COMMONS

Government missing opportunity with e-cigarettes

17 August 2018

The Science and Technology Committee publishes its Report, E-cigarettes. The Report reviews the current evidence base on the harmfulness of e-cigarettes compared to conventional cigarettes and looks at the current policies on e-cigarettes, including in NHS mental health units and in prisons. The Committee concludes that e-cigarettes should not be treated in the same way as conventional cigarettes.

E-cigarettes, estimated as 95% less harmful than conventional cigarettes, are too often being overlooked as a stop smoking tool by the NHS. Regulations should be relaxed relating to e-cigarettes’ licensing, prescribing and advertising of their health benefits. Their level of taxation and use in public places must be reconsidered.

Less harmful than conventional cigarettes

Members heard that e-cigarettes are an estimated 95% less harmful than conventional cigarettes and conclude that e-cigarettes are, too often, being overlooked as a stop smoking tool. The Committee has found that e-cigarettes are not a significant ‘gateway’, including for young non-smokers, to conventional smoking and do not pose a significant risk through second-hand inhalation.

Around 2.9 million people in the UK are currently using e-cigarettes, and it has been estimated that about 470,000 people are using them as an aid to stop smoking—and tens of thousands are using them to successfully quit smoking each year.

More freedom to advertise e-cigarettes

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 such as e-cigarettes.

Further, it is calling for a reconsideration of: their use in public places; limits on refill strengths and tank sizes; and the approval systems for stop smoking therapies such as e-cigarettes.

Long-term research programme

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.

To gather independent health-related evidence on e-cigarettes and heat-not-burn products, the Committee is calling on the Government to 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. The Government should make its research available to the public and to health professionals.
 
The Committee also heard evidence that individuals with mental health problems smoke significantly more than the rest of the population and could benefit considerably from using e-cigarettes—but many mental health trusts are misinformed about the dangers of e-cigarettes and are implementing unnecessary and inappropriate bans within their facilities.

Chair's comments

Norman Lamb MP, Chair of the Science and Technology Committee, said:

“Smoking remains a national health crisis and the Government should be considering innovative ways of reducing the smoking rate. E-cigarettes are less harmful than conventional cigarettes, but current policy and regulations do not sufficiently reflect this and businesses, transport providers and public places should stop viewing conventional and e-cigarettes as one and the same. There is no public health rationale for doing so.
 
“Concerns that e-cigarettes could be a gateway to conventional smoking, including for young non-smokers, have not materialised. If used correctly, e-cigarettes could be a key weapon in the NHS’s stop smoking arsenal.
 
“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. Medically licensed e-cigarettes would make it easier for doctors to discuss and recommend them as a stop smoking tool to aid those quitting smoking.  The approval systems for prescribing these products must be urgently reviewed.

“The percentage of people smoking among those with mental health conditions remains stubbornly high, while it is declining in the general population. People with mental health conditions are almost 2.5 times more likely to smoke compared to the general population.  It is therefore extraordinary that one-third of mental health trusts ban the use of e-cigarettes completely, while three-quarters of NHS trusts are mistakenly concerned about ‘second-hand’ e-cigarette vapour. This is unacceptable. Those with mental ill health are being badly let down and NHS England appear to have failed to give this any priority. NHS England’s default policy should be that e-cigarettes should be permitted in mental health units.”

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 on snus as part of a wider move towards a more risk aware regulatory framework for tobacco and nicotine products.

Further information

Image: Creative Commons

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