GPs advised to 'promote e-cigarettes widely' as smoking substitute

GPs have been advised to promote e-cigarettes 'as widely as possible as a substitute for smoking' by the Royal College of Physicians (RCP), following a comprehensive review of available evidence.

E-cigarettes should be used as a viable harm reduction strategy to help patients give up on the ‘addictive and lethal’ habit of tobacco smoking, according to the RCP’s Nicotine without smoke report.

The recommendation was welcomed by the RCGP, which has called on NICE to explore whether e-cigarettes should be made available on prescription to patients.

Assessing the scientific evidence, public policy, regulation and ethics of e-cigarettes, the RCP concluded that they are not a gateway to smoking and do not result in the normalisation of smoking.

Promoting the use of non-tobacco nicotine – ‘including e-cigarettes’ – is likely to ‘generate significant health gains in the UK’, it added.

Tobacco smoking is thought to cause more illness and premature death than any other avoidable cause. Smokers are estimated to lose around three months of life for every year smoked after the age of 35.

Not only smokers are affected – statistics in the report link passive smoking to around 165,000 new cases of disease in children a year, generating 300,000 primary care consultations and 9,500 hospital admissions.

E-cigarettes recommended

Tobacco smoke delivers high quantities of nicotine – the driving force behind smoking addiction – quickly to the lungs, where it can enter the blood stream and be delivered to the brain.

Nicotine itself is not highly hazardous, with nearly all health problems associated with smoking arising from the tobacco smoke, which is carcinogenic.

E-cigarettes provide smokers with the nicotine they are addicted to without the harmful tobacco smoke. It is inhaled in a vapour generated by heating a solution of water, propylene glycol, vegetable glycerine and flavouring.

Current licensed NRT – although backed by strong clinical evidence of its effectiveness – fails to replicate the rapid, high-dose delivery of nicotine that tobacco smoke does, which can make it a less satisfying alternative.

Since entering the UK market in 2007, e-cigarettes have swiftly become the most popular choice of product for smokers looking to quit or cut down on their smoking – with users more than doubling the number taking conventional medical NRT.

The report does warn that any long-term or rare side effects of vaping will not become apparent until e-cigarettes have been in widespread use for several decades.

Smoking replacement

Some of the carcinogens, oxidants and other toxins present in tobacco smoke have been detected in e-cigarette vapour, raising the possibility that long-term use may increase the risks of lung cancer, COPD, cardiovascular and other smoking-related diseases.

But it adds this is likely to be ‘substantially lower’ than those of smoking and ‘extremely low’ in absolute terms, and such risks may be reduced as vaporisation technology is refined.

The report concludes that replacing tobacco with NRT ‘almost completely prevents further damage to self or others from nicotine use’ and e-cigarettes are ‘probably close to NRT in the harm that their use confers’.

Dr Tim Ballard, RCGP vice chairman, said: ‘The college recognises e-cigarettes as a safer alternative to cigarettes and we welcome today’s comprehensive report, which should increase the confidence of GPs and our teams as we help our patients to quit smoking in order to improve their long term health.

‘However, moving forward we would be looking for clear evidence that making e-cigarettes available on prescription as part of a wider smoking cessation scheme is a wise use of both scant NHS funds and GP practice resources, before the College could get behind it.

‘We reiterate our calls for NICE to take a leading role in establishing whether making e-cigarettes available on prescription is the best way forward.’

Mr Ram Moorthy, deputy chairman of the BMA board science, said: ‘This report provides much needed insight and evidence which will help inform the debate on e-cigarettes. It is certainly interesting to see the RCP assessment of tobacco harm reduction, which recognises the potential for e-cigarettes to reduce harm associated with tobacco use.

‘E-cigarettes are increasingly being used by current and ex-smokers to help cut down and quit smoking, so regulation should focus on making sure that these devices are safe and effective for those wanting to stop smoking, and ensuring their marketing does not appeal to children and young people.’

Photo: iStock

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