E-cigarette rules should be relaxed to encourage smokers to switch, MPs told

Experts recommend changes to regulations, such as allowing larger refill containers and easing the restriction on nicotine strength in e-cigarettes.


E-cigarette regulations should be relaxed to make vaping more attractive to smokers of traditional cigarettes, expert witnesses have told a House of Commons Science and Technology Select Committee hearing.

Riccardo Polosa, professor of internal medicine at the University of Catania, in Italy, told MPs that selling larger refill containers for e-cigarettes might persuade tobacco smokers to make the switch to vaping.

“Changing the size of the bottle may impact on cigarette smokers considering switching as the cost will come down,” he said.

The restriction on nicotine strength available in e-cigarettes, currently 20mg, was also called into question as it was argued that the limit simply means that e-cigarette users were having to “vape” more often to get the desired effect.

Polosa said the EU Tobacco Products Directive currently restricted the volume of e-liquid that can be sold in one refill container to a maximum of 10ml. And in an interview with The Telegraph newspaper, published on the same day as the hearing, Christian Mulcahy, head of the UK Vaping Industry Association, said Britain’s exit from the EU could cut such regulations on e-cigarettes, leading more smokers to move to vaping.

Big health benefits

Public Health England (PHE) said in 2015 that “best estimates show e-cigarettes are 95% less harmful to your health than e-cigarettes”. And witnesses at the Commons hearing agreed that switching from normal cigarettes to e-cigarettes had substantial health benefits.

“Scientific evidence shows that there are benefits of exclusive use of e-cigarettes after using conventional cigarettes — particularly in areas such as respiratory diseases and cardiovascular diseases,” said Polosa.

“Our priority is to have as many smokers as possible switch to less harmful products.”

PHE recommends that “smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes to stop smoking” and NHS RightCare, which advises local health economies, includes information on quitting smoking by using e-cigarettes in its smoking cessation decision aid.

When questioned on the link between e-cigarettes and cancer, Peter Hajek, professor of clinical psychology at Queen Mary University in London, told the committee that, overall, studies have shown that the cancer risk of e-cigarettes is less than half the cancer risk of normal smoking.

Polosa added that there was no human data showing any evidence of nicotine itself increasing the risk of cancer.

“In vitro studies and animal studies have looked at nicotine effects but they don’t have clinical significance,” he said.

“Nicotine is not a carcinogenic substance and there is no evidence that nicotine has a carcinogenic effect.”

Avoiding combustion

Lion Shahab, senior lecturer in health psychology at University College London, explained that the differences in risk between e-cigarettes and normal cigarettes comes down to combustion.

“Combustion releases more [harmful] chemicals, e-cigarettes do not have combustion, so one has to assume that they are much safer than normal cigarettes,” he said.

Paul Aveyard, coordinating editor at the Cochrane Tobacco Addiction Group, said that there was almost no doubt that “if you smoke and you switch [to e-cigarettes] you’re better off”.

The lack of combustion also means that the “deadly side stream smoke”, the smoke that escapes from the cigarettes when the user is not inhaling, associated with traditional smoking is not an issue with e-cigarettes because the only aerosols released are those that have already been inhaled by the user.

“As PHE has already emphasised, these aerosols are 95% less harmful than common tobacco — the risks are minuscule. I’d personally be more concerned to go out and breathe the air in London than having a vaping person next to me,” said Polosa.

One-way traffic

Responding to concerns from the committee about the lack of research on the impact of e-cigarette use on non-smokers, Aveyard explained that using e-cigarettes is rarely a stepping stone from not smoking to smoking.

“The traffic is massively one way and rarely the other,” he said.

“E-cigarettes with nicotine are spectacularly unattractive to non-smokers,” said Hajek.

“It’s the same thing with nicotine replacement therapies — it’s extremely difficult to find a non-smoker who is addicted to them. If you take away the other elements of smoking it’s not as attractive,” he added.

A spokesperson for the Committee said the next session on e-cigarettes was likely to take place in mid- to late-February 2018. 

Last updated
The Pharmaceutical Journal, PJ, January 2018, Vol 300, No 7909;300(7909):DOI:10.1211/PJ.2018.20204220

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