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Why you won't find e-cigarettes in pharmacies

Friday, 16 March 2018

Remember the Public Health England (PHE) evidence review that came out at the beginning of February? For those of us that didn’t hear about it, the gist of the paper was that e-cigarettes are tremendously misunderstood, significantly less dangerous than commonly perceived, and effective in helping people to stop smoking. The review was a big win for an industry that seems to find itself confounded at every turn.

But that’s not what we’re here to talk about. Sort of.

If you do remember the evidence review, you might recall that the authors fielded the suggestion of putting e-cigarettes in hospitals. Then again, you might not—the suggestion was buried at the end of a chapter, between research on the effect of e-cigarettes in vulnerable populations and funding for local Stop Smoking Services.

In a press release accompanying the review, the authors leaned into the suggestion; PHE tobacco control lead Martin Dockerell even encouraged hospitals to ban smoking on hospital premises, and, like Ipswich and Colchester General Hospitals, to replace smoking shelters with open-air vaping pavilions.

Yet amid all of the talk of putting the e-cigarettes in hospitals, amid the hushed suggestion of selling them in the hospital shops, and amid the indignant cries of abstinence-only stop smoking proponents, no one seemed to see a reasonable middle ground between the vape shop and the hospital: the pharmacy.

Think about it: pharmacies are where you go to purchase products to help you lead a safer, healthier life—and that’s exactly what e-cigarettes offer to a great many people.

In 2014…

And indeed, the idea has been floated before. In 2014, the Royal Pharmaceutical Society (RPS) organised a panel to review the value of retailing e-cigarettes in high street pharmacies.

However, the e-cigarette landscape was very different in 2014—keep in mind that this was before PHE’s first e-cigarette evidence review in 2015, and almost three years before the TPD went into effect.

Due to a dearth of proper research and a huge breadth of unregulated e-cigarettes on the market, the RPS found that it could not “support the sale of products with limited scientific evidence on safety.”

And that was that.

In 2018…

Nowadays, the e-cigarette world is very different. We have stronger regulation on e-cigarettes to weed out any dishonest players on the market; we have not one, but two government-funded evidence reviews on the record (both of which have spoken shiningly of e-cigarettes as a stop smoking tool), we have numerous independent studies on everything from coil composition to e-liquid temperature control, and we have higher numbers than ever of smokers trying e-cigarettes to get them back on the road to health (and out of the waiting rooms of beleaguered NHS facilities countrywide).

However, we’ve also seen uptake in e-cigarettes stalling—figures are hovering just below three million e-cigarette users across the UK—despite ongoing innovation in the e-cigarette industry. Clearly e-cigarette manufacturers and retailers aren’t relaxing their campaigns and resting on their laurels (look at this very website). And grassroots efforts like National No Smoking Day (just gone, 14 March) and Stoptober (coming up in, you guessed it, October) continue to push for e-cigarettes as a viable stop smoking strategy.

Why you won’t find a cigarette in a pharmacy

A lot of people point to strict rules set in place for the licensing of nicotine-containing products with the Medicines and Healthcare products Regulatory Agency (MHRA). Beyond a labyrinthine application procedure, the fees are arguable totally non-viable: PHE estimates that the costs for a “one-off application” can rise to £390,000 with an annual recurring cost of “between £65K and £249K”.

“The absence of a licensed product, five years after the MHRA’s consultation took place, suggests that this route to market is not commercially attractive,” the PHE notes.

Others argue that the Tobacco Products Directive (TPD) is to blame. See, the TPD was drafted back at a time when the health risk gap between tobacco and e-cigarettes wasn’t widely known, and research on e-cigarettes was hard to come by. Even now, those who have been using e-cigarettes the longest have only been vaping for ten years or so—so long-term research isn’t just hard to find—it’s impossible.

This made it a reasonable move to lump e-cigarettes together with tobacco. Both of them supply nicotine, right?

If any of the evidence that has emerged since the drafting of the TPD is to be believed, not really.

Unfortunately, a lot of the damage has been done. Rules written to keep harmful tobacco products out of would-be smokers’ hands is keeping e-cigarettes out of would-be quitters’. And the two are easily confused by the public: after all, ‘e-cigarette’ is an e and a hyphen away from ‘cigarette’, and both are regulated under the Tobacco Products Directive. It’s natural to assume that the two are equally harmful.

Tobacco is dragging e-cigarettes down.

The times they are a changing

All isn’t lost, however. The picture painted by increasing study and review performed by reputable organisations is helping to clarify the distinction in effect between e-cigarettes and traditional tobacco. Nowadays, big players in the industry are pushing for change.

For example, PHE has urged the MHRA to ease up on its e-cigarette licensing operations. And the RPS, who in 2014 couldn’t endorse e-cigarettes in pharmacies, has scheduled an e-cigarette review of its own during the inaugural meeting of its Science and Research Board. And Cancer Research UK has begun producing guides for pharmacists to educate themselves on the value of harm reduction with e-cigarettes.

Don’t get us wrong: we’re not encouraging the wholesale deregulation of the e-cigarette industry. Regulation has tightened up battery manufacturing spec and has uncovered and removed dangerous chemicals from e-liquids. But as the evidence continues to point to the safety and value of e-cigarettes for smokers looking to quit, maybe it’s time that we take another look.

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