To Vape or not to Vape? DAUK’s Ellen Welch in Mail Plus

Last week, Health Secretary Sajid Javid announced that England could become the first country to prescribe e-cigarettes, as updated guidance from the Medicines and Healthcare products Regulatory Agency (MHRA) encourages vaping manufacturers to license their products as medicines. The NHS has endorsed vaping devices for some time to entice smokers to quit cigarettes, but prescribing them has not been an option before.

E-cigarettes use a liquid form of nicotine that is heated into a vapour to be inhaled – avoiding the harmful smoke generated by tobacco.

As a doctor and the partner of a smoker, I fully encouraged his decision to quit smoking when we had our first baby. I was cautious, however, about vaping. With my heightened sense of smell during pregnancy, I found the odour of the vape just as unpleasant as the scent of cigarettes – and I had serious concerns about the safety of him using an unregulated product.

But we all know the harms of smoking – it’s the main cause of preventable illnesses and deaths in England, costing the economy more than £11billion each year. The long-term data on e-cigarettes is just not available as they haven’t been around that long, but experts at the National Institute for Health and Care Excellence expect these products are less harmful than smoking. And now the MHRA has advised that vaping products will have to meet certain standards to be prescribed, as well as medical device safety regulations.

While e-cigarettes are certainly not completely risk-free, the evidence available at present – supported by these NICE guidelines – has found regulated e-cigarettes are shown to do less harm than smoking.

As a GP, I do have concerns that this news of e-cigarettes becoming ‘available on prescription’ will prompt an influx of patients to an already overwhelmed primary care service. With the current concerns about GP access, people wanting to stop smoking should be aware that this is one problem they can bypass their GP with.

At present, people wanting to quit smoking are able to access smoking cessation support services in their local areas. Staff – such as pharmacists – working in these essential services are specially trained to provide a combination of behavioural support and, if needed, pharmacotherapy to help people to stop. So people shouldn’t need to approach their GP for this and can get the ball rolling by contacting smoking helplines (listed below).

Sadly, my husband took up smoking again during the pandemic. I know too well that tirelessly listing the health risks of smoking – lung and other cancers, coronary heart disease leading to heart attack, cerebrovascular disease leading to stroke, peripheral vascular disease leading to amputation, chronic obstructive pulmonary disease and infertility – doesn’t help a smoker to quit. It’s not a realistic approach. But perhaps knowing e-cigarettes are a freely available option from NHS smoking services may provide a real incentive to quit for good.

For me, the biggest concern about smoking is my children breathing in secondhand smoke. Even if smokers go outside to light up, the smoke remains on clothes, and babies are particularly vulnerable to the effects of this. Children exposed to passive smoke are at increased risk of developing chest infections, glue ear and asthma, and they are at increased risk of cot death.

My view? If an NHS vape can help someone to stop and reduce the risks of all of these conditions then surely that’s a good thing.

NHS smokefree helpline:  0300 123 1044

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