Public Health England’s review into the use of electronic cigarettes found the devices can bring “substantial health benefits.” The question is should community pharmacies stock them? Neil Trainis reports…
It was a review that reignited an old debate and got many within community pharmacy talking. The National Pharmacy Association (NPA) for one was quick to welcome Public Health England’s (PHE) examination of the use of electronic cigarettes, insisting it will go some way to encouraging more community pharmacies to stock the devices.
In the NPA’s eyes, that could only be a good thing. The review, which called for the devices to be prescribed on the NHS within the next few years, found that vaping poses a small fraction of the risks of smoking tobacco and switching from normal cigarettes to e-cigarettes can bring “substantial health benefits.”
It claimed that e-cigarettes could be helping to generate at least 20,000 successful new quits each year although the review also revealed public misconceptions around the devices, with thousands of smokers incorrectly believing that vaping is as harmful as smoking.
Around 40% of smokers were found not to have tried an e-cigarette while less than 10% of adults understood that nicotine is not the cause of most of the harm to health as a result of smoking.
The review also claimed the evidence does not back up concerns that e-cigarettes are a gateway for young people to start smoking.
“Youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked,” PHE said.
An NPA spokesperson said: “It is now clear that, on the basis of current evidence, e-cigarettes have a legitimate place in smoking cessation, underpinned by professional advice. It is useful to have a range of options in the stop smoking ‘toolkit’ because every person responds differently to treatment and the stop smoking journey is very personal.
“Unlike corner shops and specialist vape stores, pharmacies are regulated by healthcare agencies and staff are qualified to give advice on all aspects of smoking-related health, as well as identify additional health care needs.
“Thousands of people each month successfully give up smoking with the help of local pharmacies. Pharmacies are an accessible, non-stigmatising environment, where behavioural support can be given in combination with quit products like nicotine patches or gums.
“According to the National Institute for Health & Care Excellence, people who smoke are more likely to quit if they are offered a combination of behavioural and pharmacological interventions.
“The PHE evidence review will help pharmacists provide up-to-date advice to people wishing to use e-cigarettes as part of their quit smoking journey. It will also help pharmacies decide whether or not to stock e-cigarettes for sale. Many more pharmacies will now feel confident to supply these products.”
Professor John Newton, director for health improvement at PHE, said: “Every minute someone is admitted to hospital from smoking, with around 79,000 deaths a year in England alone.
“Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders. Yet over half of smokers either falsely believe that vaping is as harmful as smoking or just don’t know.
“It would be tragic if thousands of smokers who could quit with the help of an e-cigarette are being put off due to false fears about their safety.”
Professor Dame Parveen Kumar, chair of the British Medical Association’s board of science, said: “We welcome this independent review by Public Health England on the use of e-cigarettes and their role in helping people stop smoking. It is important that our approach to these devices continues to be underpinned by a robust evidence base.
“When e-cigarettes first became available in the UK, doctors highlighted a number concerns about the lack of evidence on the impact of their use, the variable quality and safety of e-cigarettes and e-liquids, yet as this review and other research shows there is now a growing body of evidence and widespread consensus that e-cigarettes are substantially safer than smoking.
“As this review recognises e-cigarettes are the most popular device used in attempts to quit smoking, they have the potential to play an important role in reducing the harms associated with smoking which leads to 79,000 deaths in England alone every year.”
Not everyone however is convinced by the power of e-cigarettes to wean people off tobacco.
Amish Patel, a pharmacist who runs Hodgson Pharmacy in Kent, said: “We don’t currently sell any e-cigs. I personally do not think e-cigs should be sold from pharmacy. Whilst the latest report says they do not lead to people smoking, I have previously read the opposite, so will wait a little longer before making final judgement.
“I also do not believe e-cigs help break the fundamental habit of smoking, where as NRT products like patches and sprays remove the habit of hand-to-mouth entirely.
“Whilst there are certainly benefits to e-cigs over smoking, having them available on prescription is an option, but I would rather see a report comparing e-cigs vs Champix, evaluating which is the best at getting successful quitters and fewest relapses.”
Graham Phillips, the owner of Manor Pharmacy Group, told Pharmacy Business: “I believe pharmacies should stock e-cigs. I want pharmacy to be the go-to place for quitting, so while I’m 100% in favour of licensing e-cigs, I believe that if we wait for the licenses to be granted before stocking the products we will have missed the boat.
“Consumers don’t see themselves as patients because they are not ill. They will simply go elsewhere for the products and we will lose out just as we have in the vitamins and health-food markets. If we take a paternalistic attitude to the public’s health we render ourselves irrelevant as healthcare providers.
“We don’t just lose the sales, we lose the opportunity to help people make healthy choices whiles they are still apparently well. It was just the same when nicotine replacement therapy could not be supplied to pregnant women due to the
concern about risk to the unborn child: but that is looking through the wrong end of the telescope!
“The question we should have asked then was ‘which is safer in pregnancy, continuing to smoke or using NRT?’ And today’s exam question? ‘Which is safer – smoking or E-cigs?’ It’s a no-brainer!”
Laura Reed, head of professional development at Numark, said the review was a “a positive step forwards to promoting the use of licensed e-cigarettes as a smoking cessation aid.”
She said: “Numark are delighted that PHE have recognised the important role health professionals play in supporting patients to quit traditional and more harmful cigarettes. After a number of years of controversy, we champion the need to get e-cigarettes licenced in the UK and also support the prospect for them to be prescribed under UK prescribing laws.
“Whilst there is little imperial evidence of the long-term safety of the e-cigarettes, PHE say that they are 95% less harmful than smoking and could contribute significantly to public health in the long term.
“It is important that patients recognise the vital role pharmacy plays in improving their health and providing the advice and resources needed to enable them to choose the most appropriate solutions to help them make key lifestyle changes.
“The findings from this report are a positive step forwards to promoting the use of licensed e-cigarettes as a smoking cessation aid and anything that can be done to increase the opportunities to facilitate interaction with pharmacy and their communities should be applauded.”
“I do not believe e-cigs help break the fundamental habit of smoking,” Amish Patel, community pharmacist.
What do you think? Email [email protected] with your views.