People desperate to stop smoking should have access to ‘electronic cigarettes’ on the NHS as an effective means to help them quit.
That’s the recommendation of Public Health England following an independent review of evidence on the benefits of using ‘e-cigs’ – also called ‘vaping’ – compared to smoking.
Several quit smoking aids, including nicotine patches and gum, are already available on the NHS, but the evidence review found that switching to vaping could be more effective. It suggests that e-cigs could be contributing to at least 20,000 successful attempts to quit per year, and possibly more.
The review also found that vaping carries only a very small fraction of the significant health risks associated with smoking and that switching completely from smoking to vaping would deliver substantial health benefits. This is because most of the harmful effects from smoking are not from the addictive nicotine in cigarettes, but from the tar and other toxins in cigarette smoke which are not reproduced in vaping.
Other key findings from the evidence review were that:
- vaping is widely credited with improved quit success rates over the past year and an accelerated drop in smoking rates across the country
- thousands of smokers wrongly believe vaping is as harmful as smoking and around 40% of smokers have not yet tried an e-cigarette
- e-cig use in the UK has plateaued over the past few years at just under three million users
- there is no evidence to suggest that non-smokers (especially young people) who try vaping will move on to smoking. In fact, youth smoking rates continue to fall and regular use of e-cigs is almost entirely confined to people who have previously smoked.
Professor John Newton, Director for Health Improvement at Public Health England (PHE), said: “Every minute someone is admitted to hospital from smoking, with around 79,000 deaths a year in England alone. Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders.
“Yet over half of smokers either falsely believe that vaping is as harmful as smoking or just don’t know. It would be tragic if thousands of smokers who could quit with the help of an e-cigarette are being put off due to false fears about their safety.”
Professor Ann McNeill, lead author of the review, said smokers could still get their nicotine fix from vaping without the harmful effects of cigarettes. They could also gradually wean themselves off nicotine by switching to vaping liquids which contained less or none of it.
“People smoke for the nicotine, but contrary to what the vast majority believe, nicotine causes little if any of the harm,” she said. “The toxic smoke is the culprit and is the overwhelming cause of all the tobacco-related disease and death.”
On the basis of its evidence review, PHE now believes “there is compelling evidence that e-cigarettes should be made available to NHS patients”. It wants to see that happen within the next few years, but in order to be prescribed, e-cigarettes would first need to be licensed as a medicinal aid to quitting smoking. Currently no e-cigarettes in the UK are licensed in this way.
PHE is now calling on the Medicines and Healthcare products Regulatory Agency (MHRA) to continue working with e-cig manufacturers so their products can be licensed and regulated as medicinal aids to quit smoking, enabling them to be made available on the NHS.
In the meantime, PHE is advising smokers who have struggled to quit to try switching to vaping and at the same time seek professional support from their local stop smoking service, as this combination is proved to be most effective. It also wants new training on e-cigarettes for healthcare professionals, while local stop smoking services should commit to providing behavioural support for smokers trying to quit by using e-cigs.
NHS Trusts should have e-cigs for sale in hospital shops alongside other nicotine replacement products and adopt policies which support smokers’ efforts to quit through vaping. This could include a ‘carrot and stick’ approach of providing indoor private vaping areas for hospital patients while removing the outdoor smoking shelters.