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Electronic cigarettes

Executive summary

  • Electronic cigarettes are devices that deliver nicotine by heating and vapourising a solution that typically contains nicotine, propylene glycol and/or glycerol, and flavourings
  • Electronic cigarette use is increasing in smokers wanting to quit but particularly among smokers who want to reduce the health risks of smoking or to save money
  • Electronic cigarettes are not currently licensed for smoking cessation; they do have to comply with consumer protection legislation
  • The quality of electronic cigarettes is improving. With experience, users can achieve overall blood nicotine levels similar to those achieved with smoking conventional cigarettes; although it takes longer to reach these levels and they still receive less nicotine per puffing session
  • Electronic cigarettes can reduce urges to smoke and can help smokers quit, although these data are not as robust as those for licensed stop smoking medicines
  • Data from one good quality randomised controlled trial show that electronic cigarettes were as effective as nicotine patches in helping people stop smoking for six months, when used in combination with minimal support from a trained practitioner
  • Short-term exposure to electronic cigarettes appears to be associated with few serious risks. Mouth and throat irritation are the most commonly reported symptoms and these appear to subside over time. There are no high quality safety data regarding long-term electronic cigarette use but there is no a-priori reason to expect that such use may pose risks anywhere near the risks associated with smoking
  • Low levels of toxicants and carcinogens have been detected in electronic cigarette liquid and vapour although these are much lower than those found in conventional cigarette smoke and are not considered to pose any passive inhalation risk
  • Concurrent (dual) use of conventional cigarettes and electronic cigarettes has been associated with greater motivation to quit, and to a reduction of smoke intake from regular cigarettes. This may be associated with health benefits, although the extent of any such benefits remains to be determined
  • There are currently no robust data to support the concern that the existence of electronic cigarettes might ‘normalise’ smoking and increase use of conventional cigarettes

Recommendations for practice

  • Be open to electronic cigarette use in people keen to try them; especially in those that have tried, but not succeeded, in stopping smoking with the use of licensed stop smoking medicines
  • Provide advice on electronic cigarettes that includes:
    • electronic cigarettes can provide some of the nicotine that would have otherwise been obtained from smoking regular cigarettes
    • electronic cigarettes are not a magic cure, but some people find them helpful for quitting, cutting down their nicotine intake and managing temporary abstinence
    • there is a wide range of electronic cigarettes available and clients may need to try various brands, flavours and nicotine dosages before they find a brand that they like
    • electronic cigarette use is not exactly like smoking and users may need to experiment and learn to use them effectively (e.g. longer ‘drags’ are required and a number of short puffs may be needed initially to activate the ‘vapouriser’ and improve nicotine delivery)
    • although some health risks from electronic cigarette use may yet emerge, these are likely to be, at worst, only a small fraction of the risks of smoking. This is because electronic cigarettes do not contain combustion chemicals which cause lung and heart disease and cancer
  • Multi-session behavioural support, as provided by trained stop smoking practitioners, is likely to improve the efficacy of electronic cigarettes in the same way such support markedly increases the efficacy of nicotine replacement therapy (NRT)
  • Stop smoking services can provide behavioural support to clients who are using electronic cigarettes and can include these clients in their national data returns.* As with other unlicensed nicotine containing products, the stop smoking service cannot provide or prescribe them until such time as there are licensed options available
  • If a client being seen at a stop smoking service is using an electronic cigarette but also wants to use NRT, then it is OK for them to use the two in conjunction. They do not need to have stopped using the electronic cigarette before they can use NRT

*providing they adhere to the national data definitions in the service and monitoring guidance, which are based upon the
Russell Standard: www.ncsct.co.uk/usr/pub/assessing-smoking-cessation-performance-in-nhs-stop-smoking-services-the-russell-standard-clinical.pdf

full guideline available from…
www.ncsct.co.uk

National Centre for Smoking Cessation and Training. Electronic cigarettes. 2014
First included: February 2015.