The government has been urged to make e-cigarettes available on the NHS after a probe by MPs found many of the health concerns around ‘vaping’ are wrong.
A report published on Friday by Parliament’s science and technology select committee said the government should “urgently” review the approval systems for prescribing e-cigarettes, as “misconceptions” were stopping health bodies from tackling smoking as well as they could.
E-cigarettes, the report said, present an opportunity to “significantly accelerate already declining smoking rates”. Smoking remains a leading cause of death in the UK.
The devices, estimated to be 95 percent less harmful than conventional cigarettes, are “too often being overlooked” as a stop-smoking tool by the NHS, the report said, while suggesting a relaxation of regulations around their licensing, prescribing, advertising, taxation and use in public places.
The committee called on businesses, transport providers and local authorities to stop viewing “conventional and e-cigarettes as one and the same” as there is no “public health rationale for doing so”.
“If used correctly, e-cigarettes could be a key weapon in the NHS’s stop smoking arsenal,” committee chair and Lib Dem MP Norman Lamb said.
“E-cigarettes are a proven stop smoking tool and, while uncertainties undoubtedly remain about their long-term health impact, failing to explore the use of e-cigarettes could lead to the continued use of conventional cigarettes - which currently kill around 79,000 people in England every year.”
The committee found that an “unacceptable” three quarters of NHS trusts are mistakenly concerned about ‘second-hand’ e-cigarette vapour and a third of mental health trusts ban the devices completely, even though patients would “benefit considerably” from using them.
“Many mental health trusts are misinformed about the dangers of e-cigarettes and are implementing unnecessary and inappropriate bans within their facilities,” the report reads.
The committee said the restrictions were “extraordinary” given those suffering from mental health issues smoke “significantly more” than the rest of the population and are almost 2.5 times more likely to take up the habit.
“Those with mental ill health are being badly let down and NHS England appear to have failed to give this any priority,” Lamb said.
“NHS England’s default policy should be that e-cigarettes should be permitted in mental health units.”
Nearly 3m people in the UK are currently using e-cigarettes, the report claimed, and an estimated 470,000 are using them as “an aid to stop smoking”.
The Department of Health and Social Care estimates e-cigarettes contribute to between 16,000 and 22,000 people successfully quitting smoking each year “who would not otherwise have done so had they used nicotine replacement therapies or willpower alone”.
The committee is calling on the government to consider “risk-based regulation” to allow more freedom to advertise e-cigarettes as the “relatively less harmful option” and provide financial incentives, in the form of lower levels of taxation, for smokers to swap from cigarettes to less harmful alternatives.
It also wants rules governing their use in public places to be reconsidered, along with limits on refill strengths and tank sizes that “does not appear to be founded on scientific evidence”.
“The committee believes that the risk for smokers of continuing to use conventional cigarettes is greater than the uncertainty over the long-term use of e-cigarettes,” the report concludes.
According to the report: “Expert opinion is that e-cigarettes are significantly less harmful than smoking tobacco but not completely harmless. A range of toxicants have been found in e-cigarette vapour including some cancer causing agents but, in general, at levels much lower than found in cigarette smoke or at levels that are unlikely to cause harm.”
The Committee is recommending that:
- The government, the MHRA (Medicines and Healthcare products Regulatory Agency) and the e-cigarette industry should review how approval systems for stop smoking therapies could be streamlined should e-cigarette manufacturers put forward a product for medical licensing.
- There should be a wider debate on how e-cigarettes are to be dealt with in our public places, to help arrive at a solution which at least starts from the evidence rather than misconceptions about their health impacts.
- The government should continue to annually review the evidence on the health effects of e-cigarettes and extend that review to heat-not-burn products.
- Further it should support a long-term research programme overseen by Public Health England and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment with an online hub making evidence available to the public and health professionals.
- The limit on the strength of refills should be reviewed as heavy smokers may be put off persisting with them—and the restriction on tank size does not appear to be founded on scientific evidence and should therefore urgently be reviewed.
- The prohibition on making claims for the relative health benefits of stopping smoking and using e-cigarettes instead has prevented manufacturers informing smokers of the potential benefits and should be reviewed to identify scope for change post-Brexit.
- There should be a shift to a more risk-proportionate regulatory environment where regulations, advertising rules and tax duties reflect the evidence of the relative harms of the various e-cigarettes, heat-not-burn and tobacco products available.
- NHS England should set a policy of mental health facilities allowing e-cigarette use by patients unless trusts can demonstrate evidence-based reasons for not doing so.
- The government should review the evidence supporting the current ban as part of a wider move towards a more risk aware regulatory framework for tobacco and nicotine products.
* E-cigarettes and conventional cigarettes are substantially different products. A lit conventional cigarette contains tobacco and produces carbon monoxide, tar and smoke, whilst an e-cigarette does not contain tobacco and heats up its nicotine liquid rather than burning it, the report explains. E-cigarettes were first introduced to the UK market in 2007.