Nice says GPs can recommend e-cigarettes as NRT

The National Institute for Health and Care Excellence (Nice) has endorsed electronic cigarettes as a smoking cessation aid.

There is currently debate among doctors and health experts about the effectiveness of e-cigarettes as a form of nicotine replacement therapy (NRT).

The European Commission (EC) sparked a backlash from users of electronic cigarettes (known as “vapers”), who claim that any move to reduce nicotine levels in e-cigarettes would render them useless to hardened smokers seeking to curb a longstanding nicotine habit.

The EC is currently reviewing the Tobacco Products Directive and one suggestion is that electronic cigarettes should only have a nicotine level of 4mg. Currently, there are different levels of nicotine refill available which smokers trying to quit can vary according to their individual nicotine cravings. Many chronic smokers believe 4mg is too low a level to satisfy nicotine cravings and smokers will most likely revert to using tobacco products rather than continue trying to quit using e-cigarettes.

Electronic cigarettes are currently unregulated and are freely available to buy for adults over the age of 18 in the UK and as young as 16 in some countries. Many health experts are calling for more research to establish the safety of electronic cigarettes, despite the fact that since they came to market 10 years ago there have been no reported deaths linked to vaping, compared with 6 million people who die from smoking-related illnesses every year.

Nice has announced that GPs offering smoking cessation services to patients can now recommend electronic cigarettes as well as nicotine patches and gum. The new guidance was drawn up by a panel of experts, including Professor Paul Aveyard who is himself a GP and Professor of Behavioural Medicine at Oxford University. Prof Aveyard says that using e-cigarettes is “better than smoking”.

The Nice guidance concedes that “these products are likely to be less harmful than cigarettes”.

The nicotine in electronic cigarettes is regarded as “clean” nicotine as it is not delivered in harmful tobacco smoke with the by-product of tar and other potentially life-threatening chemicals such as nitrosamines and carbon monoxide.

Electronic cigarettes deliver a shot of nicotine in a vapour and there have been concerns among doctors and scientists that some of the chemicals used to deliver the nicotine may be harmful or carcinogenic.

However, electronic cigarettes not only use small amounts of chemicals common in other healthcare and cosmetic products (including baby wipes), they also do not emit the harmful smoke and tar which make tobacco products potentially lethal.

The by-products of electronic cigarettes, such as carbon monoxide, are also produced in much smaller quantities than in tobacco products; and although nicotine is a powerful stimulant which affects brain function and can be highly addictive, most smokers who have switched to e-cigarettes report having been able to quit tobacco products altogether as a result.

Many of those who switch to electronic cigarettes also report that being able to vary and control their nicotine intake also has a beneficial effect on their nicotine addiction, and some heavy smokers not only manage to quit tobacco but are happy to use electronic cigarettes with zero-level nicotine refills.

The guidance by Nice is being prepared for publication by the UK’s Medicines and Healthcare Products Agency (MRHA) and the move represents a huge step forward in electronic cigarettes being accepted as more than a just gimmick among the medical profession.

EU countries such as Italy are currently reviewing nicotine levels in e-cigarettes amid concern that these might actually be higher than advertised and therefore e-cigarettes would not be effective in helping smokers kick their nicotine addiction.

However, Nice refers to nicotine as a “fairly harmless substance” in its updated guidance on smoking cessation treatments, and advises that NRT aids like nicotine gum, patches and now e-cigarettes can safely be used in  combination with smoking tobacco, as overdosing on nicotine is not possible.

Professor Aveyard said:
“Experts believe that lifetime use of these products will be considerably less harmful than smoking. Advisors should reassure people that licensed nicotine-containing products are a safe and effective way of reducing the harm from cigarettes, and that NRT products have been shown in trials to be safe for at least five years’ use.”

In the UK, treating smoking-related illnesses costs the NHS around £2.7 billion every year and around one in every five adults now smokes tobacco products, although around two-thirds of smokers say they would like to quit smoking, according to figures from the Nice Guidance Development Group.

The spiralling cost of tobacco products is also another reason many chronic smokers have switched to electronic cigarettes: leading brands of 20 cigarettes now cost from £7.50 upwards, whereas one nicotine refill for an electronic cigarette costs around £5 and can provide the equivalent of up to 40 cigarettes, depending on individual use.