Vaping comes out of the smoking closet

E-cigarettes are fast becoming the new statins — for every study supporting their benefits, there’s another to report the harm they could cause. And for every vaper sharing their stop-smoking success, another questions the real value of e-cigarettes as a smoking-cessation aid.

In January 2018, a Public Health England (PHE) review of e-cigarettes revealed its most positive stance by far on the use of e-cigarettes, and called for them to be made available on NHS prescription in England.

The review provided an update to a 2015 report, which concluded that vaping is 95% safer than smoking tobacco cigarettes. While vaping may never surpass effective psychological or pharmacological support approaches in helping people quit, PHE recommends vaping as another option for smokers who have not succeeded with other methods.

In an ideal world, all smokers would kick the habit entirely — when this is not possible, there are substantial health benefits associated with shunning the lethal cocktail of 7,000 compounds inhaled in tobacco smoke and switching to e-cigarettes. Many argue, however, that without data on the long-term effects of sustained vaping, it will be some time before we understand the full impact of e-cigarettes on health.

While the debate continues, the vaping trade is booming, with more than 2,000 stores popping up across the nation to cater for the estimated 2.9 million vapers in the UK.

And vaping shops are doing well in supporting customers with their quit attempts, according to a study published this month. The researchers at the University of East Anglia suggested that healthcare professionals could engage with reputable vaping shops, “to ensure best outcomes for clients wanting to use e-cigarettes to quit smoking”.

But should pharmacists themselves stock the devices? In a position statement published in 2014, the Royal Pharmaceutical Society (RPS) said that it “cannot support the sale of products with limited scientific evidence on safety”.

The RPS’s newly formed Science and Research Board of the RPS scheduled e-cigarettes for discussion during its inaugural meeting this month — perhaps, in light of new evidence and advice from experts in the field, it is an opportune time to review the Society’s stance.

PHE has called on the Medicines and Healthcare products Regulatory Agency to expedite the licensing of e-cigarettes as medicinal stop-smoking aids, and with their healthcare expertise, pharmacists are ideally placed to provide and advise on these products if the licences come to fruition.

While e-cigarettes wait to pass through regulation, pharmacists should equip themselves to discuss vaping with patients. In January 2018, The Pharmaceutical Journal distributed a handy guide produced by Cancer Research UK ‘What you need to know about e-cigarettes’, which also contains an A3 poster to display in the pharmacy.

In the interests of harm reduction — following a discussion of the limits of current knowledge on safety — e-cigarettes should be recommended to tobacco smokers who are unwilling to quit, or have failed to quit using other evidence-based approaches.

But until the uncertainty over the safety of e-cigarettes can be put to bed, pharmacists should continue to exercise their professional judgment in the recommendation and sale of e-cigarette products.