A recent report from the Royal College of Physicians (28 April 2016), ‘Nicotine without smoke: tobacco harm reduction’ concludes that e-cigarettes are likely to be beneficial to UK public health. The 200-page report examines the science, public policy, regulation and ethics surrounding e-cigarettes and other non-tobacco sources of nicotine.
- E-cigarettes are not a gateway to smoking – in the UK, use of e-cigarettes is limited almost entirely to those who are already using, or have used, tobacco.
- E-cigarettes do not result in normalisation of smoking – there is no evidence that either nicotine replacement therapy (NRT) or e-cigarette use has resulted in renormalisation of smoking. None of these products has to date attracted significant use among adult never-smokers, or demonstrated evidence of significant gateway progression into smoking among young people.
- E-cigarettes and quitting smoking - among smokers, e-cigarette use is likely to lead to quit attempts that would not otherwise have happened, and in a proportion of these to successful cessation. In this way, e-cigarettes can act as a gateway from smoking.
- E-cigarettes and long-term harm - the possibility of some harm from long-term e-cigarette use cannot be dismissed due to inhalation of the ingredients other than nicotine, but is likely to be very small, and substantially smaller than that arising from tobacco smoking. With appropriate product standards to minimise exposure to the other ingredients, it should be possible to reduce risks of physical health still further. Although it is not possible to estimate the long-term health risks associated with e-cigarettes precisely, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure.
The Department of Health (ROI) responded to the report:
Smoking kills nearly 6,000 people annually in Ireland. The most important thing a smoker can do to improve their health is to quit smoking completely. There are evidence based supports in place, provided by the HSE, GPs and Pharmacists to assist smokers to quit. These include behavioural therapies, nicotine replacement therapies and other prescribed pharmaceutical products (varenicline and buproprion). The Department of Health encourages all smokers to avail of these evidence based measures. Unfortunately, for whatever reason, not every smoker who uses these methods will succeed in their quit attempt. In some instance smokers may try electronic cigarettes and in such instances, they should do so in combination with other proven supports.
The Department of Health welcomes the Royal College of Physician’s report “Nicotine without smoke: tobacco harm reduction” as it adds to the evidence base around the relative harms from the use of electronic cigarettes and continuing smoking. Whilst electronic cigarettes are not entirely harm free, they are significantly less harmful than continuing to smoke traditional tobacco products and are likely to lead to further quit attempts by smokers. The Department would encourage all health professionals to consider the findings of the RCP’s report so as to be able to inform smokers as to how best to reduce the harms to them from continuing to smoke.
The Department will continue to monitor existing and emerging evidence on the potential harms and potential benefits of these products, so as to inform any future decisions in this area.