The e-cigarette debate

The pros and cons of pharmacies selling e-cigarettes were debated by an expert panel at last month’s Pharmacy Show.

It was impossible to generalise about the evidence for e-cigarettes, because there were so many different types, said Martin Dockrell, tobacco control programme lead at Public Health England. “So far, we can’t say they are danger-free but that they will be much safer than tobacco.” Research suggested they were about 1 per cent as harmful. The dangers of second-hand exposure wouldn’t be known for another 30 years, but there was currently no evidence of any harm.

These products were continuing to evolve and so was the evidence base for their use, said Rob Darracott, chief executive of Pharmacy Voice. He described the 2.1 million people using e-cigarettes as a “mass movement”, and said “the genie is already out of the bottle.”

Dr Anthony Cox, lecturer in clinical pharmacy at the University of Birmingham, pointed out that the Commission on Human Medicines had said that e-cigarettes do not meet appropriate standards of safety, quality and efficacy. “Would we lower the bar for other products? Do we want to sell recreational drugs?”

Pharmacies had to sell a wider range of products to remain viable, and e-cigarettes naturally fitted into most pharmacies, said Michael Clapper, chief executive of manufacturer Vapestick. “E- cigarettes are an alternative product for those addicts who simply don’t want to quit or those who can’t. They’re based on the principle of harm reduction. They’re not stop smoking products, they’re alternatives for people who like to smoke.”

Some of the reaction to e- cigarettes has been counter- productive, said GP Dr James Quekett. And regulation carried risks in terms of decreasing availability. “What really worries me is the link between these products and big tobacco. It’s a gateway to addiction.”

Early evidence suggested that e-cigarettes were at least as good, if not better, than NRT, said Hazel Cheeseman, director of policy at Action on Smoking and Health. Her organisation was not worried about their use among young people and she said it should be up to pharmacists whether they sold the products. “The really important part is how they’re sold.”