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E-cigarettes will not cure people from nicotine addiction

Louise Ross urges us to stop scaremongering about e-cigarettes (The Pharmaceutical Journal 2015;295:327). She is a manager in a smoking cessation service and I can see why she says this. However, the development and marketing of e-cigarettes is not solely about smoking cessation. Far from it. It is clear that the companies involved in this have a much broader agenda. They want to reach those who have not previously used tobacco. This is already evident in California, United States, where more high school students who have not smoked are vaping than those who have previously used tobacco.

There is another point also. Of course, those providing stop smoking services focus on the single, easily measured, outcome. I agree also that vaping is almost certainly less harmful than tobacco smoking. As a pharmacist, I was also interested in curing people of addiction to nicotine. It was noticeable that those who used forms of nicotine replacement therapy (NRT) that gave a cigarette-like “hit” (e.g. inhalators, chewing gum) remained users of NRT for years. Those using patches, perhaps supplemented initially with other NRT products, were more likely to cease using NRT altogether.

Clearly products need to be licensed and regulated. This will avoid the sale of items with dangerous substances (e.g. heavy metals, certain solvents) apart from nicotine. Advertising needs to be far more closely controlled than at present and should be about smoking cessation. Pharmacies should probably not sell these products other than to those wishing to stop or reduce smoking (although I acknowledge it might be hard to police this in a pharmacy).

One final point to remember: nicotine does not give significant pleasure (I am an ex-smoker). What it does is give relief from the craving for more nicotine.

Brian Curwain

Christchuch, Dorset

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20200245

Readers' comments (6)

  • At present, we have NRT which,when sold OTC,has no better success than nothing(STS study)

    Last month,the ELONS study was finally published showing a 1-year success rate of our SSS of 7.7%.

    We know that up to one-third of those abstinent for 1 year subsequently relapse.

    We know from the annual ONS surveys that the proportion of ex-smokers in the adult population has not changed for 30 years.We also know from this survey that prevalence plateaued between 2007 and 2012 before falling again in line with ecig uptake.

    We know from the ASH surveys that the number of ex-smokers using ecigs has grown from 350k to 1.1m over the last 2 years.

    So we have a big gap between the ideal situation and reality - the question is what policy will best close it?

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  • If a smoker can switch to a nicotine product that has hardly any risk of cancer, cardiovascular or respiratory disease, why make a fuss about nicotine or any tiny residual risks? Once someone has stopped inhaling burning organic material the big job of public health is done.

    What the writer has not mentioned is that as e-cigarette use has risen among young Americans (and young Britons), smoking has fallen rapidly. This is consistent with vaping displacing smoking in those temperamentally inclined to risky behaviours. Rather than a cause for a moral panic, it is actually a good thing. The innovative low-risk disruptive product, e-cigarettes, is driving out the high-risk incumbent, cigarettes, with benefits to health at all ages.

    Those with a genuine interest in public health should try to make this transition happen faster and bigger and not try to obstruct it with poor analysis.

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  • As a smoker for 40 yrs, vaping (not the fake ciggie type of e-cigarette) is the only thing that has enabled me to stop smoking. Not one of the NRT options, or varenicline or bupropion worked for me. Use of vapers should be encouraged as a smoking cessation aid, and accepted as a better alternative than tobacco for those who relapse. As Geoff Vann says, that's not ideal, but as Clive Bates points out, stopping the inhalation of burning plant matter (with chemicals added by the tobacco industry) is the main health aim.

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  • Firstly let us not assume a layman's logic is definitely scientifically accurate enough to ascertain ecigs will not cause terminal cancer of some kind in a similar timespan to conventional cigarettes. It is too early for science to prove either scenario.
    Secondly when I quit the filthiest drug addiction on the planet nearly ten years ago I did not find the nicotine addiction per se was the big challenge to overcome; it was in fact the habit of cigarette to mouth therefore a product mirroring a cigarette would not and could not have helped me.
    Thirdly some people suggest ecigs helped them stop however they may have been ready to stop regardless.
    My point is simple; if someone absolutely wants to stop 'smoking/vaping/killing themselves' or at least damaging their health they can and the support is on their doorstep. It is up to them to decide upon the former and then try various options of support until they find what works for them. One person will use ecigs to quit smoking and another will find they only serve as a gateway to smoking conventional cigarettes. Everyone is different and some people don't even want to stop smoking!

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  • Thanks Geoff, Clive, David nd Cal for those helpful and constructive thoughts. All points duly taken on board, esp the one about youngsters trying vaping for a bit rather than smoking. It will be interesting to watch it all develop.

    Brian C

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  • For what's worth, see my letter in today's Guardian (7th Jan)


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