Our advice to smokers remains to stop immediately, completely and permanently. That’s the first point in the blog, and most smokers will at that point click away in disgust. Every smoker who has tried to quit using the methods that are endorsed by Public health are products of those past quit attempts. The problem with that picture isn’t the failure rate of NRT (although that is shocking) so much as the human cost; when we relapse to smoking we feel shame, guilt, self-hate and social stigma. All of the negativity piled up against the smoker by the “de-normalisation” of smoking comes flooding home to roost once again. The “weak willed spineless” relapsed smoker grows an even thicker skin against the anti-smoking message.
E-cigarettes haven’t been around for very long, so no reliable long-term studies of the risks they represent are available.With the regulation we currently have, as consumer products, it is hard to give smokers the reassurance they need about how safe e-cigarettes are or how effectively they deliver nicotine.
This is counter productive to a positive harm reduction message. How long do we have to wait until long term studies are done? Five years, ten years, fifty years? Carl Phillips:
“.. discouraging a smoker, even one who would have quit entirely, from switching to a low-risk alternative is almost certainly more likely to kill him than it is to save him. Similarly, a strategy of waiting for better anti-smoking tools to be developed, rather than encouraging immediate tobacco harm reduction using current options, kills more smokers every month than it could possibly ever save”
We need information based on current knowledge. Like Dr Farsalinos’ study on how effectively these devices deliver nicotine. It isn’t true that we need more long term studies to know that they are safer than the product which they are replacing. Given the risk of smoking versus the possible risk of smokeless alternatives it is surely up to the individual to decide which legal consumer product they would prefer to use. Rather than repeat, “we don’t know,” just give the risk v benefit as we see it now, with a warning that this may change with ongoing research. That was good enough for me to make the switch. To paraphrase Carl Phillips again, even if the risk from vaping is found to be only 95% better than that of smoking, the health benefits still outweigh the net health costs of switching for life. The likelihood of it being a worse risk to health than smoking is so small as to be ludicrous.
The current diversity of unlicensed e-cigarettes and the variability of their contents also presents a challenge.
The word “unlicensed” is unnecessary in this sentence. E-cigarettes are currently covered by more than 17 regulations, including Trading Standards and CHP regulations. By describing them as “unlicensed” the corollary is that they are dangerous. That is harmful to the harm reduction message. The diversity of e cigarettes is part of the mechanism which is helping smokers switch. The variability of their contents is also by design although mentioned here as a negative. Nicotine levels in e liquid is tested in UK laboratories to ensure that the strength on the label is accurate. Tests reveal that the standards are being upheld. I did not know, nor did I care, what nicotine dose I was getting using lit tobacco. I use my personal vaporiser in the same way, self titrating my nicotine levels. Absorption of nicotine from e cigarette use is on a par with that of NRT. It is implausible that a vaper would overdose on inhaled nicotine from vapour. A smoker knows the symptoms of overindulgence and simply stops use. A vaper does the same.
PHE supports the regulation by the MHRA of nicotine-containing products – including e-cigarettes – as medicines, to give people access to safe products that are also effective.
At this point however positive the rest of the bog is, Public Health have lost my support for their position. Cigarettes are not medicines. E cigarettes which are currently working well to replace cigarettes are not being used as medicines. Medicalising my nicotine use goes back to shaming me for being weak willed enough to want to use nicotine. The twin track approach – with the EU TPD strangled consumer products and MHRA approved horrors as the only choices – is only mentioned in comments to the blog. This is a disaster in the making. Everything I find effective will be illegal to purchase in two years. I won’t even be able to make my own juice.
the nicotine delivered by these products is highly variable. Without reliable standards, smokers may find their attempts to cut down or quit undermined by products which fail to reduce nicotine withdrawal adequately.
That really isn’t true at all; a vaper would up the nicotine level, or change devices. This is why the diversity works, and why the community of vapers is such a huge part of what makes vaping work. It’s also why pioneers like Louise Ross will (I’m certain) be very successful supporting new vapers. Anyway we have reliable standards of nicotine content in juice now. It’s also not the case that vapers vape to relieve withdrawal – nicotine isn’t as addictive as tobacco. If it were nicotine that was the only part of what makes vaping work, then NRT would be as effective. In a recent blog post Caerulea reports after a PH event. In one presentation John Britton showed an image of a woman smoking, with the caption “NRT doesn’t do this.” She says:
[That] moment  made me say ‘Shit – they’ve got it! They’ve finally got it!’ and grab Dave Dorn’s arm, this was from John Britton, and the caption is his, not mine. A happy smiling smoker. An attractive, normal woman. Smoking. They admitted that NRT just is not going to cut it. It has an image problem. He looks at us with our vibrant and strong community and then states ‘There is no NRT community’ to the room – and the room laughed!
The people in the room may have “got it” but to me the message being put out elsewhere seems to tell a different story.
We need to develop an appropriate response that is firmly rooted in the evidence
“Light touch” or “right touch,” licensing them as medicines is a retrograde step. The evidence doesn’t support this inappropriate response. Meanwhile the spread of negative propaganda goes on unchecked, which means that the people who are losing are the potential future vapers. I think that the correct approach would be to strengthen the current consumer regulations under which vaping is regulated, and let vapers carry on as before. We do have the right vested interests in making sure that the products we use are safe and effective.
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Medical professionals please see M.O.V.E and add your voice.