17 Oct 2012

How e-cigarettes can reduce the harm caused by smoking

This month is Stoptober, a £6m Department of Health campaign to help people to quit smoking within 28 days.  Health experts believe that if they can achieve that they are five times more likely to quit the habit for good.

Persuading people to stop smoking is what anti-tobacco groups describe as the holy grail.   Yet next week, there will be what amounts to an official acknowledgment that sometimes it is simply impossible to persuade some smokers to quit so, instead, there needs to be harm reduction.

The ‘nudge’ approach, which the government promotes as an effective method of changing people’s behaviour. The National Institute of Health and Clinical Excellence (NICE) will publish draft guidance on harm reduction and will evaluate the use of pharmaceutical products, like zyban, that are licensed to help people cut down, behavioural support and counselling, self-help techniques and nicotine-replacement products, including nicotine patches and electronic cigarettes.

The aim of the guidance will be to look at the implications of using such things nicotine replacement products long term and how stop smoking services might play a part in delivering them to smokers. All of which is based on the perfectly sound, scientific premise that nicotine itself, while addictive, does not actually cause cancer and that it can help people in the long-term wean themselves off tobacco.

Growing interest

Figures show that 67 per cent of smokers want to stop and that and that 75 per cent have tried to quit.  Professor Gerry Stimson, who was one of the founders of harm reduction and runs Knowledge-Action-Change, said that he believes the solution for dealing with tobacco “is staring us in the face”.

In a recent lecture he said:  “Those who are unable or unwilling to quit need to shift to safer nicotine products.  Public health needs to catch up.”

Certainly, the popularity of e-cigs is increasing.  According to Action on Smoking and Tobacco (ASH), the proportion of smokers currently using e-cigarettes has more than doubled from 3 per cent in 2010 to 7 per cent in 2012, which they estimate is between 650,000 and 700,000 smokers in Great Britain.  Even higher were the figures for those who have ever tried an e-cig.  In 2010, it was nine per cent of smokers.  By this year it had risen to 22 per cent and the World Health Organisation believes it will reach one million by next year.

Although the NICE guidance is not expected to concentrate on e-cigs, there is growing interest in this means of ‘nictoine delivery’.

E-cigs are a means of inhaling pure nicotine in a vapour.  The device heats up the nicotine, which can be refilled.  Apart from anything it is cost-effective.  The start-up cost of the two electronic devices is about £75 and the phials of nictoine are about £5 but they hold the equivalent of about 200 cigarettes.  So for a heavy smoker, savings can be made within 10 days to two weeks.

Tiramisu-flavoured tobacco

Just off the high street in Rugby is one of the country’s first e-cigarette shops, Smoke No Smoke.  On a recent grey, chilly Monday we visited the shop and in the space of the 90 minutes we were there more than a dozen people came in either wanting to try them for the first time or asking for refills, which come in a variety of flavours including espresso, tiramisu and straight-forward tobacco.

They were all ages of adults, too, determined to cut down or give up and many of them had either tried a friend’s e-cig or had been tipped off about their shop by their GP or the local hospital.  One woman who came in for a refill had been smoking 40 a day for 20 years and had not had a cigarette for five months.

Jim Lacey, who runs the shop and has a franchise to open a number of others, said that since he opened in January he has been getting about 130 customers a week.  Mr Lacey said they are coming in for a variety of reasons:  they either want to stop smoking and nothing else has worked or they want to reduce their nicotine intake or they have smoking-related health problems.

The problem for enthusiasts of e-cigarettes is that they are not regulated.  The Medicines Healthcare Products Regulatory Agency (MHRA) has not licensed them although next year will begin the discussion on what should be regulated and how they can be regulated.  It could be, for instance, that it is ‘light touch’ regulation which means they could be sold in corner shops.  But it also means that if they are licensed, they can then be prescribed by doctors.


And even tobacco manufacturers are showing interest.  One large company has several patent applications in the pipeline while another apparently even has a harm reduction division, carrying with it all the hallmarks of ‘if you can’t beat them, join them’.

Next month, too,  the WHO’s convention on tobacco control is to discuss the impact of e-cigs.  They will consider whether they contravene WHO rules on tobacco control which prohibits promotion of smoking products and if they indeed give these products a level of legitimacy if they are regulated rather than banned.  On the other hand, they say, regulating them would at least mean they could be treated like other medical products.

Next Monday and Tuesday delegates will converge in London for City Health 2012 – an international conference to look at policy and practice in relation to public health in cities.

And while the conference papers will largely centre on drug and alcohol use, one of the speakers will specifically look at this issue.  The abstract even states:  “The greatest emerging, but still largely untapped, public health movement in western nations is tobacco harm reduction (THR), the substitution of low-risk tobacco and nicotine products for smoking. ”

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