helping patients, especially adults, understand why using a spacer with pMDI is recommended.
References
- Lung Foundation Australia. Spacer and puffer inhaler device technique fact sheet. 2025. At: https://lungfoundation.com.au/support-resources/resource-hub/spacer-and-puffer-inhaler-device-technique-fact-sheet/
- National Asthma Council Australia. Spacer use and care fact sheet. 2025. At: www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/factsheets/spacer-use-and-care
- Respiratory Therapeutic Guidelines. Inhalational drug delivery devices Melbourne: Therapeutic Guidelines; 2020 (amended 2025). At: https://app.tg.org.au/viewTopic?etgAccess=true&guidelinePage=Respiratory&topicfile=inhalational-drug-delivery-devices&guidelinename=Respiratory&sectionId=toc_d1e208#toc_d1e208
- National Asthma Council Australia. AeroChamber Plus* Flow-Vu* Spacers for pMDIs Information Paper. 2025. At: www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/information-paper/aerochamber-plus-flow-vu-spacers-pmdi
- Asthma Australia. Devices and Techniques. 2025. At: www.asthma.org.au/devices-techniques/puffer-and-spacer/
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[post_content] => Although somewhat kept on the down low, nicotine inhalators – manufactured by the likes of Pfizer and Kenvue – have been discontinued. Are Pharmacist Only vapes the next best option?
Deepali Gupta, an advanced cardiac pharmacist at Queensland Health and co-chair of the Statewide Smoking Cessation Working Group, first heard rumblings in mid-2024 that nicotine inhalators would be discontinued.
‘This started off with some reports from overseas,’ she said. ‘The reason for discontinuation was because the resin required to make the mouthpieces can’t be sourced.’
This news affects a significant subset of patients with mental ill health, many of whom have higher rates of smoking and who currently rely on inhalators as part of their nicotine replacement therapy.
Nicorette inhaler discontinued in Australia, Pharmacies that sell non prescribed vapes in Melbourne?
byu/Angrygoat87 inquittingsmoking
‘At Queensland Health, nicotine inhalators are on the list of approved medicines for mental health and acute behaviour management patients,’ Ms Gupta said. ‘So as soon as we heard there’s a possibility they may be discontinued, we were concerned that it would affect patient care in the mental health unit.’
After confirming with the manufacturer at the time that there was sufficient stock of nicotine inhalators for at least 12 months, Ms Gupta and team were relieved.
‘We were also advised that Kenvue would be seeking out another supplier for the resin for manufacturing of mouthpieces, which was the main reason why they were at risk of being discontinued,’ she said.
‘Then [earlier this year] we received a notice through a community pharmacist that nicotine inhalators are discontinued. And that the pharmacy group is displaying posters in their pharmacies for their clients.’
Despite reaching out to the manufacturer multiple times, no feedback was received. ‘There is also nothing on the Therapeutics Goods Administration’s website about this discontinuation,’ she added.
Why are smoking rates higher in those with mental ill health?
Among Australians aged 18 years and over, smoking rates have been steadily declining – sitting at 11.1% in 2022–23.
‘[But in my experience] if you go to a mental health ward, around 50% of people are current smokers,’ Ms Gupta said.
The reasons for this are multifactorial. Higher smoking rates are often observed in communities experiencing social and economic disadvantage, including some Aboriginal and Torres Strait Islander communities, where complex social and emotional wellbeing factors play a role.
‘[And] people who are suffering from [poor] mental health may be living in low socioeconomic situations,’ she said.
What makes nicotine inhalators more appealing?
When it comes to smoking cessation, nicotine inhalators are the preferred nicotine replacement therapy (NRT) option among patients with mental ill health, Ms Gupta said.
Explaining the precise chewing technique required to release nicotine from gum can be challenging for someone experiencing acute mental illness. Likewise, conveying that nicotine lozenges must be held in the mouth for an extended period to ensure absorption rather than being wasted in the digestive tract poses a similar difficulty.
Some patients may also experience discomfort or anxiety about having a patch on their skin and may remove it prematurely, Ms Gupta said.
‘And sprays have a very strong taste, which can put them off completely,’ she added.
Nicotine inhalators, on the other hand, are much easier for patients to adapt to.
‘They are already used to the hand-to-mouth method from smoking, and the inhalator only needs to be set up once,’ Ms Gupta said. ‘You just tell them to suck on it whenever they feel they need to smoke. That works really well to keep mental health clientele calm.’
Should vapes be used as a substitute?
Ms Gupta recently turned to a close community pharmacist friend to ask, ‘What’s the situation with nicotine inhalators?’ Confirming they haven’t been available for many months, the pharmacist suggested that vapes are in stock and can be supplied over the counter. Hearing this from a senior pharmacist with decades of experience and a patient-first ethos alarmed Ms Gupta.
‘Some people may argue that vapes can be used as NRT, however, we know the amount of nicotine supplied through vapes is significantly higher. This feeds into the nicotine addiction rather than using lower levels and targeting nicotine withdrawal,’ she said. ‘If they are looking for NRT, we should be using the TGA-approved medications.’
Understanding that nicotine dependence varies per patient is key – particularly among patients with mental ill health, who often experience high levels of dependence and
derive symptomatic relief from nicotine. Vapes may not be therapeutically appropriate for this patient population, and are also not permitted in the same spaces as smoking – including in hospitals. So for these patients, it’s crucial to have as many options available as possible.
For example, those who have high dependence may need up to three nicotine patches. Patients should also be initiated on combination NRT, similar to how pain relief is approached.
‘You need something for the whole day and then a quick-acting [therapy] for the breakthrough,’ Ms Gupta said.
In Ms Gupta’s view, NRT is not being optimally utilised prior to a step-up therapy with varenicline and bupropion. But a targeted approach works best.
‘Some people don't want to [try] patches or gum and prefer to go straight onto tablets, so varenicline is a great option for them. Others don't want to take more medicines and are worried about adverse effects, so it's best to start them on NRT,’ she said. ‘It’s important to individualise treatment to see what your patient wants.’
For more information, refer to PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
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[post_content] => Mark Chantachak MPS has worked as a locum in many places in Australia. And
he’s learned a thing or two along the way.
What set you towards becoming a regular locum?
Over a decade ago, when there was an oversupply of pharmacists in Australia, I ended up working in a few casual roles.
Then an old friend referred me to a locum agency back in 2012. After enlisting with them, I suddenly started getting a lot of phone calls for jobs – from one-day postings to longer-term offerings for weeks or months at a time, and even permanent part-time roles. From there, the opportunities only grew.
Now I’ve enlisted with three to four agencies, and I also gain work through social media platforms. One of the best things about locuming is the flexibility.
You can dictate your own working schedule, choose when and where you work, and take a vacation whenever you feel like it. You can also kill two birds with one stone: working and travelling. I like to think of it as a working vacation. And on countryside locum stints, there’s no need to battle heavy traffic to get to work. You can even walk if you want to.
Where in Australia have you worked as a locum?
You wouldn’t believe the list of the places I’ve been to: Corowa, Parkes, West Wyalong, Orange, Boggabri and Dareton in New South Wales; Heyfield, Donald, Nhill, Horsham, Rainbow, Jeparit, Bendigo, Warragul, Drouin, Morwell, Swan Hill, Bairnsdale, Ballarat, Lakes Entrance, Sale, Moe and Seymour in Victoria; Cairns and Atherton in Queensland; and Broome in Western Australia – to name just a few!
Every destination offers its own perks. As tourist towns, Broome, Cairns and Atherton have a lot of activities to offer. In these spots, you also get to meet the international workers during social activities, such as language, Latin dancing and poker nights. I liked Broome for its friendly staff who educated me on the making of TikTok videos. Another highlight was the camel riding. But my most rewarding stay would have to be in Heyfield, where I experienced both personal and professional growth. My social skills vastly improved through meeting so many people at football, tennis, touch football, and basketball games.
During my time there, I also had the pleasure of participating in the World’s Greatest Shave, where I coloured and shaved my head, with the whole town rallying to raise funds for cancer research. I had a friend who survived leukaemia.
What are the ideal ingredients for a successful locum posting?
Keeping up with continuing professional development and education is important for staying current with practice. Personality is also important. In my opinion, you have to be a people person to be a good locum, because, as your workplace is always changing, you need to continually get on well with new staff and patients.
You also have to love road trips. Some drives to locum stints can be quite long, so you have to love travelling to new, different towns – sometimes in the middle of nowhere.
Flexibility is also key; you need to be able to adapt to new procedures quickly. Different teams work in different ways, so you have to be able to adjust to how they work. And then there’s the need for speed. You have to pick things up quickly and complete tasks at a rapid pace.
Confidence, empathy and the ability to identify conflicts early – so you can iron out any issue between staff – will also set you on the right path.
Where would you like to be in 5 years?
Continuing to work and travel around Australia, but exclusively in rural and regional areas. There’s a lot of countryside I still want to explore.
I could honestly see myself carrying on this working lifestyle into my retirement years. And perhaps one day, when I have a family, I’ll have them in tow on my locum adventures.
Any advice for ECPs?
Attend all the conferences and seminars you can. As well as continuing your professional development, they are also great for networking with fellow pharmacists, interns and students – which opens up both friendship and job opportunities.
I also encourage involvement in community activities during placements. Explore all the locational possibilities, and weigh up the pros and cons of each destination.
[post_title] => Locum life in rural and regional Australia
[post_excerpt] => Mark Chantachak MPS has worked as a locum in many places in Australia. And
he’s learned a thing or two along the way.
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[post_content] => The biggest pharmacy organisations in Australia have put out a joint statement to advance autonomous pharmacist prescribing.
The Joint Pharmacy Organisations’ Paper for Endorsed Pharmacist Prescribers, authored by PSA, the Pharmacy Guild of Australia and Advanced Pharmacy Australia, recommends that the Pharmacy Board of Australia introduce an endorsement for pharmacists to be able to prescribe autonomously within a self-determined scope of practice.
The proposed endorsement will enable pharmacists to use the full extent of their training for patient care. Pharmacists will be able to assume appropriate prescribing responsibilities within their scope across settings – improving access, safety and continuity of care, particularly where health care services are stretched.
Why endorse pharmacist prescribing?
The current fragmentation of prescribing authority between states and territories is leading to inequities in patient access and inconsistencies in professional recognition.
Endorsement would allow the Pharmacy Board of Australia to formally recognise pharmacists who meet specific education and competence standards as Endorsed Pharmacist Prescribers.
Will the endorsement support harmonisation?
Should endorsement be introduced, it’s proposed that uniform national standards be established, ensuring that all endorsed pharmacists are recognised to practise within their qualified scope.
The uniform national standards for pharmacist prescribing will potentially be achieved through a registration system under the Pharmacy Board of Australia, supported by the Health Professionals Prescribing Pathway. This framework provides a consistent, competency-based approach to prescribing that applies across all states and territories, ensuring all pharmacists across Australia are held to the same regulatory, educational and professional standards – creating a unified, transparent standard for safe and effective prescribing practice.
[caption id="attachment_30798" align="alignright" width="225"] PSA Vice President Professor Mark Naunton MPS[/caption]
This will promote workforce mobility, allowing pharmacists to move freely between jurisdictions without re-credentialing.
‘A nationally consistent approach via registration endorsement through the Board for pharmacist prescribers is vital to ensure access to health care services is equitable for all Australian patients, and that pharmacists are able to work to their full scope of practice regardless of which setting they work in – community, hospital, general practice, or a residential aged care home,’ said PSA Vice President Professor Mark Naunton MPS.
How can pharmacists define their individual scope of practice?
A Decision-Making Framework for Scope of Practice will need to be developed by the Board alongside the endorsement to help pharmacists determine whether a particular prescribing activity falls within their competence and authority.
The proposed Framework should provide structured guidance for pharmacists to self-assess, document and justify their scope of practice in relation to prescribing activities. Pharmacists will be required to evaluate their competence, setting, patient needs and available resources before undertaking prescribing responsibilities.
‘The framework will ensure pharmacists prescribe autonomously but responsibly because they will be guided by their education and training, pharmacy practice standard, scope of practice, professional development, and collaboration with health care teams,’ Prof Naunton said.
How will pharmacists become Endorsed Pharmacist Prescribers?
The paper recommends that to gain endorsement, registered pharmacists must successfully complete an Australian Pharmacy Council (APC) accredited and Pharmacy Board of Australia approved course that aligns with the National Prescribing Competency Framework.
It’s proposed that pharmacists demonstrate the full range of competencies outlined in the Framework, including:
‘We’ve seen various pilot programs in action, in states like Queensland, New South Wales and Victoria. The goal is now establishing a consistent, national approach to pharmacist prescribing.' Professor Mark Naunton MPSQueensland’s pilot for chronic disease management has shown improved access in rural and remote areas, with positive outcomes for patients with chronic conditions. And hospital-based programs such as Partnered Pharmacist Medication Charting and Partnered Pharmacist Medication Prescribing have achieved up to 94% reductions in medicines errors, with shorter hospital stays for patients. ‘We’ve seen various pilot programs in action, in states like Queensland, New South Wales and Victoria. The goal is now establishing a consistent, national approach to pharmacist prescribing,’ Prof Naunton said.
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[post_content] => With glucagon-like peptide-1 receptor agonists (GLP-1 RAs) back and some basal insulins disappearing, pharmacists face a new wave of complexity in diabetes management.
Diabetes management has been significantly disrupted in recent years, from ongoing shortages of (GLP-1 RAs) to the discontinuation of several insulin formulations.
But with medicines like semaglutide (Ozempic) back on the market and the impending discontinuation of another long-acting basal insulin analogue – there are further complexities to navigate.
Here, Australian Pharmacist explores how the sector is tackling these issues.
Ozempic return leads to medicine double-ups
Medicine shortages of popular diabetes medicines have eased this year, including the official removal of Ozempic from the Therapeutic Goods Administration’s medicine shortages list in July.
But throughout the shortage period, it became common for patients to receive multiple prescriptions for whichever medicine was available at the time, said Kirrily Chambers MPS, Advanced Practice Pharmacist and credentialled diabetes educator during the National Medicines Symposium 2025, held last week.
For example, when Ozempic was out of stock, Ms Chambers said patients were often issued a prescription for sitagliptin (Januvia) in addition to their usual semaglutide.
‘When there have been issues with not being able to get [the medicine], people will often pick up both scripts when it comes back on the market,’ she said.
‘A patient might collect a 6-month prescription for Januvia. Then, when they present to the pharmacy, the pharmacist says, “Mrs Jones, your Ozempic is back – would you like one?” The patient says, “Yes, please,” forgetting the GP or specialist had advised using Januvia only while Ozempic was unavailable.’
If pharmacists encounter this situation, they should contact the GP or specialist to confirm the prescribing was intended.
‘We're now ringing to say, “Hey, did you really mean to put this person on multiple things? Because 6 months ago, they weren't on all these medications”,’ she said. ‘This is part of deprescribing to keep people safe, so that they're not bouncing into hospital.’
Regular Diabetes MedsChecks and medicines reconciliation, or a Home Medicines Review where appropriate, is critical to help the person living with diabetes understand the therapeutic approach. Any issues or duplications identified should then be communicated to the multidisciplinary team.
Discontinuations leave some patients without options
In the last few years, numerous diabetes medicines have faced discontinuation, including several insulin formulations and the GLP-1 RA liraglutide(Saxenda). There have also been device discontinuations, which can make diabetes care more difficult for older patients, said Associate Professor Margaret McGill AM, nurse manager and associate director at Royal Prince Alfred Hospital’s Diabetes Centre.
‘We know that people are living longer … and that age is the biggest predictor of type 2 diabetes,’ she said. ‘So we now see many referrals of people in their 80s and 90s – and some of these people need to go on insulin.’
Often, older patients don’t have the dexterity to navigate some of the newer devices, including putting a cartridge into a reusable pen.
‘When we lose the simple devices … it’s really impactful,’ A/Prof McGill told Symposium delegates.
Distinguished Professor David Simmons, the Chief Medical Officer, Diabetes Australia, has tried to ensure there are replacements for some of these devices.
‘Protaphane [is] one that we're trying to do, and it's quite challenging,’ he said.
‘If you're working with people [who have], for example, gestational diabetes, and they only have a limited number of weeks to actually understand what they're doing, some of the quicker learning devices are superior to learning how to put a cartridge into a pen.’
But the device discontinuation causing the most concern, however, is insulin detemir (Levemir) – which is set to be discontinued by December 2026.
Some patients who can tolerate a once daily dose of insulin could go on glargine, Prof Simmons said. However, the individual risks must be calculated for each patient.
‘For those who need Levemir twice daily so it can cover them during the day and night, there's a big risk when we go to once a day,’ he said.
‘During the day, they will be at risk of hypos – perhaps when they're driving if they haven't got a sensor on, or if the sensor is not working. If they then reduce their dose and their glucose goes up, they're going to be more hyperglycaemic at night – which will directly lead to long-term complications.’
While Diabetes Australia is looking into management strategies, the only current solution for these patients is an insulin pump.
‘There’s nothing else that's going to replace it for those individuals, and they may not be able to afford a pump,’ Prof Simmons said. ‘So we're certainly concerned about that. And GPs and pharmacists need to be very much aware that this is what's coming.’
Finding the right therapeutic approach
When considering new medicines for patients that are appropriate for diabetes, they must be selected for a person through a complex algorithm, said Dr Gary Deed, Chair of the Diabetes Specific Interest group at the Royal Australian College of General Practitioners.
‘[You] have to think, “do [they] have high blood pressure, lipid problems, kidney disease, metabolic-associated fatty liver disease? And how then, do I adapt that framework to the choices of medications and then negotiate with [the patient]?’ he said.
‘[You need a] well-trained, systematic approach and a very clear perspective of what that person is, not just physically, but also emotionally, and how they live.’
Renza Scibilia, a diabetes advocate who has lived with type 1 diabetes for 27 years, said that there’s a broad spectrum of people living with diabetes, and their understanding of the diabetes landscape may vary, including:
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[post_content] => Questions about spacers are abundant in community pharmacy. AP answers some of the trickiest ones pharmacists face.
Aren’t spacers just for kids?’ This is a common misconception pharmacists hear. People of all ages should use a spacer whenever they use a pressurised metered dose inhaler (pMDI).1 Spacers slow down aerosol spray, improve lung delivery and reduce oropharyngeal adverse effects like irritation, hoarseness or oral thrush from inhaled corticosteroids (ICS).1,2
They’re also useful for anyone who struggles with coordination or breath timing. When used correctly with a spacer, a pMDI delivers medicine as effectively as a nebuliser, and is often more efficient and convenient.2
Which spacers are better?
Spacers can be made of plastic or cardboard. Collapsible spacers are more compact for the patient to carry. Cardboard spacers fold flat for easy storage. Some spacers have additional features e.g. anti-static spacers improve delivery of active ingredient by preventing medicine from sticking to the walls.4
Some spacers have an inhalation indicator that moves when the patient inhales and whistles if they inhale too fast.4 Spacers with one-way valves stop exhalation into the chamber, helping keep the medicine inside and making delivery more effective.4
Anti-bacterial spacers are embedded with materials e.g. silver ion to inhibit bacteria growth. Choice of spacer depends on age, treatment, budget, dexterity and lifestyle. It should suit the patient, be easy to put together and be compatible with their inhaler.2,3 The Spacers for pMDIs Chart helps identify spacer options. Visit www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/charts
Do all inhalers fit into a spacer?
Not always. Some spacers have a rigid or fixed connection end. Those pMDIs with circular mouthpieces may require spacers with a flexible rubber/silicone opening that can form a seal around the mouthpiece. If in doubt, test the fit in the pharmacy and demonstrate with the patient’s own device.
Which devices don’t need spacers?
Breath-actuated inhalers, such as Accuhaler, Autohaler, Breezhaler, Ellipta, Respimat, Spiromax, and Turbuhaler are not spacer-compatible.5
Who needs to use a mask with a spacer?
A tightly fitting face mask is used for anyone who may find it harder to take a breath in through their mouth or cannot seal their lips tightly around the mouthpiece of an inhaler or spacer.2
What’s the big takeaway?
Spacers aren’t just for kids. For adults, they support technique and mean better medicine delivery with fewer adverse effects. Pharmacists play a key role in helping patients, especially adults, understand why using a spacer with pMDI is recommended.
References
- Lung Foundation Australia. Spacer and puffer inhaler device technique fact sheet. 2025. At: https://lungfoundation.com.au/support-resources/resource-hub/spacer-and-puffer-inhaler-device-technique-fact-sheet/
- National Asthma Council Australia. Spacer use and care fact sheet. 2025. At: www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/factsheets/spacer-use-and-care
- Respiratory Therapeutic Guidelines. Inhalational drug delivery devices Melbourne: Therapeutic Guidelines; 2020 (amended 2025). At: https://app.tg.org.au/viewTopic?etgAccess=true&guidelinePage=Respiratory&topicfile=inhalational-drug-delivery-devices&guidelinename=Respiratory&sectionId=toc_d1e208#toc_d1e208
- National Asthma Council Australia. AeroChamber Plus* Flow-Vu* Spacers for pMDIs Information Paper. 2025. At: www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/information-paper/aerochamber-plus-flow-vu-spacers-pmdi
- Asthma Australia. Devices and Techniques. 2025. At: www.asthma.org.au/devices-techniques/puffer-and-spacer/
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[post_content] => Although somewhat kept on the down low, nicotine inhalators – manufactured by the likes of Pfizer and Kenvue – have been discontinued. Are Pharmacist Only vapes the next best option?
Deepali Gupta, an advanced cardiac pharmacist at Queensland Health and co-chair of the Statewide Smoking Cessation Working Group, first heard rumblings in mid-2024 that nicotine inhalators would be discontinued.
‘This started off with some reports from overseas,’ she said. ‘The reason for discontinuation was because the resin required to make the mouthpieces can’t be sourced.’
This news affects a significant subset of patients with mental ill health, many of whom have higher rates of smoking and who currently rely on inhalators as part of their nicotine replacement therapy.
Nicorette inhaler discontinued in Australia, Pharmacies that sell non prescribed vapes in Melbourne?
byu/Angrygoat87 inquittingsmoking
‘At Queensland Health, nicotine inhalators are on the list of approved medicines for mental health and acute behaviour management patients,’ Ms Gupta said. ‘So as soon as we heard there’s a possibility they may be discontinued, we were concerned that it would affect patient care in the mental health unit.’
After confirming with the manufacturer at the time that there was sufficient stock of nicotine inhalators for at least 12 months, Ms Gupta and team were relieved.
‘We were also advised that Kenvue would be seeking out another supplier for the resin for manufacturing of mouthpieces, which was the main reason why they were at risk of being discontinued,’ she said.
‘Then [earlier this year] we received a notice through a community pharmacist that nicotine inhalators are discontinued. And that the pharmacy group is displaying posters in their pharmacies for their clients.’
Despite reaching out to the manufacturer multiple times, no feedback was received. ‘There is also nothing on the Therapeutics Goods Administration’s website about this discontinuation,’ she added.
Why are smoking rates higher in those with mental ill health?
Among Australians aged 18 years and over, smoking rates have been steadily declining – sitting at 11.1% in 2022–23.
‘[But in my experience] if you go to a mental health ward, around 50% of people are current smokers,’ Ms Gupta said.
The reasons for this are multifactorial. Higher smoking rates are often observed in communities experiencing social and economic disadvantage, including some Aboriginal and Torres Strait Islander communities, where complex social and emotional wellbeing factors play a role.
‘[And] people who are suffering from [poor] mental health may be living in low socioeconomic situations,’ she said.
What makes nicotine inhalators more appealing?
When it comes to smoking cessation, nicotine inhalators are the preferred nicotine replacement therapy (NRT) option among patients with mental ill health, Ms Gupta said.
Explaining the precise chewing technique required to release nicotine from gum can be challenging for someone experiencing acute mental illness. Likewise, conveying that nicotine lozenges must be held in the mouth for an extended period to ensure absorption rather than being wasted in the digestive tract poses a similar difficulty.
Some patients may also experience discomfort or anxiety about having a patch on their skin and may remove it prematurely, Ms Gupta said.
‘And sprays have a very strong taste, which can put them off completely,’ she added.
Nicotine inhalators, on the other hand, are much easier for patients to adapt to.
‘They are already used to the hand-to-mouth method from smoking, and the inhalator only needs to be set up once,’ Ms Gupta said. ‘You just tell them to suck on it whenever they feel they need to smoke. That works really well to keep mental health clientele calm.’
Should vapes be used as a substitute?
Ms Gupta recently turned to a close community pharmacist friend to ask, ‘What’s the situation with nicotine inhalators?’ Confirming they haven’t been available for many months, the pharmacist suggested that vapes are in stock and can be supplied over the counter. Hearing this from a senior pharmacist with decades of experience and a patient-first ethos alarmed Ms Gupta.
‘Some people may argue that vapes can be used as NRT, however, we know the amount of nicotine supplied through vapes is significantly higher. This feeds into the nicotine addiction rather than using lower levels and targeting nicotine withdrawal,’ she said. ‘If they are looking for NRT, we should be using the TGA-approved medications.’
Understanding that nicotine dependence varies per patient is key – particularly among patients with mental ill health, who often experience high levels of dependence and
derive symptomatic relief from nicotine. Vapes may not be therapeutically appropriate for this patient population, and are also not permitted in the same spaces as smoking – including in hospitals. So for these patients, it’s crucial to have as many options available as possible.
For example, those who have high dependence may need up to three nicotine patches. Patients should also be initiated on combination NRT, similar to how pain relief is approached.
‘You need something for the whole day and then a quick-acting [therapy] for the breakthrough,’ Ms Gupta said.
In Ms Gupta’s view, NRT is not being optimally utilised prior to a step-up therapy with varenicline and bupropion. But a targeted approach works best.
‘Some people don't want to [try] patches or gum and prefer to go straight onto tablets, so varenicline is a great option for them. Others don't want to take more medicines and are worried about adverse effects, so it's best to start them on NRT,’ she said. ‘It’s important to individualise treatment to see what your patient wants.’
For more information, refer to PSA’s Professional practice guidelines for pharmacists: nicotine dependence support.
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[post_content] => Mark Chantachak MPS has worked as a locum in many places in Australia. And
he’s learned a thing or two along the way.
What set you towards becoming a regular locum?
Over a decade ago, when there was an oversupply of pharmacists in Australia, I ended up working in a few casual roles.
Then an old friend referred me to a locum agency back in 2012. After enlisting with them, I suddenly started getting a lot of phone calls for jobs – from one-day postings to longer-term offerings for weeks or months at a time, and even permanent part-time roles. From there, the opportunities only grew.
Now I’ve enlisted with three to four agencies, and I also gain work through social media platforms. One of the best things about locuming is the flexibility.
You can dictate your own working schedule, choose when and where you work, and take a vacation whenever you feel like it. You can also kill two birds with one stone: working and travelling. I like to think of it as a working vacation. And on countryside locum stints, there’s no need to battle heavy traffic to get to work. You can even walk if you want to.
Where in Australia have you worked as a locum?
You wouldn’t believe the list of the places I’ve been to: Corowa, Parkes, West Wyalong, Orange, Boggabri and Dareton in New South Wales; Heyfield, Donald, Nhill, Horsham, Rainbow, Jeparit, Bendigo, Warragul, Drouin, Morwell, Swan Hill, Bairnsdale, Ballarat, Lakes Entrance, Sale, Moe and Seymour in Victoria; Cairns and Atherton in Queensland; and Broome in Western Australia – to name just a few!
Every destination offers its own perks. As tourist towns, Broome, Cairns and Atherton have a lot of activities to offer. In these spots, you also get to meet the international workers during social activities, such as language, Latin dancing and poker nights. I liked Broome for its friendly staff who educated me on the making of TikTok videos. Another highlight was the camel riding. But my most rewarding stay would have to be in Heyfield, where I experienced both personal and professional growth. My social skills vastly improved through meeting so many people at football, tennis, touch football, and basketball games.
During my time there, I also had the pleasure of participating in the World’s Greatest Shave, where I coloured and shaved my head, with the whole town rallying to raise funds for cancer research. I had a friend who survived leukaemia.
What are the ideal ingredients for a successful locum posting?
Keeping up with continuing professional development and education is important for staying current with practice. Personality is also important. In my opinion, you have to be a people person to be a good locum, because, as your workplace is always changing, you need to continually get on well with new staff and patients.
You also have to love road trips. Some drives to locum stints can be quite long, so you have to love travelling to new, different towns – sometimes in the middle of nowhere.
Flexibility is also key; you need to be able to adapt to new procedures quickly. Different teams work in different ways, so you have to be able to adjust to how they work. And then there’s the need for speed. You have to pick things up quickly and complete tasks at a rapid pace.
Confidence, empathy and the ability to identify conflicts early – so you can iron out any issue between staff – will also set you on the right path.
Where would you like to be in 5 years?
Continuing to work and travel around Australia, but exclusively in rural and regional areas. There’s a lot of countryside I still want to explore.
I could honestly see myself carrying on this working lifestyle into my retirement years. And perhaps one day, when I have a family, I’ll have them in tow on my locum adventures.
Any advice for ECPs?
Attend all the conferences and seminars you can. As well as continuing your professional development, they are also great for networking with fellow pharmacists, interns and students – which opens up both friendship and job opportunities.
I also encourage involvement in community activities during placements. Explore all the locational possibilities, and weigh up the pros and cons of each destination.
[post_title] => Locum life in rural and regional Australia
[post_excerpt] => Mark Chantachak MPS has worked as a locum in many places in Australia. And
he’s learned a thing or two along the way.
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[post_content] => The biggest pharmacy organisations in Australia have put out a joint statement to advance autonomous pharmacist prescribing.
The Joint Pharmacy Organisations’ Paper for Endorsed Pharmacist Prescribers, authored by PSA, the Pharmacy Guild of Australia and Advanced Pharmacy Australia, recommends that the Pharmacy Board of Australia introduce an endorsement for pharmacists to be able to prescribe autonomously within a self-determined scope of practice.
The proposed endorsement will enable pharmacists to use the full extent of their training for patient care. Pharmacists will be able to assume appropriate prescribing responsibilities within their scope across settings – improving access, safety and continuity of care, particularly where health care services are stretched.
Why endorse pharmacist prescribing?
The current fragmentation of prescribing authority between states and territories is leading to inequities in patient access and inconsistencies in professional recognition.
Endorsement would allow the Pharmacy Board of Australia to formally recognise pharmacists who meet specific education and competence standards as Endorsed Pharmacist Prescribers.
Will the endorsement support harmonisation?
Should endorsement be introduced, it’s proposed that uniform national standards be established, ensuring that all endorsed pharmacists are recognised to practise within their qualified scope.
The uniform national standards for pharmacist prescribing will potentially be achieved through a registration system under the Pharmacy Board of Australia, supported by the Health Professionals Prescribing Pathway. This framework provides a consistent, competency-based approach to prescribing that applies across all states and territories, ensuring all pharmacists across Australia are held to the same regulatory, educational and professional standards – creating a unified, transparent standard for safe and effective prescribing practice.
[caption id="attachment_30798" align="alignright" width="225"] PSA Vice President Professor Mark Naunton MPS[/caption]
This will promote workforce mobility, allowing pharmacists to move freely between jurisdictions without re-credentialing.
‘A nationally consistent approach via registration endorsement through the Board for pharmacist prescribers is vital to ensure access to health care services is equitable for all Australian patients, and that pharmacists are able to work to their full scope of practice regardless of which setting they work in – community, hospital, general practice, or a residential aged care home,’ said PSA Vice President Professor Mark Naunton MPS.
How can pharmacists define their individual scope of practice?
A Decision-Making Framework for Scope of Practice will need to be developed by the Board alongside the endorsement to help pharmacists determine whether a particular prescribing activity falls within their competence and authority.
The proposed Framework should provide structured guidance for pharmacists to self-assess, document and justify their scope of practice in relation to prescribing activities. Pharmacists will be required to evaluate their competence, setting, patient needs and available resources before undertaking prescribing responsibilities.
‘The framework will ensure pharmacists prescribe autonomously but responsibly because they will be guided by their education and training, pharmacy practice standard, scope of practice, professional development, and collaboration with health care teams,’ Prof Naunton said.
How will pharmacists become Endorsed Pharmacist Prescribers?
The paper recommends that to gain endorsement, registered pharmacists must successfully complete an Australian Pharmacy Council (APC) accredited and Pharmacy Board of Australia approved course that aligns with the National Prescribing Competency Framework.
It’s proposed that pharmacists demonstrate the full range of competencies outlined in the Framework, including:
‘We’ve seen various pilot programs in action, in states like Queensland, New South Wales and Victoria. The goal is now establishing a consistent, national approach to pharmacist prescribing.' Professor Mark Naunton MPSQueensland’s pilot for chronic disease management has shown improved access in rural and remote areas, with positive outcomes for patients with chronic conditions. And hospital-based programs such as Partnered Pharmacist Medication Charting and Partnered Pharmacist Medication Prescribing have achieved up to 94% reductions in medicines errors, with shorter hospital stays for patients. ‘We’ve seen various pilot programs in action, in states like Queensland, New South Wales and Victoria. The goal is now establishing a consistent, national approach to pharmacist prescribing,’ Prof Naunton said.
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[post_content] => With glucagon-like peptide-1 receptor agonists (GLP-1 RAs) back and some basal insulins disappearing, pharmacists face a new wave of complexity in diabetes management.
Diabetes management has been significantly disrupted in recent years, from ongoing shortages of (GLP-1 RAs) to the discontinuation of several insulin formulations.
But with medicines like semaglutide (Ozempic) back on the market and the impending discontinuation of another long-acting basal insulin analogue – there are further complexities to navigate.
Here, Australian Pharmacist explores how the sector is tackling these issues.
Ozempic return leads to medicine double-ups
Medicine shortages of popular diabetes medicines have eased this year, including the official removal of Ozempic from the Therapeutic Goods Administration’s medicine shortages list in July.
But throughout the shortage period, it became common for patients to receive multiple prescriptions for whichever medicine was available at the time, said Kirrily Chambers MPS, Advanced Practice Pharmacist and credentialled diabetes educator during the National Medicines Symposium 2025, held last week.
For example, when Ozempic was out of stock, Ms Chambers said patients were often issued a prescription for sitagliptin (Januvia) in addition to their usual semaglutide.
‘When there have been issues with not being able to get [the medicine], people will often pick up both scripts when it comes back on the market,’ she said.
‘A patient might collect a 6-month prescription for Januvia. Then, when they present to the pharmacy, the pharmacist says, “Mrs Jones, your Ozempic is back – would you like one?” The patient says, “Yes, please,” forgetting the GP or specialist had advised using Januvia only while Ozempic was unavailable.’
If pharmacists encounter this situation, they should contact the GP or specialist to confirm the prescribing was intended.
‘We're now ringing to say, “Hey, did you really mean to put this person on multiple things? Because 6 months ago, they weren't on all these medications”,’ she said. ‘This is part of deprescribing to keep people safe, so that they're not bouncing into hospital.’
Regular Diabetes MedsChecks and medicines reconciliation, or a Home Medicines Review where appropriate, is critical to help the person living with diabetes understand the therapeutic approach. Any issues or duplications identified should then be communicated to the multidisciplinary team.
Discontinuations leave some patients without options
In the last few years, numerous diabetes medicines have faced discontinuation, including several insulin formulations and the GLP-1 RA liraglutide(Saxenda). There have also been device discontinuations, which can make diabetes care more difficult for older patients, said Associate Professor Margaret McGill AM, nurse manager and associate director at Royal Prince Alfred Hospital’s Diabetes Centre.
‘We know that people are living longer … and that age is the biggest predictor of type 2 diabetes,’ she said. ‘So we now see many referrals of people in their 80s and 90s – and some of these people need to go on insulin.’
Often, older patients don’t have the dexterity to navigate some of the newer devices, including putting a cartridge into a reusable pen.
‘When we lose the simple devices … it’s really impactful,’ A/Prof McGill told Symposium delegates.
Distinguished Professor David Simmons, the Chief Medical Officer, Diabetes Australia, has tried to ensure there are replacements for some of these devices.
‘Protaphane [is] one that we're trying to do, and it's quite challenging,’ he said.
‘If you're working with people [who have], for example, gestational diabetes, and they only have a limited number of weeks to actually understand what they're doing, some of the quicker learning devices are superior to learning how to put a cartridge into a pen.’
But the device discontinuation causing the most concern, however, is insulin detemir (Levemir) – which is set to be discontinued by December 2026.
Some patients who can tolerate a once daily dose of insulin could go on glargine, Prof Simmons said. However, the individual risks must be calculated for each patient.
‘For those who need Levemir twice daily so it can cover them during the day and night, there's a big risk when we go to once a day,’ he said.
‘During the day, they will be at risk of hypos – perhaps when they're driving if they haven't got a sensor on, or if the sensor is not working. If they then reduce their dose and their glucose goes up, they're going to be more hyperglycaemic at night – which will directly lead to long-term complications.’
While Diabetes Australia is looking into management strategies, the only current solution for these patients is an insulin pump.
‘There’s nothing else that's going to replace it for those individuals, and they may not be able to afford a pump,’ Prof Simmons said. ‘So we're certainly concerned about that. And GPs and pharmacists need to be very much aware that this is what's coming.’
Finding the right therapeutic approach
When considering new medicines for patients that are appropriate for diabetes, they must be selected for a person through a complex algorithm, said Dr Gary Deed, Chair of the Diabetes Specific Interest group at the Royal Australian College of General Practitioners.
‘[You] have to think, “do [they] have high blood pressure, lipid problems, kidney disease, metabolic-associated fatty liver disease? And how then, do I adapt that framework to the choices of medications and then negotiate with [the patient]?’ he said.
‘[You need a] well-trained, systematic approach and a very clear perspective of what that person is, not just physically, but also emotionally, and how they live.’
Renza Scibilia, a diabetes advocate who has lived with type 1 diabetes for 27 years, said that there’s a broad spectrum of people living with diabetes, and their understanding of the diabetes landscape may vary, including:
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[post_content] => Questions about spacers are abundant in community pharmacy. AP answers some of the trickiest ones pharmacists face.
Aren’t spacers just for kids?’ This is a common misconception pharmacists hear. People of all ages should use a spacer whenever they use a pressurised metered dose inhaler (pMDI).1 Spacers slow down aerosol spray, improve lung delivery and reduce oropharyngeal adverse effects like irritation, hoarseness or oral thrush from inhaled corticosteroids (ICS).1,2
They’re also useful for anyone who struggles with coordination or breath timing. When used correctly with a spacer, a pMDI delivers medicine as effectively as a nebuliser, and is often more efficient and convenient.2
Which spacers are better?
Spacers can be made of plastic or cardboard. Collapsible spacers are more compact for the patient to carry. Cardboard spacers fold flat for easy storage. Some spacers have additional features e.g. anti-static spacers improve delivery of active ingredient by preventing medicine from sticking to the walls.4
Some spacers have an inhalation indicator that moves when the patient inhales and whistles if they inhale too fast.4 Spacers with one-way valves stop exhalation into the chamber, helping keep the medicine inside and making delivery more effective.4
Anti-bacterial spacers are embedded with materials e.g. silver ion to inhibit bacteria growth. Choice of spacer depends on age, treatment, budget, dexterity and lifestyle. It should suit the patient, be easy to put together and be compatible with their inhaler.2,3 The Spacers for pMDIs Chart helps identify spacer options. Visit www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/charts
Do all inhalers fit into a spacer?
Not always. Some spacers have a rigid or fixed connection end. Those pMDIs with circular mouthpieces may require spacers with a flexible rubber/silicone opening that can form a seal around the mouthpiece. If in doubt, test the fit in the pharmacy and demonstrate with the patient’s own device.
Which devices don’t need spacers?
Breath-actuated inhalers, such as Accuhaler, Autohaler, Breezhaler, Ellipta, Respimat, Spiromax, and Turbuhaler are not spacer-compatible.5
Who needs to use a mask with a spacer?
A tightly fitting face mask is used for anyone who may find it harder to take a breath in through their mouth or cannot seal their lips tightly around the mouthpiece of an inhaler or spacer.2
What’s the big takeaway?
Spacers aren’t just for kids. For adults, they support technique and mean better medicine delivery with fewer adverse effects. Pharmacists play a key role in helping patients, especially adults, understand why using a spacer with pMDI is recommended.
References
- Lung Foundation Australia. Spacer and puffer inhaler device technique fact sheet. 2025. At: https://lungfoundation.com.au/support-resources/resource-hub/spacer-and-puffer-inhaler-device-technique-fact-sheet/
- National Asthma Council Australia. Spacer use and care fact sheet. 2025. At: www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/factsheets/spacer-use-and-care
- Respiratory Therapeutic Guidelines. Inhalational drug delivery devices Melbourne: Therapeutic Guidelines; 2020 (amended 2025). At: https://app.tg.org.au/viewTopic?etgAccess=true&guidelinePage=Respiratory&topicfile=inhalational-drug-delivery-devices&guidelinename=Respiratory&sectionId=toc_d1e208#toc_d1e208
- National Asthma Council Australia. AeroChamber Plus* Flow-Vu* Spacers for pMDIs Information Paper. 2025. At: www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/information-paper/aerochamber-plus-flow-vu-spacers-pmdi
- Asthma Australia. Devices and Techniques. 2025. At: www.asthma.org.au/devices-techniques/puffer-and-spacer/
[post_title] => Why all patients should be using a spacer
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
