British American Tobacco’s e-Voke is the first of its kind to receive a drug licence
For any smoker in the UK looking to kick the habit, your favourite medical professional may soon prescribe you an e-cigarette. According to Reuters, British American Tobacco’s e-Voke recently became the first vaping device to be given a drug licence in the UK, meaning it’s officially recognised by the state-funded National Health Service as a “quit smoking medicine.”
“We want to ensure licensed nicotine containing products—including e-cigarettes—which make medicinal claims are available and meet appropriate standards of safety, quality and efficacy to help reduce the harms from smoking,” the Medicines and Healthcare Products Regulatory Agency (MHRA) said in a statement on Monday.
Reuters writes that the e-Voke licence was issued “towards the end of last year” and that British American Tobacco is “currently evaluating plans to commercialise” their product. It’s still unclear as to whether vaping really is safer than cigarettes, but a report issued by Public Health England last year suggests that it could be 95 percent less harmful than the real thing. More importantly, e-cigarettes could represent the first step in a smoker’s journey to quitting. Professor Ann McNeill, who helped author the report, described it as a potential “gamechanger” in public health.
Not everyone was on board with the study’s data, however. While some health agencies expressed support, the British Medical Association was more guarded, noting that there needed to be a “stronger regulatory framework.” As such, it’s unlikely we’ll see e-cigarette dispensers in clinics any time soon.
In the US, the idea of an e-cigarette as a prescribed therapeutic device for smokers is likely a long way off. Last fall, a government task force found there simply wasn’t enough evidence to make such a case. “The current evidence is insufficient to recommend electronic nicotine delivery systems for tobacco cessation in adults, including pregnant women,” reads a report from the US Preventive Services Task Force. That conclusion aligns with a famous 2010 legal case involving the FDA, in which the government agency wanted to regulate e-cigarettes before import and sale like they do items like nicotine patches. An appellate court eventually found that e-cigarettes could only be regulated as tobacco products—not as a drug or therapeutic-drug mechanism—and that companies were in fact marketing to smokers (and not those looking to quit).
Former smokers in the Waterville area say ‘They’re a million times better than tobacco.’
Steven Clark, of Winslow, hits his gel pen vaporizer at Empire Vape Shop on Main Street in Waterville on Friday. Clark says that vaping has helped him quit smoking a pack and a half of cigarettes per day. Staff photo by Michael G. Seamans
WATERVILLE — Steven Clark started smoking cigarettes at 18, but only in social situations when others would light up.
As time went on, however, he began smoking regularly and like many others became addicted.
Cigarettes aren’t cheap at $6 to $8 a pack. One day Clark, now 25, did the math. He figured he was spending about $100 a week— or about $4,800 a year — on the unhealthful, dirty habit.
Clark, of Winslow, vowed to kick the habit. He tried quitting cold turkey, chewing nicotine gum, even took prescribed medicine from his doctor, but nothing worked.
Then he stepped into Empire Vape Shop on Main Street and got set up with an electronic cigarette or “mod.” He tried different flavored vape juices such as strawberry-banana, experimented with intensity of flavor and decided to include nicotine as well with a plan to use it on a decreasing basis until he eliminates it altogether.
For the first time, he found a method for quitting smoking that really worked, he said.
“I went from smoking a pack-and-a-half a day to three cigarettes a day within 24 hours of vaping,” Clark said Sunday. “Tomorrow actually marks two weeks without a cigarette.”
He said he doesn’t smell like an ashtray anymore, has more money in his pocket — he spends between $12 and $24 a week on electronic cigarette ingredients — and feels a whole lot better.
“I have more energy, I sleep better, I’m able to smell better,” he said.
What has so far proved to be a godsend for Clark is stirring controversy among many people who think the ingredients in vapor cigarettes may be dangerous for people, including children who may pick up the hobby.
The federal government is considering regulating liquids used in vapor cigarettes. Maine officials are considering taxing them.
Clark is concerned about such proposals and says he will do anything in his power to prevent that from happening.
“To me, it’s the government’s way of saying, ‘Hey, let’s make money off this’ because it’s a growing industry. That’s just my personal opinion,” Clark said. “I think it’s our job as a community to properly educate people on how vaping is safer than smoking cigarettes.”
He purchases his vapor cigarette supplies at Empire Vape Shop at 251 Main St.
Shop owner Graham Vinson also is a former cigarette smoker who quit by using vapor cigarettes.
Like Clark, Vinson is convinced that vaping is a more healthful alternative to smoking cigarettes and helps wean people off nicotine.
Vinson has been in the industry about six years and worked for his competitor before opening his own shop Dec. 7, he said. He says he is conscientious, keeps up with the latest studies on ingredients for vapor cigarettes and does not use ingredients that have been deemed poor. He says the vaping industry in the U.S. has done a good job of regulating itself.
“We’re here because we know that cigarettes are killing people. We’ve known it for years,” Vinson, 36, said.
Unlike Clark, his patron, Vinson feels strongly that the vapor cigarette industry should be regulated to keep “shoddy manufacturers” out of the picture.
“I don’t know that I’m going to agree that it should be taxed,” he said. “Yes, by all means, regulate it so we don’t have to deal with shady producers. Regulations are coming. I’m personally all for it because I vape what I make. We make sure it’s very clean.”
Vinson and his fiancee, Stephanie Hawkins, a former case worker, are partners in the business and feel strongly that it is important to give back to the community, he said. They donated gifts, food, clothes and other items to a family through the Salvation Army at Christmas. They sponsored a dog at the local humane society by buying it special food and paying its adoption fee and veterinarian bills. The couple also are running a special drawing to benefit the local food pantry.
“I’m just trying to be a good business and be part of the community,” Vinson said.
Vinson said he is not going to claim that electronic cigarettes are an end-all — and perfectly healthful.
“But I do know they’re a million times better than tobacco,” he said.
“It’s a lot more environmentally friendly, if you will,” Clark said. “The more people we get into vaping, the less cigarette butts we’re going to have littering streets or filling landfills.”
While some people argue there are unhealthful chemicals in the liquid in vapor cigarettes, Clark maintains there are fewer chemicals in an electronic cigarette than in a traditional one.
“The ultimate plan of vaping in general for most people is to wean off nicotine completely but continue vaping,” he said. “That’s the main goal across the entire industry — is weaning people off while keeping the hobby.”
An expert independent evidence review published by Public Health England concluded that e-cigarettes are significantly less harmful to health than tobacco and have the potential to help smokers quit smoking.
They are rushing into legislation without having done their homework
They said that the current best estimate is that e-cigarettes are around 95% less harmful than smoking.
However, there are some who take a different view and who are cautious about the growth of this phenomenon.
The Welsh Government started out by wanting to introduce the same restrictions on the use of e-cigarettes in public as apply to cigarettes.
They now only want to limit the ban to some public spaces and buildings.
They are concerned that e-cigarettes will normalise smoking, especially for children.
They want to take a precautionary approach against the possibility that the vapour from e-cigarettes might be harmful.
What they are not doing is considering evidence of the good that e-cigarettes do and how their own actions might undermine that benefit.
They are rushing into legislation without having done their homework so as to justify their ban.
When the smoking ban was introduced in Wales there was very clear evidence as to the harmful impact of second-hand smoke on people’s health.
Ministers are using legislation to try to regulate a perfectly legal activity
I sat on a cross-party committee that spent months looking at the research and listening to expert testimony before backing that ban.
There is no such evidence with regards to e-cigarettes.
Instead, ministers are using legislation to try to regulate a perfectly legal activity so as to change people’s behaviour.
The anti-smoking campaign group ASH Wales, Cancer Research UK and Tenovus are among those opposed to this ban, while the British Heart Foundation, British Lung Foundation and the Royal College of Physicians want more evidence to be gathered.
Furthermore, in a public consultation on the proposals last year, 79% of responses were opposed.
Some people who vape are concerned that they will now be cast outside to join the smokers and that this will lead to them returning to smoking.
Indeed, there is some evidence in other countries that this is what has happened.
There is strong evidence that e-cigarettes have enabled a large number of people to give up smoking, something that decades of lectures by government have failed to do.
The Public Health England review found that almost all of the 2.6 million adults using e-cigarettes in Great Britain are current or ex-smokers.
Most are using the devices to help them quit smoking or to prevent them going back to cigarettes.
As for the danger of normalising smoking or encouraging young people to take it up, other studies have found that this is not the case.
The concern that e-cigarettes would lure young people to smoking has not been supported by evidence
A survey by Action on Smoking and Health (ASH) Wales found very few young people between 13 and 18 who have never smoked have tried e-cigarettes. Less than 3% of “never-smokers” who responded to the survey reported having tried an e-cigarette.
The survey also suggested that, of the young people who had tried e-cigarettes, a quarter had done so to help them stop smoking or cut down on the number of cigarettes they smoked.
Professor Peter Hajek, director of the Tobacco Dependence Research Unit at Queen Mary University of London, told a summit in Wales that “virtually nobody” who is a non-smoker experimenting with e-cigarettes would move on to daily smoking.
He said: “The concern that e-cigarettes would lure young people to smoking has not been supported by evidence.
“About half of non-smokers who experiment with cigarettes progress to daily smoking.
“In a striking contrast to this alarming effect, among non-smokers experimenting with e-cigarettes, virtually nobody progresses to daily use.”
Another survey, commissioned by the Welsh Government, reported at the end of last year.
Researchers asked regular users of vaping devices if they had previously been tobacco-users, and almost every single respondent said yes. Of the 3,565 people aged 16 and older spoken to, only 1% of adults said they were e-cigarette users who had never smoked before.
A further 9% said they had tried e-cigarettes and considered themselves “non-smokers”.
Of those who currently use e-cigarettes, not one person said they had never smoked before.
Government shouldn’t tell people how to conduct their lives without good-quality evidence
Both Cancer Research UK and ASH Wales have warned that the e-cigarette ban could be a backwards step in the fight to reduce smoking rates.
In addition, the saving to the public purse of the growth of e-cigarettes is substantial, and that is before we consider the improved health of ex-smokers.
The Health and Social Care Information Centre states that the average cost to the taxpayer of helping a smoker quit using Nicotine Replacement Therapy products rather than e-cigarettes is between £150 and £300.
Many people need more than one treatment and many revert back to smoking after some time.
There are roughly 467,530 smokers in Wales (20% of the adult population).
If each of those quit smoking via vaping instead of using taxpayer-funded Nicotine Replacement Therapy products, then the saving to the Welsh health budget could be more than £10.5m.
Good legislation is evidence-based and will seek to right a wrong or improve the quality of our lives.
Proposals by Welsh ministers to restrict the use of e-cigarettes in some public places fail to meet either of those criteria.
It is not the role of government to tell people how to conduct their lives without good-quality evidence of harm to support their actions.
Media Wales Chief Reporter Martin Shipton argues why electronic cigarettes should be banned in indoor public places
The first priority of any government must be to keep its population alive and healthy.
Inevitably this can lead to the imposition of regulations and restrictions that will annoy and even infuriate some.
Libertarian fundamentalists will moan about the “nanny state” and say people must have the right to behave as they please within the law. But in the interests of the majority, regulation is sometimes necessary.
The issue of whether individuals should be allowed to smoke electronic cigarettes in indoor public places is the latest battleground where freedom versus prudent regulation is being played out.
Many have no conscience about the fact that most non-smokers find tobacco smoke nauseating
I support Health Minister Mark Drakeford’s wish to get a ban in place, which is in line with the policy of the World Health Organisation and, incidentally, that of the British Medical Association.
The sometimes aggressive stance of e-cigarette proponents is reminiscent of the position taken by many conventional smokers before their products were banned in such a way.
Many insisted they had an absolute right to smoke anywhere they chose, and had no conscience about the fact that most non-smokers find tobacco smoke nauseating.
How many restaurant meals were ruined by someone on the next table who found it impossible to resist smoking between courses or immediately they had finished their meal?
A smoking ban in public places took more than 40 years to be introduced after scientific research proved definitively that there was a causal link between smoking and cancer.
It wasn’t until numerous studies demonstrated a link between passive smoking and life-threatening health conditions that legislators decided to take action.
A significant number of lives were lost while politicians agonised over whether it was fair to limit the rights of smokers, despite overwhelming evidence that a ban on smoking in public places was the right measure to pass.
The ban struck the right balance between regulation and personal liberty.
For those of us who suffer from asthma or other lung-related conditions, the ban has been even more beneficial
People could continue to smoke if they were foolish enough to want to do so; they just wouldn’t be allowed to impose their disgusting habit on others in indoor public places.
As a result of the ban, it is now far more pleasant to eat out, to have a drink in a pub and to visit all manner of public spaces without having to inhale other people’s smoke.
For those of us who suffer from asthma or other lung-related conditions, the ban has been even more beneficial.
In only a few years since the ban was introduced, an intrusive environmental pollutant that damaged our health and our spirits has been evicted from our lives.
Now our well-being and peace of mind is at risk once more from new kinds of smoking products that, in some cases, are being heavily marketed at young people in particular.
E-cigarettes are, we are told, 95% safer than tobacco products.
Even if that were so – and they haven’t been on the market nearly long enough to evaluate their long-term health impact – a risk 5% as potent as smoking conventional cigarettes should be seen in the context of an industry which killed an estimated 100 million people in the 20th century – far more than all who died in World War I and World War II combined.
And if current smoking patterns continue, the number of lives lost from smoking in the 21st century will leap to around a billion.
Reintroducing smoking into the public sphere risks re-normalising an activity curtailed due to its negative health impacts
Supporters of e-cigarettes argue that since the risk they pose to individuals is so much less, and as they can be used as a means of weaning people off tobacco, they should be granted the status of full social acceptability.
Reintroducing smoking into the public sphere, albeit that the products concerned are e-cigarettes, risks re-normalising an activity that was curtailed because of its negative health impacts.
Before we allow the gains to be lost, we should consider whether the precautionary principle should be applied in these circumstances.
The precautionary principle holds that a course of action should not be embarked on if there is a reasonable chance that harm may ensue and where there is insufficient scientific consensus that the risk is negligible.
Much to the annoyance of the e-cigarette lobby, the World Health Authority concluded in 2014 that, in line with the precautionary principle, e-cigarettes should be banned in public places.
Focusing on the fact that while e-cigarettes contain no tobacco, they have high levels of nicotine, the WHO’s report said: “Nicotine is the addictive component of tobacco. It can have adverse effects during pregnancy and may contribute to cardiovascular disease. Although nicotine itself is not a carcinogen, it may function as a ‘tumour promoter’.
“Nicotine seems involved in fundamental aspects of the biology of malignant diseases, as well as of neurodegeneration.
“The evidence is sufficient to caution children and adolescents, pregnant women and women of reproductive age about (e-cigarette) use because of the potential for foetal and adolescent nicotine exposure to have long-term consequences for brain development.”
For me, the case for banning e-cigarettes in public places is a no-brainer
The report continues: “The main health risk from nicotine exposure other than through inhalation is nicotine overdose by ingestion or through dermal contact.
“Since most countries do not monitor these incidents the information is very scarce.
“Reports from the US and the UK nonetheless indicate that the number of reported incidents involving nicotine poisoning has risen substantially as the use of (e-cigarettes) has increased.
“The actual number of cases is probably much higher than those reported.”
Turning to the issue of whether e-cigarettes could pose a risk to those who passively inhale the vapour they generate, the WHO report states: “The use of (e-cigarettes) in places where smoking is not allowed … increases the exposure to exhaled aerosol toxicants of potential harm to bystanders.”
The report concludes: “The increasing concentration of the (e-cigarette) market in the hands of the transnational tobacco companies is of grave concern in light of the history of the corporations that dominate that industry.”
For me, the case for banning e-cigarettes in public places is a no-brainer. There is nothing to stop those wishing to use them as an aid to giving up tobacco doing so in their own homes.