E-cigarettes are at least 95% safer than smoking tobacco cigarettes, says Public Health England

Pharmacists offering stop smoking services can now support smokers trying to quit using e-cigarettes and even recommend would-be quitters try them, according to Public Health England (PHE).

However, the Royal Pharmaceutical Society (RPS) is advising pharmacies not to advertise or sell the products because they are unregulated.

PHE commissioned a review of e-cigarettes, published on 19 August 2015 , which concluded that vaping was at least 95% safer than smoking tobacco cigarettes and did not act as a gateway to smoking for children and non-smokers^[1]
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“It is not known whether current e-cigarette products are more or less effective than licensed stop smoking medications, but they are much more popular, thereby providing an opportunity to expand the number of smokers stopping successfully,” the report says.

As a result, PHE has informed pharmacists and other health professionals offering stop smoking services that they can support smokers attempting to quit using the devices and can even suggest that they try using them.

“There are opportunities for e-cigarettes to be welcomed by smoking cessations services because, when used in combination with the psychosocial support that stop smoking services provide, you are likely to see the maximum benefit in helping people to quit… [stop smoking services] should be having a conversation about the full range of tools that are available,” Kevin Fenton, PHE chair of health and well-being, told a press briefing on 18 August 2015.

But he emphasised that no specific brand of the unregulated products should be recommended.

“E-cigarettes are not completely risk free but when compared with smoking, evidence shows they carry just a fraction of the harm,” he said. “The problem is people increasingly think they are at least as harmful and this may be keeping millions of smokers from quitting.”

In May 2015, the Action on Smoking and Health Smokefree GB survey found that 22.1% of people think vaping is as harmful or more harmful than smoking, compared with 8.1% in 2013.

Howard Duff, RPS director for England, says that although the report added to the growing body of information about the use of e-cigarettes as a quitting aid, they are currently unlicensed products with no standardisation of safety, quality or efficacy. “As such, we believe they should not be sold or advertised from pharmacies,” he says.

Duff explains that e-cigarettes contain less harmful toxins than tobacco but still contain nicotine, which is an addictive substance.

“As they are a very new product, no one can be sure of the consequences of long-term use on health and further research is needed to determine this,” he says. “We echo the views of PHE and support the original intention of the Medicines and Healthcare products Regulatory Agency (MHRA) to regulate e-cigarettes as medicinal products as an aid to smoking cessation.”

The licensing process would align e-cigarettes with other nicotine reduction therapies and ensure quality control and standardisation of products, he adds.

Elizabeth Wade, director of policy at Pharmacy Voice, also believes licensing and regulation is still required to ensure the safety of e-cigarettes.

“Pharmacy Voice has previously called for a rigorous systematic review of the evidence surrounding e-cigarettes, and so welcomes PHE’s efforts in this area,” she says. “However, licensing and regulation is still required to standardise these devices, provide greater assurances for patients and the public, and align their use with current nicotine replacement therapy products.

“It is equally important that marketing of these products is regulated so that e-cigarettes are not glorified in any way or targeted at non-smokers as a fashion accessory.

“Until licensing is in place, where a pharmacy owner decides to sell e-cigarettes, we believe pharmacists should be free to exercise their clinical judgement, as they would normally do in the exercise of their professional practice.”

A spokesperson for the MHRA says it is not currently considering any e-cigarette products for licensing. A medicines licence has been granted to Kind Consumer for an inhaler device called Voke, which is also used in a way that mimics smoking activity. However, it involves no heat or combustion, and produces no ash or smoke vapour. The device, activated by inhaling, is expected to be launched by the end of 2015 by Kind Consumer’s commercial partner Nicovations. Voke will be available on the general sale list in the UK.