Tobacco Harm Reduction and the right to health

Tobacco harm reduction and the right to health 11 The first modern e-cigarette came onto the market in 2003. Since then, there have been numerous product developments. Vaping products range from very simple disposable or partially disposable devices through to more complicated devices which consumers can customise for themselves using different component parts or settings. Using vaping products instead of combustible tobacco cigarettes reduces the users’ exposure to multiple toxicants and carcinogens present in tobacco smoke. This means that vaping products are up at least 95 per cent safer than cigarettes. 16 There is no evidence so far that second-hand vapour causes harm to bystanders. 17 Case study: e-cigarettes in the UK – official endorsement, rapid consumer uptake, smoking in continued decline The UK has taken many steps to embrace tobacco harm reduction. As early as 2007, use of safer forms of nicotine was endorsed by the Royal College of Physicians, 18 an endorsement that was repeated in 2016. 19 The evidence reviews by Public Health England that conclude ‘e-cigarettes are 95% less harmful to your health than normal cigarettes’ have been very influential. 20,21 In the UK, e-cigarettes are tightly regulated for quality and safety. Most of the anti-smoking and health NGOs and many trusted medical bodies endorse the use of e-cigarettes as a way to help people stop smoking tobacco. These include ASH (Action on Smoking and Health), 22 Cancer Research UK, 23 the British Heart Foundation, 24 the Royal College of General Practitioners, 25 and the Royal College of Psychiatrists. 26 The importance of innovation and less harmful alternatives has been adopted within government, 27 with the Department of Health (in England) setting the ambition to go ‘smoke-free’ by 2030 “with smokers quitting or moving to reduced risk products like e-cigarettes.” 28 A recent randomised controlled trial in a UK NHS smoking cessation service showed that vaping was almost twice as effective as NRT in supporting smokers to quit smoking. 2 9 As of 2019, an estimated 7.1% of the total UK adult population – 3.6 million people – use e-cigarettes. Over half (54.1%) of current e-cigarette users are ex- smokers, a proportion which has grown year on year, while the proportion of dual users (people who vape who also smoke) has declined to 39.8%. Ex-smokers report using e-cigarettes to help them quit (31%), to prevent relapse (20%), because they enjoy it (14%) and to save money (13%). Dual users report using e-cigarettes to cut down on tobacco (21%), to save money compared to smoking (16%) and to help them stop smoking (14%). 31 16 McNeill, A. et al. Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England . PHE, 2018 https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco- products-evidence-review 17 McNeill, A. et al. Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England . PHE, 2018 https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco- products-evidence-review 18 Royal College of Physicians, Tobacco Advisory Group. Harm reduction in nicotine addiction: helping people who can’t quit . RCP, 2007 19 Royal College of Physicians, Tobacco Advisory Group. Nicotine without smoke; tobacco harm reduction . RCP, 2016 20 McNeill, A. et al. E-cigarettes: an evidence update: a report commissioned by Public Health England . PHE, 2015. https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update 21 McNeill A. et al (2018). Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. PHE, 2018 22 Action on Smoking and Health (ASH) website (accessed December 2019) Harm reduction https://ash.org.uk/category/ information-and-resources/product-regulation/harm-reduction/ 23 Cancer Research UK website. Our policy on e-cigarettes (2019) https://www.cancerresearchuk.org/about-us/we- develop-policy/our-policy-on-preventing-cancer/our-policy-on-tobacco-control-and-cancer/our-policy-on-e-cigarettes 24 British Heart Foundation Smokers who switch to vaping see improvements in their blood vessel health – a press release about the VESUVIUS study, funded by the British Heart Foundation (November 2019) https://www.bhf.org.uk/ what-we-do/news-from-the-bhf/news-archive/2019/november/smokers-who-switch-to-vaping-see-improvements-in- their-blood-vessel-health 25 Royal College of General Practitioners (RCGP) website (accessed December 2019): https://www.rcgp.org.uk/policy/rcgp-policy-areas/e-cigarettes-non-combustible-inhaled-tobacco-products.aspx 26 Royal College of Psychiatrists Position statement: The prescribing of varenicline and vaping (electronic cigarettes) to patients with severe mental illness (2018) https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh- policy/position-statements/ps05_18.pdf?sfvrsn=2bb7fdfe_4 27 UK Department of Health (2019) Towards a smoke-free generation: the tobacco control plan for England p. 15, p. 27. https://www.gov.uk/government/publications/towards-a-smoke-free-generation-tobacco-control-plan-for-england 28 UK Department of Health (2019), Advancing our health: prevention in the 2020s – consultation document . https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health- prevention-in-the-2020s-consultation-document 29 Hajek, P., Phillips Waller A., Przulj, D. et al. (2019) A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy New England Journal of Medicine (DOI: 10.1056/NEJMoa1808779). https://www.nejm.org/doi/pdf/10.1056/ NEJMoa1808779?articleTools=true 30 Action on Smoking and Health (ASH) (2019) Use of e-cigarettes among adults in Great Britain https://ash.org.uk/wp-content/uploads/2019/09/Use-of-e-cigarettes-among-adults-2019.pdf 31 Action on Smoking and Health (ASH) (2019) Use of e-cigarettes among adults in Great Britain . https://ash.org.uk/wp- content/uploads/2019/09/Use-of-e-cigarettes-among-adults-2019.pdf