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Electronic cigarettes, which produce a nicotine vapour without tobacco, have become increasingly popular in the last decade, bringing with them a fair bit of controversy.

We’ve blogged before about the ongoing research into e-cigarettes – including some of the misleading headlines that have followed. And much of this has focused on debates around whether the devices themselves are safe, and whether they can successfully help people stop smoking.

Stop Smoking Services are still the most effective way to help people move away from tobacco. But with increasing pressure from government cuts, these vital services are under threat. So alongside a suitable funding solution, it’s important to fully understand other opportunities, like e-cigarettes.

And a new report, published today by the Royal College of Physicians, focuses on one area where e-cigarettes could make a real difference.

As with some of the recent headline-grabbing reports on e-cigarettes, it summarises all the available evidence on the devices. But this latest analysis switches the focus onto the potential e-cigarettes have for reducing the harm from tobacco by simply being an alternative source of nicotine for smokers.

The report is extensive, covering everything from the science of how our bodies absorb nicotine, through the different types of nicotine replacement therapies available to people, and the impact of tobacco control policies at a population level.

Crucially, it helps tackle a common misconception that e-cigarettes are as harmful as smoking. And as we’ll explore below, this could be an important opportunity for smokers who aren’t planning to stop smoking – or find it very difficult to stop – to switch to a far safer source of nicotine.

What is harm reduction?

The idea behind harm reduction approaches is to accept that people may be unwilling or unable to move away from a dangerous behaviour. The goal is then to find ways of minimising the harmful consequences of that behaviour. A couple of commonly used examples are clean needles for intravenous drug users, and seatbelts in cars.

And when it comes to smoking, attempts to reduce the harm of tobacco are largely aimed at substituting nicotine.

Smoking still kills more than 270 people in the UK every day. And while nicotine is the main addictive substance in cigarettes, there’s no evidence it can cause cancer.

So, as the new report states, finding safer alternatives to tobacco as a source of nicotine could have a big impact on public health:

The health and life expectancy of today’s smokers could be radically improved by encouraging as many as possible to switch to a smoke-free source of nicotine

The idea of replacing the source of nicotine isn’t new – especially when it comes to helping people stop smoking. But the rapid growth in the popularity of e-cigarettes suggests the way that nicotine is substituted could be worth reassessing.

Replacing nicotine

Nicotine replacement therapy (NRT) provides medical quality nicotine without the cocktail of toxic chemicals in tobacco, or the ones produced through combustion to make smoke. It has been shown to help people stop smoking by weaning them off the nicotine their brain has been trained to crave.

But NRT is also recommended by the National Institute for Health and Care Excellence (NICE) as a substitute for tobacco. Some people choose to use NRT longer term to stop them relapsing, and evidence from people who’ve used these products for years shows no increase in their risk of cancer or cardiovascular disease.

But the NRT medications available on the NHS and over-the-counter can’t deliver nicotine with the same hit as cigarettes. Nicotine patches are designed to slowly release nicotine over 16 or 24 hours, which is different to how nicotine levels peak following a cigarette. Nasal sprays, gum and inhalators can trigger a quicker rise in nicotine in the blood but, as this report highlights, the peak isn’t as high as from cigarettes, and it also takes much longer to reach.

Evidence shows that combining a patch with one of these fast-release products is an effective approach when looking to substitute the nicotine a person would usually get from tobacco. But people can be concerned that in using patches or quick-release products they may be exposed to too much nicotine, even though the evidence actually shows most people don’t normally use enough to be expected to benefit from it.

So NRT offers smokers a clean source of nicotine, and if you’re looking for something reliable you can get on the NHS, this is your safest bet. In combination with professional behavioural support, this gives smokers the best chance of stopping smoking altogether.

But the truth remains that the approved products aren’t as effective at delivering nicotine as a cigarette. And for many smokers, the main problem with NRT from a harm reduction perspective is that they just don’t appeal as much as cigarettes.

It’s here that many believe e-cigarettes could be the answer.

The e-cigarette opportunity

The evidence summarised in the new report points towards e-cigarettes as being a potentially powerful tool to reduce the harm of tobacco.

E-cigarettes, particularly the more advanced models, can deliver nicotine in a higher dose more quickly. When you inhale nicotine rather than get it through the skin like patches, it reaches the brain more quickly, and e-cigarettes may more closely match the way someone would smoke.

The vast range of products available aren’t medically approved, and vary greatly in quality, but the latest figures show that they are already more popular than NRT.

The next important question is one of safety. And in terms of the level of risk for using e-cigarettes compared to tobacco, the expert panel at the Royal College of Physicians concludes that:

Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure

So whether this estimate turns out to be spot on or a fraction off the mark, it certainly seems there is a huge benefit to be had in smokers switching to an e-cigarette.

Professor Linda Bauld, an author of the Royal College of Physicians report and Cancer Research UK’s expert in cancer prevention based at the University of Stirling, agrees.

Smokers and the public should be reassured that e-cigarettes offer a viable route away from tobacco and are unlikely to have a negative impact on bystanders

– Professor Linda Bauld

“E-cigarettes are still a relatively new technology,” she says. “However, we already know a lot about these products, as today’s Royal College of Physicians report outlines. Smokers and the public should be reassured that e-cigarettes offer a viable route away from tobacco and are unlikely to have a negative impact on bystanders.”

According to Bauld, there’s an important balance to be had between what’s popular and what’s successful for those looking to stop smoking.

“There’s likely to be the most benefit where we can combine the most popular route to stopping – e-cigarettes – with the most successful – free local Stop Smoking Services,” she says.

And Bauld stresses that smokers can still make use of Stop Smoking Services and licensed Nicotine Replace Therapies alongside an e-cigarette if they choose to.

“The behavioural support that services provide can complement the e-cigarettes ability to replace the nicotine in tobacco,” she adds.

“The combined benefit of these approaches could really help prevent cancers caused by tobacco, and we need to seize this opportunity.”

But isn’t evidence on e-cigarettes conflicting?

E-cigarettes are being fiercely debated and, with mixed media reports and sometimes conflicting headlines, it’s not surprising that the picture may seem unclear. But the scientific and public health community in the UK agree that e-cigarettes are less harmful than tobacco – something that today’s report reinforces.

But this latest report isn’t the first of its kind. Public Health England released a summary of research on e-cigarettes last year, which had a different focus but reached much the same positive conclusion about the opportunity for these products in tobacco control.

And we, along with the British Lung Foundation, Royal Society for Public Health and many others have signed a consensus statement which says: “We all agree that e-cigarettes are significantly less harmful than smoking.”

Scientists will continue to explore all the potential impacts of these products, and we’re investing in studies to help answer some of the remaining questions. But because there hasn’t yet been the time to gather long-term data on e-cigarettes, it’s still not possible to say for certain what the long-term impact of these products will be.

But as this important new report makes clear, smokers who want to continue using nicotine, or feel they can’t manage without it, can consider e-cigarettes a valid, safer alternative to tobacco.

Nikki Smith is a senior health information officer at Cancer Research UK

Comments

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Holly North July 5, 2016

Yes of course electronic cigarettes reducing the disadvantages of tobacco cigarettes. Tobacco cigarettes is injurious for health because it burns tobacco but electronic cigarettes burns the fruit liquid by electric so it’s quite safe for our heath. Doctors also voted electronic cigarettes more safe then tobacco cigarettes. Thank you.

Daniela Provvedi June 3, 2016

There is an extremely interesting program on BBC iPlayer called “E-cigarettes: Miracle or Menace?”. It was shown on BBC 2 on the 22nd May, presented by Michael Mosley on a program called Horizon. Highly recommend watching this program. It gave me all the answers.

Cheryl June 2, 2016

E cigarettes that can deliver powerful shots of nicotine to the brain can have a dangerous affect on a person with a brain injury. .? Would you say that this statement is true? Brain chemistry can be disturbed by release of adrenalin or dopamine through nicotine? This effect on an already delicate scarred brain is worrying. My son suffered a traumatic brain injury 2 1/2 years ago. I believe his last seizure was a result of ‘vaping’ high strength nicotine. I am unable to prove this , however I have read around the subject of how nicotine works on the brain. My son did not smoke cigarettes before his accident, or afterwards, it seems that it is fashionable to ‘vape’ ‘ for younger generation. I agree less harmful than smoking. Other dangers that are not so apparent remain. Similar risks with excessive caffeine drinks/ pills.

June Toner June 2, 2016

I very much doubt it… there have got to be hidden dangers with e-cigarettes also, but the industry who stand to benefit most from this new phenomenon will do their utmost to keep it under wraps.

David May 4, 2016

I’ll never go back to those cancer sticks after experiencing vaping.

Chris April 30, 2016

Polycythemia. That’s what my doctor said. If you don’t quit smoking, you are not in for a good life. Just after that (and a lot of googling) I stumbled on vaping. Never really expecting to quit smoking with this funky new thing, I found myself literally not being able to stand the taste of a cigarette with just a few days. Thank heavens. I don’t have polycythemia anymore and I really enjoy vaping. I have reduced my nicotine use by fractions in the last two years, too. Vaping, for me, has been a god send.

John April 29, 2016

Vaping probably saved my life. As a man in my mid forties with a strong family history of heart disease I knew I had to quit smoking but found it impossible to do. As a last resort I tried electronic cigarettes and to my surprise they worked, I haven’t touched tobacco for 14 months and never will again. Vaping made quitting smoking easy, almost enjoyable and I think that is key to it’s success. It doesn’t just replace nicotine, it replaces smoking with something much better.I have found it to be much less addictive than tobacco and my health has dramatically improved. Cleethorpes below states that people vape frequently and fears that this may reinforce addiction, but in my opinion this is not the case. Electronic cigarettes are much less effective in delivering nicotine and so have to be used more often to achieve the same nicotine dose, as a result people making the switch to e cigs will use it quite a lot, especially at the start, but this settles down after a while. People tend to take a few puffs regularly, yes they will vape more than they smoked but actually their nicotine consumption will be lower.Ultimately it is not about curing addiction, it’s about harm reduction, avoiding the tar and toxins in tobacco smoke.I my opinion electronic cigarettes are one of the most important health innovations in our lifetime and their inventor Hon Lik would be a worthy recipient of this Nobel Prize for Medicine.

mark April 29, 2016

i suffer with asthma and was on my blue inhalers 10 times aday i started vaping 10 weeks ago and havnt used my inhalers since no waking up cougthing or sat wheezing all day i dont use the cheap ecigs as they dont work i use proper high power vaparisers as they give you the right amount of nicotine to stop you ever needing a cigarette again

Carol mcbay April 29, 2016

I thnk it 8s still better ghan smoking normal cigarettes

Ade April 29, 2016

I had my last smoke on October 31st 2015.I bought an E-Cig and haven’t smoked since.I don’t even feel like having a cigarette.Also,instead of spending nearly £70 a week,I now spend £4-99 on liquid…winner all round :)

Pat April 29, 2016

I suffer with asthma I have found that if I am near a person using an e-cigarette the vapor affects my breathing and I can,t breath properly, so for them to say they have a negative impact on bystanders is not right and should be investigated more

Ray PG Yeates April 28, 2016

” Reducing the harm of tobacco, could e-cigarettes be part of the solution? ” imo if you had been inclined to actually listen to the millions smokers switching and quitting you would already known the answer is a resounding ” YES ” by now. Sigh……

Concerned April 28, 2016

So the reports of conflicts of interest within those who compiled the report for the summary of evidence were unfounded, and concerns such as Cleethorpes’ below can be ignored?

Cleethorpes April 28, 2016

I have observed smokers increasing their addiction by vaping frequently, and smoking when an opportunity presents itself.

Dorothy Gunning April 28, 2016

I had my last cigarette on 14th March 2016. I have been using E cigarettes since then using a combination of nicotine and fruit flavours, and have not had the inclination to smoke a real cigartette. I have saved money also, which is a good thing too.