Electronic cigarettes: Community Pharmacists’ Perception

Marques Gomes & Nabhani-Gebara | June 2014

Electronic cigarettes: Community Pharmacists’ Perception

Ana Marques Gomes Mpharm, MRPharmSShereen Nabhani Gebara, PharmD, BCOP

Marques Gomes & Nabhani-Gebara| June 2014

Multidisciplinary research group

Collaboration between Pharmacists, Pharmaceutics expert and Analytical ChemistsCurrents projects include

Public perception study (Poster presentation)Role of e-cigarettes in the patient care pathwayAnalysis of content and distribution patterns of e-cigarettes and e-refills


E-cigarettesRuyan Ltd. (Mr. Hon Lik, Co-founder) introduced it in China in 2004 as an aid for smoking cessation and replacement.

Ruyan America's Chairman, Mr. Hon Lik

“I used to be a big smoker myself and knowing the harmful effects associated with it very well, I told myself I couldn’t go on like that. I tried nicotine patches but […] I missed the effect of the sudden impact, the act of smoking, the sensation of smoking. So I started thinking of a way to create vapor containing nicotine, similar to cigarette smoke but not as harmful for the organism.”

Ruyan literally means "Resembling smoking".


40 years later

-http://www.thevapestore.com/pages/how-does-it-work [Accessed on line in April 2014]-Patent no. US3200819 A. Gilbert Herbert A. 17 Ago 1965.

Design

http://www.thevapestore.com/pages/how-does-it-work


Over 2 million consumers now regularly use electronic cigarettes

In 2013, the MHRA announced they will be regulated by 2016

The Royal Pharmaceutical Society and The Chief Pharmaceutical officers in the UK strongly supported the MHRA’s decision

The EU Parliament voted for a dual supply route: medicinal products (if marketed as quitting aids) and tobacco products

-http://www.ash.org.uk/media-room/press-releases/:over-2-million-britons-now-regularly-use-electronic-cigarettes [Accessed on line in May 2014]-Sukkar E. PJ online (1 March 2014), 292, 223-4. -Ridge KW, et al. Opinion/Letter section. PJ online (3 May 2014), 292, 473.

Regulations


Grana, et al.E-Cigarettes: A Scientific Review Based on analysis of 82 studiesNicotine and toxins, including carcinogens, were identified in the exhaled aerosolThe nicotine content of the cartridge e-liquid revealed poor concordance of labelled contentMajor injuries have resulted from e-cigarette use, including explosions and firesCytotoxicity varied among productsThere is little evidence of harmful effects in the short to medium term from repeated exposure to propylene glycol

Grana, et al. Circulation 2014; 129: 1972-86

Why regulation?


Bullen C, et al. RCT Investigating whether e-cigs are more effective than nicotine patches or placebo e-cigarettes at helping smokers to quitn= 657 Verified abstinence at 6 months after quit date

Nicotine e-cigarettes group (7.3%) vs Patches (5.8%), p-value= 0.46Placebo e-cigarettes (4.1%), p-value= 0.44

Concluded that among smokers wanting to quit, nicotine e-cigarettes might be as effective as patches for achieving cessation at 6 months. Identified no difference in adverse events

Bullen C, et al. Lancet 2013; 382: 1629-37

What is the evidence?


Brown et al. A large cross-sectional survey of the English population. n= 5863 adults who had smoked within the previous 12 months and made at least one quit attempt during that period with either

e-cigarette only NRT bought OTC onlyno aid

Higher self reported abstinence with e-cigarette

Brown J, et al. Addiction 2014 Accepted Article

What is the evidence?


Aim and objectives

The aim of this study was to gauge community pharmacists’ current experience and perceptions of electronic cigarettes

Objectives:

To evaluate the community pharmacists current experience with e-cigarettes To gauge their perception on safety and current useTo gauge their perception on the upcoming MHRA regulationsTo find out their training needs to be able to counsel patients


Methods

Self-completion questionnaire was designed

Drop off-pick up method

Data was entered and analysed using MS Excel.


RESULTS & DISCUSSION


Sample Profile

92/154 participants: 66% male; 34% female

11% of sample from big chains; the rest is small, independent

49% - Full time

37% - Locum

5% - Part time

5% Manager

3% - Superintendent


Sample Profile

Number of patients currently enrolled on smoking cessation

services

73% of surveyed pharmacies sell e-cigarettes.

Of these only 3% of all e-cigarettes sales are nicotine-free.


Adverse effects≈ 20% of our sample came across side effects from e-cigarettes reported by patients


Perception on use

Ranking:

1. Smoking Cessation Aid

2. Relapse prevention

3. Public use (‘dual use’)

4. Social, recreational use


Safety and effectiveness

The design of e-cigarettes encourages smokers to give up

Nicotine delivery is more efficient with e-cigarettes than

NRTs

Manufacturing of e-cigarettes is unreliable

E-cigarettes are safe for users

E-cigarettes do not cause any side effects


0

10

20

30

40

50

60

70

80

90

100

2 1

1012

9

19

14

35

8

41

46

52

62

27

52

32

38

27

37

13

42

9

52

913

1

7

15

2

8

2 1 1 0 1

Strongly Agree Agree

Neutral Disagree

Strongly Disagree

Perc

enta

ge o

f Pha

rmac

ists

(%)


Comparative Effectiveness


Perception of regulations

97% of pharmacists are in support of the regulations announced

for 2016

Major benefits from regulations were ranked as:

1. Reassurance of safety for users

2. Regulated as an established NRT

3. Increase profit for retail pharmacy

4. Prevent the possibility of misuse


Stricter regulations are required for:


Training needs

83% of the survey pharmacists said they felt ready to stock and

supply e-cigarettes under the new regulations.

There’s a need for training to support counselling


Training content

SafetyDosage instructionsAdverse eventsImplementation into smoking cessation patient care pathway


Conclusion

Widespread availability in pharmacies

Regulations welcomed

E-cigarettes perceived as effective with a potential role as a smoking cessation aid

Side-effects have been reported

Training needs


Acknowledgements

Research GroupDr Gianpiero CalabreseDr Reem KayyaliDr Steve Barton

Zohra Yasmin


Thank you for your attention

Electronic cigarettes: Community Pharmacists’ Perception

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