The explosion of e-cigarettes to the market has seen health professionals race against time to discover whether their introduction has been for better or for worse. To find out more, Chief Executive of ASH Hazel Cheeseman, gives us her thoughts.
In 2010 ASH first surveyed the public about electronic cigarettes. At the time only 9% of smokers had tried an electronic cigarette and less than 40% of people had ever heard of them. By 2014 the landscape had completely changed. Half of smokers had tried an electronic cigarette, 2.1 million people were regularly using them and awareness was near universal.
This explosion of the market has created some serious questions for public health professionals and government as the speed of the products growth has outpaced regulation and evidence.
In the UK we were lucky that early on we started to consider some of these complex questions. In 2011 NICE started the process of creating what became in 2013 guidance on tobacco harm reduction. This set out clear principles regarding the use of nicotine to support people not yet ready or willing to quit to reduce the harm from smoking. Recommendations included providing licenced NRT long and short term, encouraging people who can't yet quit to cut down and providing good communication about the relative safety of long term nicotine use. This guidance has provided a useful context for thinking about future policy on electronic cigarettes.
There remain enduring misconceptions among the public and professionals that nicotine is a major source of harm. Too few smokers understand that while they are addicted to the nicotine, it is the smoke which is killing them. One in two life time smokers will die for their habit, losing on average 10 years of life. By comparison, studies of long term NRT use show few indications of harm.
While many electronic cigarettes contain nicotine they also contain a range of other ingredients which are heated by an element and inhaled as a vapour. There is significant variation between products, however. Research has found high levels of variability in the content of nicotine and different products contain different toxins in different concentrations. All this makes absolute assurances of safety difficult, although it is clear that electronic cigarettes are many magnitudes safer than smoking.
The current evidence in the UK indicates that use by people who have never smoked is rare. The overwhelming majority of people using electronic cigarettes are those who currently smoke or used to smoke. This is true of both adults and children. People say they ‘vape' either to cut down or quit tobacco and there is growing evidence that products are effective in helping people achieve these goals.
The market in the UK is continuing to evolve and will change further as new regulations come into force. From October this year it will be an offence to sell an electronic cigarette to a child. In 2016 a new directive from the EU will come into force which will, among other things, place restrictions on advertising, place a requirement on manufacturers to notify the ingredients in their products and require health warnings regarding the addictiveness of nicotine.
It is also expected that more products will opt in to medicinal regulation and be licenced by the MHRA. These products could be available on prescription, will be able to advertise in the same way as other over the counter medications, and will be able to make health claims.
ASH continues to be optimistic about the potential for electronic cigarettes to support more smokers to become smokefree but we believe it is vital that the market is appropriately regulated to ensure products are as safe as possible and not marketed to non-smokers.
The message for now is that there are no circumstances in which it is safer to smoke than to use an electronic cigarette. Given the dreadful burden of disease caused by smoking we must find a way to make the most of the opportunities and ensure that risks are minimised.
For more information head to the Regulating nicotine products page.