Experts debate the medicinal licensing of e-cigarettes

Reviewed by Emily Henderson, B.Sc.Jan 13 2022

As the UK announces support for medicinal licensing of electronic cigarettes, experts debate the issue in The BMJ.

Nicholas Hopkinson at Imperial College London welcomes the move, saying this will give doctors another means to help smokers quit.

E-cigarettes are currently regulated as consumer products so cannot be promoted as smoking cessation aids, he explains. Yet a Cochrane review already supports existing e-cigarettes as a smoking cessation aid, as does recently updated guidance from the National Institute for Health and Care Excellence.

The introduction of e-cigarettes that have been through a stricter medicinal licensing process "should provide further reassurance to healthcare professionals that they can help their patients to quit smoking in this way, particularly in mental health settings where smoking rates remain high," he writes.

It is also likely to improve confidence among smokers who so far have been reluctant to try this approach, as well as reversing false beliefs about relative harm when compared with smoking, he adds.

He emphasizes that medically licensed e-cigarettes, as and when they become available, will be only one among many tools to support smoking cessation, all ideally delivered alongside psychological support for behavior change.

It is also important to ensure that debate around e-cigarettes does not distract from other necessary tasks to achieve the UK's ambition to be smoke free by 2030, such as introducing a "polluter pays" levy on tobacco industry profits and raising the age of sale from 18 to 21, he adds.

There are still more than six million people who smoke in the UK: medicinal licensing of e-cigarettes could help many of them to live longer, healthier lives, he concludes.

But Jørgen Vestbo at the University of Manchester and colleagues say that the effectiveness of e-cigarettes in helping people to quit is unproved and potentially harmful.

They point to trial evidence showing that people using e-cigarettes tend to continue vaping, whereas most people using medicinal nicotine products quit, and many restart smoking while they continue vaping (known as "dual use"). The widespread use of e-cigarettes also carries a substantial societal risk of accepting addiction, they add.

What's more, many e-cigarettes are produced and marketed by companies owned by the tobacco industry - an industry with a history of lying to the public and spending fortunes on marketing, including to teenagers. "We should protect children and adolescents from these cynical marketeers and allow them to be the first generation in a century not addicted to nicotine," they write.

To disguise e-cigarettes as a sensible harm reduction strategy "will risk weakening sustainable smoking cessation strategies," they argue.

"Instead, doctors should help to revive a decent NHS funded smoking cessation service, lobby politicians to increase taxes on products containing nicotine, and restrict smoking - as well as vaping - even more."