I Am A Doctor—Guidelines On Recommending E-Cigarettes

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e-cigarette
safety
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#1

This briefing from the National Centre for Smoking Cessation and Training on e-cigarettes will help you in making your decision, and gaining more clarity on e-cigarettes. We also invite you to see other articles in this section, and email us with any questions.

Executive summary

Electronic cigarettes are devices that deliver nicotine by heating and vaporizing a solution that typically contains nicotine, propylene glycol and/or vegetable glycerin, and flavourings. Electronic cigarette use is increasing in smokers wanting to quit, but particularly among smokers who want to reduce the health risks of smoking or to save money. These devices are not currently licensed for smoking cessation, but they do have to comply with consumer protection legislation.

The quality of electronic cigarettes is improving. With experience, users can achieve overall blood nicotine levels close to those achieved with smoking conventional cigarettes, although it takes longer to reach these levels and they still receive less nicotine per session. Electronic cigarettes can reduce urges to smoke and can help smokers quit, although these data are not as robust as those for licensed stop-smoking medicines. Data from one quality randomised and controlled trial show that electronic cigarettes were as effective as nicotine patches in helping people stop smoking for six months, when used in combination with minimal support from a trained practitioner. Short-term exposure to electronic cigarettes appears to be associated with few serious risks. Mouth and throat irritation are the most commonly reported symptoms and these tend to subside over time. There are no high quality safety data regarding long-term electronic cigarette use but there isn’t an a-priori reason to expect that such use may pose risks anywhere near the risks associated with smoking.

Low levels of toxicants and carcinogens have been detected in electronic cigarette liquid and vapour, although these are much lower than those found in conventional cigarette smoke, and are not considered to pose any passive inhalation risk. Concurrent (dual) use of conventional cigarettes and electronic cigarettes has been associated with greater motivation to quit, and with a reduction of smoke intake from regular cigarettes. This could be associated with health benefits, although the extent of any such benefits remains to be determined.

There are currently no robust data to support the concern that the existence of electronic cigarettes might ‘normalise’ smoking and increase use of conventional cigarettes.

Recommendations for practice

Be open to electronic cigarette use in people keen to try them, especially in those that have tried, but not succeeded, in stopping smoking with the use of licensed stop smoking medicines.

Provide advice on electronic cigarettes that includes:

  • Electronic cigarettes can provide some of the nicotine that would have otherwise been obtained from smoking regular cigarettes

  • Electronic cigarettes are not a magic cure, but some people find them helpful for quitting, cutting down their nicotine intake and managing temporary abstinence

  • There are a wide range of electronic cigarettes available, and clients may need to try various brands, flavours and nicotine dosages before they find a type that they like

  • Electronic cigarette use is not exactly like smoking and users may need to experiment and learn to use them effectively (e.g. longer ‘drags’ are required and a number of short puffs may be needed initially to activate the ‘vaporizer’ and improve nicotine delivery)

  • Although some health risks from electronic cigarette use may yet emerge, these are likely to be, at worst, only a small fraction of the risks of smoking. This is because electronic cigarettes do not contain carcinogenic chemicals which cause cancer, as well as lung and heart disease

  • Multi-session behavioural support, as provided by trained stop smoking practitioners, is likely to improve the efficacy of electronic cigarettes in the same way such support markedly increases the efficacy of nicotine replacement therapy (NRT)

  • Stop smoking services can provide behavioural support to clients who are using electronic cigarettes and can include these clients in their national data returns.* As with other unlicensed nicotine containing products, the stop smoking service cannot provide or prescribe them until such time as there are licensed options available

  • If a client being seen at a stop smoking service is using an electronic cigarette but also wants to use NRT, then it is OK for them to use the two in conjunction. They do not need to have stopped using the electronic cigarette before they can use NRT* providing they adhere to the national data definitions in the service and monitoring guidance, which are based upon the Russell Standard: www.ncsct.co.uk/usr/pub/assessing-smoking-cessation-performance-in-nhs-stop-smoking-services-the-russell-standard-clinical.pdf

Download PDF: http://www.ncsct.co.uk/usr/pub/e-cigarette_briefing.pdf


#2

Electronic cigarette use is not exactly like smoking and users may need to experiment and learn to use them effectively (e.g. longer ‘drags’ are required and a number of short puffs may be needed initially to activate the ‘vaporizer’ and improve nicotine delivery)

I find it helpful to relay this to beginners - we have definitely dealt with somone’s vape ‘not working’ or producing a lot of spitback because the customer is drawing hard and fast like they usually would with a cigarette. It is easy to forget about this being a current vaper who doesn’t really pay attention to how I am drawing at this point.