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E-cigarettes beneficial to UK health and help quitting

Support their use and promote them as strategy for tobacco harm reduction, say experts

Louise Prime

Thursday, 28 April 2016

Electronic cigarettes have the potential to contribute to reducing the death and disability caused by Britain’s biggest killer, experts said this morning. In their analysis* in The BMJ they called for e-cigarettes, whose use as a stop-smoking aid now exceeds that of nicotine replacement therapy, to be supported by government and promoted as a tobacco harm reduction strategy.

The writers analysed a new report by the Royal College of Physicians into the role of e-cigarettes in tobacco harm reduction. They said that although smoking is less prevalent than it was, there are still almost 9 million smokers in the UK, and the proportion of smokers is higher in disadvantaged populations; smoking is the greatest single avoidable cause of premature death, disability and social inequalities in health in this country.

They pointed out that the harm that smoking causes to health is from the carcinogens, carbon monoxide and other toxins in cigarettes, not from the nicotine they contain; which means that using other sources of nicotine can help people to avoid the health harms from smoking. However, many smokers who try to quit using various forms of nicotine replacement therapy go back to smoking, partly because of the relatively low nicotine doses they contain, and partly because they miss the behavioural and sensory components of tobacco smoking. This, they said, is where e-cigarettes have helped.

They said: “The emergence of e-cigarettes has revolutionised the choice of nicotine products available to smokers … some newer designs … are able to deliver sufficient nicotine to replicate at least the venous (if not arterial) nicotine levels achieved by smoking. E-cigarettes also reproduce many of the behavioural and sensory characteristics of smoking and benefit from perception as a consumer rather than medicinal product.”

Already, they explained, nicotine replacement therapy has been overtaken by e-cigarettes as the primary smoking cessation aid – most of the UK’s estimated 2.6 million users are smokers or ex-smokers, a third of whom no longer smoke.

The RCP report found that although e-cigarettes are not totally safe, the level of any health harm from long-term vapour inhalation (based on today’s e-cigarettes) is unlikely to exceed even 5% of the harm caused by tobacco smoking. Nor did its authors find evidence that the use of e-cigarettes renormalises smoking, or that using them where smoking is prohibited represents a significant health hazard.

They said e-cigarettes can be an important means of reducing the harm to individuals and society of tobacco use, so their use should continue to be supported by government, and promoted as a tobacco harm prevention strategy.

The authors of the BMJ Analysis concluded: “The evidence summarised in the RCP report shows that e-cigarettes have so far been beneficial to UK public health, both at individual and population level, by providing smokers with a viable alternative to tobacco smoking. While it is important to recognise that e-cigarettes are not hazard free, the primary comparator for these hazards is the substantially greater risk presented by obtaining nicotine from tobacco smoke.”


* Britton J, et al. Nicotine without smoke – putting electronic cigarettes in context. BMJ 2016;353:i1745. doi: 10.1136/bmj.i1745.

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