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Professor Howard Parker
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NO SMOKE
WITHOUT FIRE
E-cigarettes are coming to
your service shortly. Should
we be concerned, asks
Professor Howard Parker
It’s becoming clear that e-cigarettes are going to be very popular in the UK.
The market, already worth around $250m in the USA, is growing rapidly here. The majority of
drug misuse service users are also tobacco smokers, part of the country’s 10m heavy smokers.
Many will soon be seeing e-cigarette users in their social worlds and will be contemplating
trying or using these new gadgets. The presence of e-cigarette use will in turn become an
issue for our services.
E-cigarettes have prospered from being both outside tobacco regulation and new
medicines approval. Regulation across the world is thus chasing rising consumption. There is
no international consensus, so while strict sales restrictions are in place in Australia, Canada
and some EU countries, in others like the UK there is essentially no national governance.
Proposals for EU-wide regulation is a faraway promise whereby if any prohibition does emerge
it will be after the ‘vaping’ market has been saturated and fully established and all the
structures, if required to run an illicit market, have bedded in.
E-cigarette prototypes were created by Chinese pharmacists during the last decade and
China continues to be the global supplier of a wide range of e-kits. In the UK, sales began via
the internet and through small-scale retailers with market stalls, kiosks and small shops –
usually in ‘poor’ areas. Still prohibited on eBay, these cigarettes are sourced from China mainly
via Alibaba.com. However, while the small players are doing very well and expanding rapidly,
so rich are the potential pickings that major companies like E-Lites have moved in. With recent
national TV advertising and flashing billboards at Sky televised football matches to support a
major growth in retail outlets, the vaping market is going to be very big business. Essentially
we now have a product which has not been ‘approved’, and which is banned in many
countries, on sale in Tesco and Morrisons.
For the uninitiated, e-cigarettes deliver a nicotine hit as liquid nicotine, held in a small
cartridge. It is vapourised as the user pulls on their mock cigarette as if smoking normally. The
delivery is powered by a cell or rechargeable battery. The ranges of products and kits are
enormous and sophisticated. The upmarket paraphernalia, sold in supermarkets and garage
forecourts, tends to be smartly packaged in mock cigarette-packets while other more industrial
kits are found on market stalls. It will be interesting to see if regular users develop a
psychological attachment to their paraphernalia, as we associate with drug-taking rituals
around bongs and pipes. That the nicotine comes in multiple flavours including coffee and
chocolate suggests suppliers have an interest in maintaining their customers and thus their
profits. These profits will be made from starter kits priced at between £25 and £40 and the cost
of replacement nicotine cartridges, on which a regular user will spend around £15 a week.
Intuitively a device that delivers nicotine without the carcinogenic chemicals in cigarette tar
and smoke looks like a harm reduction winner for heavy tobacco smokers. If no major risks are
identified from vaping, then eventually we may have a product which, when set in a CBT-type
programme, aids smoking cessation and/or reduces morbidity. The market makers emphasise that
vaping is very satisfying and suppliers argue that e-refills are cheaper than the heavy use of
cigarettes. They indeed promote the harm reductions in switching to e-smoking, emphasising that
there is no dangerous smoke to harm others and no legal restrictions on vaping in public places.
E-cigarette use will pose some interesting issues for health professionals in general and
alcohol and drug services and smoking cessation programmes in particular. The harm reduction
benefits are hard to dismiss for heavy smokers, yet e-cigarettes do not have a scientific clean
bill of health, with key public health monitors and recent research studies urging caution. So it
won’t be easy to form clinical views or provide information and advice packs about e-smoking.
Other knotty issues include: should services allow clients to vape on the premises or
indeed bring the kits to appointments or on programmes, and if so at what age? Just
recharging your G9 battery in the IT suite? Should staff be allowed to use e-cigarettes at
work? Should vaping nicotine be included on assessment documents? How can e-cigarette
use be recorded on databases without being lost in ‘other’? Should incidents of exploding
batteries or clients dismantling the kits as part of risky behaviour be recorded and reported,
and to whom? Should pregnant clients be advised to use or not use e-cigarettes as an
alternative to their addiction to tobacco and/or cannabis? Are the kits to be considered a
safeguarding risk, given drinking liquid nicotine can kill small children?
No doubt there’ll soon be a sociology PhD – e-cigarettes as a global symbol of postmodern
consumption. For those working in the substance use and primary care fields, e-cigarettes bring
harm reduction versus abstinence back into focus. Some intelligent pragmatism will be required
in developing policy and practice and it will be worth listening to the first wave of vaping service
users in trying to develop sensitive responses to their new habit. Better an e-cigarette than a
crack pipe.
Professor Howard Parker has worked in the drug and alcohol field for more than 25 years as
a lecturer, researcher, author, trainer and consultant.
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drinkanddrugsnews
| April 2013
www.drinkanddrugsnews.com