In just two years e-cigarette users have increased threefold to 2.1 million, but do we actually know what we’re smoking? Are they any better than normal cigarettes? Our resident GP explains why health professionals aren’t as enthusiastic about them as you’d like.

BY DR ALISON BARWISE – JULY 23, 2015

Smoking conventional cigarettes is bad for you. You know that. And so do the 10 million people in the UK that currently smoke. But the effects of the options available to you as an alternative to tobacco are less clear. Especially considering that traditional nicotine replacement therapy (NRT) and other prescription drugs to help people stop smoking such as Bupropion and Varenicline are being eclipsed by the e-cigarette.

It’s socially acceptable, easily accessible and benefits from a variety of scents and flavours. But how bad is it for you? Here are the facts…

Good news

The benefit of e-cigarettes is that they don’t contain the toxic chemicals you’ll find in cigarettes. The main ingredient is nicotine which, whilst addictive and associated with transient adverse side effects, is less likely to be responsible for smoking related illness and death than the tar, arsenic, lead, hydrogen cyanide, carbon monoxide and other delights you’ll find in a tab.

Bad news

However, the current lack of regulation (and fact that they’re not a licensed medicine) means that there could be unwanted surprises and varying doses of nictonine in your e-cig. Formaldehyde and acetaldehyde, which are carcinogenic, and toxic metals, such as lead and nickel, have been found. Imagine if this was the case for, say, penicillin. One shop could sell you 250mg, another 1000mg, another 5mg and another 100mg mixed in with some additional active ingredients. How do you know which one you need, which one is more likely to work and which one could, in fact, be harmful to your health?

Good news

E-cigarettes don’t produce tobacco smoke so the risks of passive smoking associated with conventional cigarettes do not apply to e-cigarettes. There is ongoing research into this area to examine the effects of exposing non-smokers to vapour from e-cigarettes, but as the dose of nicotine in an enclosed space inhaled by a passive e-cigarette smoker is about one tenth of the level generated by a conventional cigarette, the risks are likely to be low.

Bad news

Health professionals still recommend avoiding using them around pregnant women, babies and children.

Good news

Well, kind of good news for future e-cigarette users. New EU legislation has stated that e-cigarettes need regulation. There is currently a review of how this EU legislation will be implemented into UK laws but a draft regulation currently suggests that e-cigarettes from 2016 will need to be licenced as a medicine. Some manufacturers are currently looking to apply for a Medicines and Healthcare Products Regulatory Agency (MRHA) licence for their e-cigarettes. If the legislation doesn’t make it obligatory to be licenced the EU recommendations will mean that even unlicensed e-cigarettes will have to meet certain standards.

More good news

E-cigarettes may be effective as a smoking cessation product. Research is limited but some clinical trials suggest that e-cigarettes are equally as effective in helping smokers quit as transdermal NRT patches or the NRT inhalator. Research is ongoing and if legislation and research is favourable we may see changes in the National Institute for Health and Care Excellence (NICE) recommendations for smoking cessation.

Bad news

Unlike approved NRTs, which benefit from stringent regulation, licensing and background of research, E-cigarettes aren’t currently part of the NHS Stop Smoking service. This means that they are not available on NHS prescription whereas NRT and alternative smoking cessation drugs are. Apart from offering medication to help smokers quit, the NHS Stop Smoking service offers valuable support that e-cigarette users may be not accessing.

Good news

E-cigarettes have played a major role in helping people quit smoking. More people are looking to stop smoking presently than they ever were. This suggests e-cigarettes are preferred over other cessation aids.

Bad news

E-cigarettes have been around for more than ten years, but the long term effects of using them is not yet well established. It is currently not possible to guarantee the long term safety of using these products and health professionals are therefore often reluctant to recommend them.

Our GP advises…

Without the recommendation of National Institute for Health and Care Excellence (NICE) and the current licensing issues and absence of long term risk data it is difficult for me to recommend using e-cigarettes over conventional smoking cessation products like NRT, Bupropion and Varenicline. However, if you choose to use an e-cigarette my advice would be this. They come with some risks but are more likely to be better for you than conventional cigarettes. Be careful to avoid over-using your e-cigarette and actually increasing your nicotine addiction, take steps to prevent normalising smoking (especially by avoiding using e-cigarettes around young people) and consider using your e-cigarette to stop smoking long term.

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