E-cigarettes work: I’d prescribe them if I could

As part of a debate I was involved with at the Conservative conference this week on public health policy and e-cigarette legislation, I demonstrated an e-cigarette to the audience by inhaling on it. Judging from the reaction of some of them you would have thought I had just rolled up my sleeve and injected heroin, and this is one of the problems with public perception of this form of nicotine replacement therapy. Without being driven by doctors e-cigarettes have become the public’s preferred choice of nicotine replacement, with an estimated 2.9 million people now using them, up from 700,000 in 2012 when figures were first collected.

The basic point remains that smoking continues to be the single biggest cause of preventable early death and illness in England, with some 100,000 deaths in the UK attributable to smoking each year despite the rate of smoking having halved in the last 50 years. Even on the most optimistic grounds, and including implementing policies currently under consideration, this prevalence is unlikely to reduce to 10 per cent by 2025.

As a GP committed to reducing morbidity and mortality in smokers, I have no doubt that the NHS and recent smoking cessation campaigns have been very effective at helping the ‘soft underbelly’ of smokers quit. This is obviously hugely encouraging, but we face a tougher challenge with smokers who have either been unable to quit or who choose not to. I now believe this means that our views on smoking cessation need to widen to include harm reduction as a valid end-point rather than the absolute cessation of cigarettes or nicotine-related products.

It is vital to remember here that it is not nicotine that kills smokers – after all, medicinal nicotine has a minimal effect on the body, usually consisting of a temporary small rise in pulse and blood pressure – but the 7,000 or so chemicals inhaled in tobacco smoke. These include niceties such as arsenic, cyanide, lead and ammonia as well as almost 70 potential cancer-causing chemicals, so preventing smokers from inhaling smoke is a key aim of health professionals. Smoking one cigarette takes around 11 minutes off your life so smoking 20 a day for a week loses a day of life expectancy.

I use the term ‘harm reduction’ to mean decreasing the burden of death and disease, without completely eliminating nicotine use. In 2007 the Royal College of Physicians stated that ‘if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lived could be saved’.

Licensed NRT products include transdermal patches, tablets and lozenges, inhalators, gum and nasal or mouth sprays. In practice however I have found that these sometimes fail to help smokers quit because they are not delivering nicotine in the same way that cigarettes do, including not being able to address the sensory cues and rituals so often associated with smoking. This may in part explain the dramatic rise in the use of e-cigarettes by smokers trying to quit because they offer smokers a similar experience to their normal habit. In my surgery, increasing numbers of smokers are telling me they are trying these as an aid to cutting down smoking or quitting, and ignoring this phenomenon is not helpful.

For the first time, there are more ex-smokers (1.5 million) who use e-cigarettes than current smokers (1.3 million) and the main reason given by ex-smokers who are currently vaping is to help prevent them returning to their cigarettes. Despite their phenomenal increase in popularity though, public perceptions of harm from e-cigarettes remains inaccurate with only 13 per cent of people accurately understanding that e-cigarettes are considerably safer than smoking, and with just under a third of smokers knowing that nicotine replacement therapy in general is much less harmful than smoking.

60 years after the seminal publication of smoking on health by Doll and Hill, we must continue to strive to reduce the impact of cigarettes on the health of the country. Ignoring the rise in e-cigarette use among smokers is not an option in my view, and I would have no qualms whatsoever about being able to prescribe regulated e-cigarettes on prescription. It may be nicotine that makes it hard for smokers to quit, but it is smoke and tar that puts them in the ground.


  • Asylumsix

    I tried to quit smoking for 15 years, I invested 1000’s upon 1000’s of dollars into trying to quit, over 40 serious quit attempts and everything failed me.

    After finding the setup that worked for me, one that met my needs after smoking 22 years I quit putting tobacco cigarettes in my face, lighting them on fire and inhaling that toxic swill. To put it as simple as possible vaping just works, millions globally have proven that.

    My doctor failed me, public health failed me, support groups failed me, pills failed me, all sorts of NRT’s failed me and do you know why? It’s because they are geared towards nicotine cessation when nicotine isn’t the enemy, the byproducts of combustion are what kills which aren’t found in vapor products at levels to worry about.

    Guess what world people like mild stimulants like nicotine, if we were to get our caffeine from smoking something it would be just as bad as tobacco, there would be 10’s of millions of deaths from smoking to deliver the caffeine. Vapor products allow me to use nicotine via a delivery mechanism that is similar to smoking, a mechanism that can deliver very quick while reducing the risks while substantially reducing my exposure to toxins in comparison to tobacco cigarettes.

  • Robert Harvey

    it doesn’t help the situation when many work places impose a no vaping inside rule and even some who insist vapers share the same area to vape as smokers use to smoke as well as shopping centres and other public places that have no vaping rules in place.
    for many this indicates that vaping and smoking is basically the same thing be they smokers or non smokers alike.
    I even know of some who vape who are starting to wonder if they might as well not have bothered switching, the only thing that keeps them going is the £££’s they are saving by vaping, if that were to change they would probably go back to smoking.

  • Steve Brown

    “60 years after the seminal publication of smoking on health by Doll and Hill ….” which has been totally falsified by many subsequent studies.
    The entire discussion about smoking has been poisoned by ASH and its false divisions between smoking, second-hand smoke and vaping.
    I grew up in the 50s when most people smoked. I travelled on the upper deck of buses where smokers were. Cinemas provided ashtrays on the backs of the seats in front for smokers. Where are the bodies of the millions who must have thus been poisoned?
    The death rate from lung cancer has risen since then. So has the incidence of nuclear weapons testing. Of late, the proliferation of diesel-powered vehicles has suddenly begun to cause alarm because of their emissions of particulate matter which can harm the lungs. Now, many car owners, suckered into buying diesel cars by Governments giving financial incentives to do so in the name of Green Goodness, now find themselves being financially penalised for owning the self-same once planet-saving car.
    It’s all total bollocks. Mankind has, since the taming of fire, lived with smoke. Caves, huts, cottages, all were smoke-ridden but mankind survived. Tobacco smoke is far less harmful to you than smoke from burning oleander.

  • Ben Harding

    I started vaping 3.5 years ago. I instantly – instantly – stopped a 20-a-day smoking addiction. I’m still addicted to nicotine, but I don’t care. I can run upstairs. I’ve stopped snoring (I think), I don’t stink of fags. I’ve saved huge amounts of money. I’m hoping it’s saved my life.

  • JonathanBagley

    I am very much against providing ecigs on prescription. A serviceable battery costs around £5 and perfectly adequate (I use them every day) disposable tanks are available from Poundland. I mix my own flavourless liquid from 72mg concentrate (can now be bought only semi-legally) and this costs 60p a week. Standard liquid can be bought for £1 per 10ml and most people wouldn’t need more than two bottles a week. The NHS has better things than recreational nicotine on which to spend our taxes. Everyone now knows about ecigs and they are widely available and very cheap. Providing them on prescription will serve only to antagonise anti smokers.