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Smoking cessation

E-cigarettes should be available on prescription, Public Health England says

Smoking cessation services should convey to smokers the important message that e-cigarettes are 95% less harmful than tobacco cigarettes, the public health body advises.

E-cigarettes should be made available on NHS prescription in England as an aid to stop smoking, according to the results of a review by Public Health England (PHE).

The UK drugs regulator should also “expedite” licensing of the products as a medicinal quit aid because there is now “compelling evidence” that NHS patients would benefit, the review concluded.

PHE called on smoking-cessation services to convey the key message to smokers that e-cigarettes are at least 95% less harmful than traditional tobacco cigarettes.

Smokers who want to quit should also be clear that nicotine causes little damage to health — the potentially cancerous harm comes from inhaling the constituents of tobacco smoke.

Ann McNeill, professor of tobacco addiction at King’s College London and the report’s lead author, said: “It’s of great concern that smokers still have such a poor understanding about what causes the harm from smoking. When people smoke tobacco cigarettes, they inhale a lethal mix of 7,000 smoke constituents, 70 of which are known to cause cancer.

“People smoke for the nicotine, but contrary to what the vast majority believe, nicotine causes little if any of the harm. The toxic smoke is the culprit and is the overwhelming cause of all the tobacco-related disease and death.”

The report, which updates PHE’s 2015 review of e-cigarettes, was commissioned following the government’s tobacco control plan for England published last year, which included the ambition to create a “smoke-free generation.”

The latest PHE report revealed that there were “substantial health benefits” from switching completely from smoking a tobacco cigarette to vaping.

It estimated that up to 57,000 smokers a year were quitting the habit after switching to e-cigarettes, and it recommended that stop-smoking practitioners and health professionals should provide behavioural support to smokers who want to use an e-cigarette to help them quit smoking.

Stop-smoking service practitioners and health professionals supporting smokers to quit should also receive education and training in the use of e-cigarettes in quit attempts, it recommended.

Dave Edwards was the first community pharmacist to provide a smoking cessation service contracted by Hywel Dda university health board in Wales, and he has a 60% success rate in persuading smokers to quit. He is now a consultant pharmacist adviser in smoking cessation to the board’s primary healthcare team.

Edwards said he advises some smokers to use e-cigarettes as an alternative to smoking tobacco cigarettes if they are otherwise unlikely to quit.

“It’s the ‘silver standard’ — I think e-cigarettes can be a good substitute,” he said.

But he reiterated that the gold standard is always for the person to successfully complete a 12-week stop-smoking programme.

The report was also welcomed by the National Pharmacy Association (NPA) which said it is “now clear that e-cigarettes have a legitimate place in smoking cessation underpinned by professional advice.”

It said the PHE report would help pharmacists provide advice to people keen to quit but also help pharmacies decide whether to stock e-cigarettes for sale. Many more pharmacies will now feel confident to supply these products, the NPA said.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20204369

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