As the UK announces support for medicinal licensing of e-cigarettes, Nicholas S Hopkinson argues that this will give doctors another means to help smokers quit. But Jørgen Vestbo, Andrew Bush, and Jonathan Grigg say that its benefit is unproved and that harms are likely
A recent announcement by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA),1 that it “seeks to encourage the licensing of electronic cigarettes and other inhaled nicotine-containing products as drugs and aims to support companies to submit marketing authorisation applications for these products,” should be welcomed.
E-cigarettes are electronic nicotine delivery systems: users inhale vapour created by heating liquid containing a humectant (propylene glycol or vegetable glycerine), nicotine, and flavourings.2 Although no serious commentator describes e-cigarettes as “completely safe,” the most toxic component of tobacco smoke—solid tar particulates—as well as carbon monoxide are completely absent from e-cigarette vapour. Users’ exposure levels to other constituents are orders of magnitude lower than in people who smoke.23 For this reason, the UK government’s independent Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) describes the relative risk of adverse health effects from vaping to be “substantially lower” than those from smoking.4
E-cigarettes are already widely available and are regulated as consumer products in accordance with the EU Tobacco Products Directive, which has been incorporated into UK law. Around 3.9 million people in the UK use e-cigarettes, two thirds of whom are now ex-smokers.5 Vaping by people who have never smoked remains rare, and in children and young people it is almost exclusively carried out among those who have been smokers or still are.6 Nevertheless, survey data show that nearly a third of smokers have never tried e-cigarettes, and around a third of smokers incorrectly believe them to be at least as harmful as conventional smoking.5