Louise Ross urges us to stop scaremongering about e-cigarettes (
The Pharmaceutical Journal
2015;295:327). She is a manager in a smoking cessation service and I can see why she says this. However, the development and marketing of e-cigarettes is not solely about smoking cessation. Far from it. It is clear that the companies involved in this have a much broader agenda. They want to reach those who have not previously used tobacco. This is already evident in California, United States, where more high school students who have not smoked are vaping than those who have previously used tobacco.
There is another point also. Of course, those providing stop smoking services focus on the single, easily measured, outcome. I agree also that vaping is almost certainly less harmful than tobacco smoking. As a pharmacist, I was also interested in curing people of addiction to nicotine. It was noticeable that those who used forms of nicotine replacement therapy (NRT) that gave a cigarette-like “hit” (e.g. inhalators, chewing gum) remained users of NRT for years. Those using patches, perhaps supplemented initially with other NRT products, were more likely to cease using NRT altogether.
Clearly products need to be licensed and regulated. This will avoid the sale of items with dangerous substances (e.g. heavy metals, certain solvents) apart from nicotine. Advertising needs to be far more closely controlled than at present and should be about smoking cessation. Pharmacies should probably not sell these products other than to those wishing to stop or reduce smoking (although I acknowledge it might be hard to police this in a pharmacy).
One final point to remember: nicotine does not give significant pleasure (I am an ex-smoker). What it does is give relief from the craving for more nicotine.