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The use of e-cigarettes has massively increased over the last three or four years. There may
be as many as two million people using them now in the UK. The real difference between
an e-cigarette and a conventional cigarette or cigar or any other sort of conventional
tobacco use is the fact that tobacco is burnt, and the nicotine comes along with smoke. Whereas
an e-cigarette basically you've got the device to vaporise nicotine. They contain nicotine,
propylene glycol and or glycerol and sometimes flavourings, to give the hit of nicotine that
you'd otherwise get from a cigarette. It very much depends how you use an e-cigarette
what nicotine levels you actually achieve. That's a bit like smoking ordinary cigarettes
actually. Some people don't get very high levels of nicotine from smoking. It depends
how you puff, how deeply you puff, how frequently you puff and so on.
Given that e-cigarettes have only really been around for a very few years it's extraordinary
the variety that are available. Essentially there are three generations, if you like.
There's no real guidance for this sort of thing, after all these are consumer products.
There is no approval for these products. They're not medications and therefore they don't come
under the MHRA and so on. The guidance was that the MHRA were going to perhaps give medical
licenses for the products in 2016, but there was a European directive which came out at
the end of 2013 and another one from the European parliament that has come out in February 2014,
which has said that these things can be regulated, but they will probably not be medications.
They will probably stay under the consumer banner.
There has been a lot of discussion about whether e-cigarettes can lead people, like a gateway,
into smoking cigarettes. So far, that does not seem to be the case. Obviously if there
is a risk that say kids would try them for novelty value, that they might go on to smoking
cigarettes, that would be an absolute disaster. In terms of using e-cigarettes with a conventional
cigarette, we can't think of any real risks there. The most common problems, adverse reactions
to using an e-cigarette are throat and mouth irritation. Usually that's self-limiting.
Maybe changing the brand, changing the way people puff, can improve that. There have
been no significant adverse reactions. I have to couch that with the fact that there
haven't been proper safety studies in the same way as you would do safety studies for
conventional medications such as nicotine replacements and the other stop smoking medications.
Given the fact that e-cigarettes have only really been around for three or four years
in significant numbers, we don't know anything about the long term effects of their use.
Essentially, we know the ingredients of e-cigarettes are safe. It's going to take a lot of long
term research to be absolutely sure of that, but nicotine from cigarettes is extremely
addictive. In fact, probably as addictive as injected *** or snorted ***, because
of the route of delivery. Inhaled nicotine in smoke is very, very addictive. I am told
by the researchers that have looked at e-cigarettes a lot, that nicotine of e-cigarettes is probably
somewhere between smoked nicotine and nicotine replacement in terms of addiction. So, there
is some potential for addiction there but it's not likely to be as bad as normal cigarettes.
In terms of what an e-cigarette can do to remove the likelihood of smoking, if you like.
Certainly they've been shown to reduce the urges to smoke, but not necessarily any other
of the nicotine withdrawal symptoms which make people go on smoking ordinary cigarettes.
There aren't a lot of studies yet, but they are coming through all the time. It does seem
that e-cigarettes should benefit people in stopping smoking.
Looking at the studies that have come out so far, some of them haven't been the best
constructed and they may have been a bit underpowered, and so we don't really know what the result
is. Certainly it seems to be that it would make sense to use e-cigarettes for smoking
cessation. Actually one study has shown that there is at least an equivalent benefit to
some form of nicotine replacement but I think the key is that it is when support is used.
It's not just a question of, "Go and use some e-cigarettes." Try and engage a smoker in
a supported quit attempt, with a stop smoking advisor usually through the stop smoking services.
Interestingly the stop smoking services are perfectly allowed to help support a smoker
through a quit attempt using e-cigarettes. They can't prescribe them and they can't recommend
any particular kinds, but they can give the support and that's probably the key to stopping
generally anyway. I think the first thing to be is open about
the use of e-cigarettes, particularly in people who have tried and not succeeded on the conventional
kinds of stop smoking medications. We're fairly convinced that there is likely benefit, and
it would be a real shame not to let people use it, if they're really not happy to try
anything else. I have to say, on the other hand that we have an evidence base for the
conventional treatments and the staff that support quit attempts in the stop smoking
services are familiar with the use of those. It would make sense to try and get people
to use those things first. I would strongly recommend the website of the national centre
for smoking cessation and training, that's NCSCT.co.uk. They have updated briefings on
all sorts of things to do with stopping smoking, but the one on e-cigarettes is particularly
good and I have to say I found it very valuable.