October 29, 2021

expert reaction to Department of Health press release ‘e-cigarettes could be prescribed on the NHS in world first’

The press release from The Department of Health and Social Care (DHSC) states that e-cigarettes could be prescribed on the NHS in England to help people stop smoking tobacco products.

Prof Jacob George, Professor of Cardiovascular Medicine and Therapeutics, University of Dundee, said:

“This is very welcome news for millions of people who are trying to quit tobacco cigarettes. Clinical trial evidence suggests that it is more effective than nicotine patches for smoking cessation and it has positive effects on blood vessels when tobacco smokers switch to e-cigarettes.”

Prof Peter Hajek, Director of the Tobacco Dependence Research Unit, Queen Mary University of London (QMUL), said:

“I have an ambivalent take on this. On the one hand, the initiative provides a positive message that e-cigarettes are much less risky than smoking and help smokers quit. On the other hand, I am not sure that medicinal licensing of e-cigarettes is a good idea as it is likely that only tobacco industry will be able to face the costs that medicinal licensing entails, and they may only want products that will not endanger their core business. Smokers are more likely to benefit from e-cigarettes if they can select flavours, strengths and products that they like, rather than being limited to whatever becomes licensed. It also does not seem necessary for the NHS to pay for something that smokers are happy to buy themselves. 

“Overall, it would seem easier to just recommend existing products which are well regulated by consumer protection regulations. There is sufficient evidence available now that these products are effective and dramatically reduce the risks of smoking.”  

Prof John Britton, Emeritus Professor of Epidemiology, University of Nottingham, said: 

“Having a medically licensed e-cigarette available for prescription would be a major development, so any move by the MHRA to make that more likely is welcome. However, e-cigarette manufacturers have had the option to apply to the MHRA for a medicine license for years, but the costs of compliance with medicines regulations have been prohibitive and none has yet come to market. That’s why a bespoke regulatory system for all nicotine products, that allows market access and endorsement by health professionals in inverse proportion to health hazard, is urgently needed. Otherwise, tobacco will remain the default choice of the more than six million smokers in the UK.”

Prof Robert West, Professor of Health Psychology, Department of Behavioural Science and Health, UCL, said:

“Since the advent of e-cigarettes the UK has taken a balanced approach, recognising their potential use in helping smokers to stop while ensuring that they are not marketed to young people who are not already smokers. There is strong evidence that this approach has been successful, increasing the numbers of smokers quitting with negligible take-up of e-cigarettes by non-smokers. Smokers can already get e-cigarettes from some stop-smoking services and this move could expand access to e-cigarettes. However, the regulatory hurdles to be overcome for a product to be licensed are still huge and I am not confident that any e-cigarette manufacturer that is independent of the tobacco industry will have the resources to overcome these hurdles. This could very easily lead to a situation where tobacco company e-cigarettes with limited effectiveness can be prescribed while much better ones cannot. In my view, no healthcare provider should prescribe an e-cigarette produced by a tobacco company.”

Prof Alan Boobis, Emeritus Professor of Toxicology at Imperial College London and Chair of the UK Committee on Toxicity, said:

“I believe that in any discussion on public health it is important to include an objective assessment of potential harm. In the debate on the use of e-cigarettes, the Committee on Toxicity has assessed the relative risk from vaping. I think it’s fair to say that using an e-cigarette that meets current consumer standards will be a lot less harmful than smoking cigarettes. Smokers trying to quit can try vaping, without waiting for a medicinally licensed product to go on sale before doing so. However, licensed vaping products will have to meet a defined standard set by the medicines regulator, the MHRA, and in return they will be available to clinicians to prescribe to their patients, which will be an important step forward.”

Prof Linda Bauld, Bruce and John Usher Chair in Public Health, University of Edinburgh, said:

“This is excellent news. While there is good evidence that e-cigarettes available as consumer products can help smokers to quit, we also know that up to one in three smokers in the UK has not tried these devices. Smokers have concerns about safety and misperceptions about the relative risks of e-cigarettes compared with tobacco. For some, cost is also perceived as a barrier. The option of having approved devices that could be prescribed would reassure smokers about relative risks and also assist in reaching those least able to afford e-cigarettes.

“Smoking remains the leading preventable cause of inequalities in health so anything we can do to help less affluent smokers in particular to quit is a step in the right direction.”

Declared interests

Prof Bauld: “no conflicts.”

Prof George: “NO DOI.”

Prof Hajek: “no conflict.”

No others received.