E-cigarettes are set to be prescribed on the NHS under plans announced by the government to tackle smoking. How do these devices work, how safe are they and what is the debate around them?

What are e-cigarettes?

E-cigarettes are now a common sight. According to the charity Action on Smoking and Health (ASH), 7.1% of adults in Great Britain use e-cigarettes, equating to about 3.6 million people. The devices work by heating up a liquid to produce a vapour which is inhaled. This liquid usually contains nicotine as well as other components such as propylene glycol, vegetable glycerine and flavourings. There is a variety of styles on offer, from those that look like cigarettes to “pod vapes” which look a little like a dictaphone in shape and contain a rechargeable battery and a “pod” with a liquid-filled tank, mouthpiece and coil.

Are they safe?

In the UK at least the answer is “pretty much”. The key point is that e-cigarettes do not produce tar or carbon monoxide – which can cause lung disease and cancer – so are much safer than cigarette smoking. And, as the NHS notes, while nicotine is addictive it is relatively harmless; it is already used in many other products, such as nicotine patches and gum, to help people stop smoking.The NHS says e-cigarettes are not completely risk free, however. “The liquid and vapour contain some potentially harmful chemicals also found in cigarette smoke.” But these chemicals are found at much lower levels in e-cigarettes, it says.

E-cigarettes have not been without controversy. In 2019, 2,500 cases of lung disease and 55 deaths in the US were associated with vaping – though it later emerged this was probably due to people using e-cigarettes containing THC from cannabis, the chemical that gives a high to cannabis users, together with vitamin E acetate.Another concern is whether young people and others who have never smoked become hooked on e-cigarettes, an issue that has caused many experts in the US to speak out against the devices. Tobacco companies have also begun creating the devices, which makes some experts wary about supporting them.

But experts in the UK have said smoking and vaping here is regulated far more rigorously than in the US, given the rules on advertising, age, health warnings and lower levels of nicotine in products. They say that the devices are an important and safe tool to help people quit the far more dangerous act of smoking.Figures from ASH suggest that less than 5% of e-cigarette users have never smoked. The biggest group of e-cigarette users – at 64.6% – are former smokers. “As in previous years the main reason given by ex-smokers for vaping is to help them quit (36%) then to prevent relapse (20%),” ASH states.

What do UK experts make of the government’s announcement?

The move to make e-cigarettes available on the NHS has largely been welcomed. Prof Alan Boobis, emeritus professor of toxicology at Imperial College London and chair of the UK Committee on Toxicity, said smokers could already buy e-cigarettes to try to quit. But he added: “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, the Bruce and John Usher chair of public health at the University of Edinburgh, said the announcement was excellent news, noting smoking remained the leading preventable cause of inequalities in health, and that up to a third of smokers in the UK had not tried the 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,” she said. “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.”

However, Prof Peter Hajek, director of the tobacco dependence research unit at Queen Mary University of London, said that while there were potential benefits there were other considerations. “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.” Reported The Guardian.