Report reiterates benefits of e-cigarettes

The Royal College of Physicians (RCP) was the first major public health body to back vaping as a quitting tool, publishing a report in 2007. Three years later, it was still the only credible source of information on relative safety. The RCP published Nicotine Without Smoke in 2016 and concluded that vaping was an effective way to quit. Now, in 2024, it has released E-cigarettes and

Harm Reduction – An Evidence Review.

The E-cigarettes and Harm Reduction: An Evidence Review is a new report that looks at how vaping can contribute to the prevention of smoking-related deaths, disability, and inequalities in tobacco use. It builds on 2007’s Harm Reduction in Nicotine Addiction and 2016’s Nicotine Without Smoke.

So, what does the new review tell us about what we now know scientifically about vaping? And what do the RCP’s recommendations to government ministers tell us about the future direction of vaping?

Nicotine

The RCP states: “Smokers are addicted primarily to the nicotine in tobacco, which causes them to continue to use tobacco products and hence to suffer the devastating health harms from the non-nicotine constituents of tobacco smoke, including tar particles and carbon monoxide.”

The experts reiterate that, based on all current evidence, nicotine poses “little if any direct health harm”. For a short time after inhaling nicotine, people may experience “enhanced cognitive effects” such as being better able to focus their concentration. There will also be a slight rise in their heart rate and blood pressure, but these return to normal as the nicotine breaks down and leaves the bloodstream.

As there is a continuum of risk for both cigarettes and vapes, the RCP says the two products are at opposite ends of the scale – tobacco being at the very harmful end “while e-cigarettes and oral nicotine products are likely to be at the lower end of the range.”

Smoking and Vaping Trends

The number of people who smoke has been falling consistently, but this trend reversed during the pandemic as lockdown pushed up smoking rates, especially among 18-24 year olds.

Despite widespread concern about a teen vaping “epidemic”, the RCP makes it clear: “Vaping remains primarily an activity of smokers and ex-smokers, who make up around 93% of all people who use vaping products”.

How Effective is Vaping For Quitting?

Despite what anti-vape campaigners say, the evidence is solid. The RCP points to findings from multiple randomised controlled trials and the Cochrane Living Review which make it clear that vaping is “more effective than nicotine replacement therapy in helping people to quit smoking”.

They say vaping has a role to play with those groups in society who find quitting the hardest:

• Pregnant women
• People with mental health conditions
• Smokers with no motivation to quit
• Homeless people
• Prison populations

They point to good results being achieved by offering free vape starter kits to smoking patients in NHS A&E departments and social housing.

Health Impact of Vaping

The RCP states that cigarettes are demonstrably extremely dangerous and lethal.

Studies show that vapes:

• deliver similar concentrations of nicotine to the bloodstream compared to smoking
• produce fewer toxicants and at lower concentrations
• have lower levels of markers of oxidative stress and inflammation in people who smoke

Studies on heavy metals and second-hand exposure are still too limited to prove harm.

Legislation

At the time of the report’s release, the UK government had voted in the Tobacco and Vapes Bill.

Encouraging People to use Vaping to Quit

The RCP states that more needs to be done by the government to encourage smokers to switch to vaping, echoing calls made in the Khan Review two years ago.

The organisation says accurate information should be printed on or in cigarette packets and there needs to be a focus on cost: “The price of e-cigarettes is likely to be a significant determinant of their consumption; higher prices lead to lower use.”

In Summary

Professor Sanjay Agrawal, the RCP Special Advisor on Tobacco, said: “We know that e-cigarettes are at least twice as effective as just smoking unaided when it comes to quitting. So, it is vital that adults are enabled to use e-cigarettes to quit smoking so they can be successful in making a full transition.”

“But we cannot ignore the significant rise in children and young people vaping, or the environmental impact of disposable devices. Vaping may be safer than tobacco, but it has its own risks. We recommend regulations be put in place to create a much-needed safety net – protecting young people from vaping but allowing people to use e-cigarettes to quit smoking.”

The RCP’s report states that while vaping is not harmless, it is “substantially less harmful” for users and bystanders than smoking.

The RCP reiterates its stance of supporting risk-based harm reduction by promoting vaping. It says that this is “ethically and scientifically more justifiable than a preventionist approach” which advocates for vaping bans yet ignores the harm from smoking.

RCP Recommendations

The RCP lists a series of recommendations for the government to consider, designed to maximise the benefits of vaping as part of a public health harm reduction measure.

These include:

• More research should be conducted to explore the long-term impact of nicotine use
• Legislation should be in place to prevent vapes from dry burning or running at extremely high temperatures
• Vapers should be told of the benefits of using a cooler draw – like direct-to-lung vaping
• We need to know more about how people move from vaping to smoking
• The UK should link with findings from other countries
• Vaping should be heavily promoted to smokers
• Vaping should be heavily promoted to hard-to-reach groups
• The NHS should offer vaping to smoking patients
• More research is needed to determine which e-liquid flavours work best
• Methods of researching vaping health risks need to be standardised
• People need to be educated about the true risks of vaping to combat the misinformation people read and hear in the media
• E-liquid flavours must continue to be made available to adults
• Cigarette packets should carry pro-vaping messages