July 26, 2018 . by Matthew Hern
Information for service providers and service users on nicotine vapourisers (also known as e-cigarettes)
The stop smoking service offers support to people who are smoking tobacco products and who may wish to use e-cigarettes as an aide to quitting smoking.
Quitting the smoking of tobacco products is one of the main things that people can do to improve their own health and the health of those around them. The evidence available to date shows that e-cigarettes are significantly less harmful than smoking tobacco.
Recent NCSCT advice to commissioners of local stop smoking services is that services should be open to helping smokers who want to quit smoking with the help of e-cigarettes.
Who can use e-cigarettes?
There are currently no known restrictions. E-cigarettes can be particularly helpful for smokers that have tried, but not succeeded, in stopping smoking with the use of licenced stop smoking medicines.
What is an e-cigarette?
An electronic cigarette (e-cig or e-cigarette), personal vaporizer (PV) or electronic nicotine delivery system (ENDS) is a battery-powered vaporizer that simulates the feeling of smoking. They are often cylindrical, with many variations. Some e-cigarettes look like traditional cigarettes, but others do not. There are disposable or reusable versions. The liquid in the devices usually contains nicotine suspended in propylene glycol and glycerine. The levels of nicotine in the cartridges may vary and most also contain flavourings. When a user sucks on the device, a sensor detects air flow and heats the liquid in the cartridge so that it evaporates. The vapour delivers the nicotine to the user. There is no side-stream smoke but some nicotine vapour is released into the air as the smoker exhales.
The NCSCT briefing on electronic cigarettes has further information and images.
Are e-cigarettes an MHRA licensed product?
E-cigarettes are currently not licenced but do have to comply with consumer protection legislation. There is one MHRA approved nicotine inhaler that has been granted marketing authorisation from MHRA, this product is VOKE and is not yet available on the market.
From May 2016 electronic cigarettes will be subject to EU Tobacco products Directive (TPD) that became law on 29 April.
E-cigarettes containing up to 20mg/ml of nicotine come under the TPD and will be subject to regulations such as; limit on nicotine strength, size limit for refills, safety mechanisms such as childproof fastening and opening, warnings that the product contains nicotine which is a highly addictive substance and not recommended for use by non-smokers and provision of greater consumer information.
Products containing more than 20mg/ml of nicotine will require marketing authorisation as medicines.
Can people who use e-cigarettes only and have stopped smoking tobacco products still use the service?
No. At present, the service is only open to people who smoke tobacco products and who are using an e-cigarette or want to use an e-cigarette to help them quit tobacco.
Can a stop smoking provider make a claim for helping someone to quit tobacco products even if they used an unlicensed product such as an e-cigarette to help them quit?
A smoker who chooses a nicotine vapouriser to support their quit attempt can be claimed as a 4 week quit for the purposes of payment and collection of national data so long as the:
How long should an e-cigarette be used for?
There is no suggested duration of usage for e-cigarettes. However, as with other NRT withdrawal programmes, the stop smoking service would encourage clients to reduce and ultimately stop their usage of e-cigarettes following successfully quitting tobacco smoking.
ASH, in line with NICE Guidance on tobacco harm reduction, always recommends that quitting all forms of nicotine use is the best option for smokers.
Can e-cigarettes be used in combination with any other stop smoking medication?
E-cigarettes can be used in combination with other NRT products – this is known as combination therapy.
Where can e-cigarettes be bought?
As e-cigarettes are not a licenced stop smoking medication they are not available under prescription or on a voucher. Therefore people will need to buy and pay for the e-cigarette themselves.
E-cigarettes can be purchased from a wide variety of vendors: e-cigarette shops, pharmacies, garage forecourts, local newsagents and online.
Subject to parliamentary approval, from 6 October 2015 it will be illegal to sell nicotine vaporiser products to anyone under the age of 18 years.
Should we recommend an e-cigarette product?
No. As the products are not licensed, health care professionals and the stop smoking service should not recommend a specific e-cigarette product.
NCSCT briefing on electronic cigarettes (p3) has a list of recommendations for practice which includes general advice about e-cigarettes.
What are the safety and harm issues with e-cigarettes?
Compared with smoking, using an electronic cigarette is safer. However, in the absence of a thorough clinical evaluation and long term population level surveillance, absolute safety of such products cannot be guaranteed. By comparison, the harm from tobacco smoking – the leading cause of preventable death in the UK – is well established.
Most, but not all electronic cigarettes contain nicotine. As noted above, the harm from smoking comes mainly from inhaling tobacco smoke rather than the nicotine. However, nicotine is an addictive drug which stimulates the nervous system, increasing the heart rate and blood pressure.
Toxins have been found in a number of studies of electronic cigarettes although these are at levels much lower than those found in cigarettes and not at levels which would generally cause concern.
Most of the safety concerns regarding electronic cigarettes relate to the absence of appropriate product regulation and inconsistencies in quality control. The current lack of regulatory oversight means that there is significant variability in device effectiveness, nicotine delivery and cartridge nicotine content both between and sometimes within product brands.
Other things to be mindful of around the safety of e-cigarettes is when charging them. Electrical Safety First has a few tips on their website.
Is there a problem with secondary vapors?
Although electronic cigarettes do not produce smoke, users exhale a smoke-like vapour which consists largely of propylene glycol and glycerine. The level of nicotine present in electronic cigarette vapour is about one tenth of that generated by a cigarette. Any health risks of second-hand exposure to propylene glycol vapour are likely to be limited to irritation of the throat.
How should I treat e-cigarettes in our smokefree policy?
E-cigarettes are not banned under Smokefree legislation. Different organisations have different approaches to how they manage e-cigarettes in their organisational smokefree policy.
ASH UK poses some food for thought for organisations considering whether to ban e-cigarettes from their premises.
ASH briefing – Electronic Cigarettes www.ash.org.uk/files/documents/ASH_715.pdf
NCSCT Electronic Cigarettes http://www.ncsct.co.uk/usr/pub/e-cigarette_briefing.pdf
NHS Choices – Stop Smoking Treatments http://www.nhs.uk/conditions/smoking-%28quitting%29/Pages/Treatment.aspx
For further information on e-cigarettes, please contact the Nottinghamshire Stop Smoking Service at firstname.lastname@example.org