The e-cigarette: opportunity or threat? SSA Annual Symposium 2015 Deborah Arnott Chief Executive...
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Transcript of The e-cigarette: opportunity or threat? SSA Annual Symposium 2015 Deborah Arnott Chief Executive...
The e-cigarette: opportunity or threat?
SSA Annual Symposium 2015Deborah ArnottChief ExecutiveAction on Smoking and Health
What we’re going to cover
• Tobacco use: the context
• Harm reduction: the obvious next step
• Why e-cigs challenge the consensus
• What’s the evidence
• Building support for an evidence-based approach
• Lessons learnt
UK: world leader in TC
BUT: significant and widening gap between rich and poor
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
Year
0
10
20
30
40
Cig
aret
te s
mo
kin
g %
3533
32 32
34
31 3130
29 3028
2927
32
Routine & manual
20 21 20 1917
19 1817 17 16 16
15 16 16
Non-routine
11.3
25.3
Harm reduction: obvious next step
“People smoke for nicotine but they die from the tar”
Russell MAH. Low-tar medium nicotine cigarettes: a new approach to safer smoking. BMJ1976;1:1430–3
Key principles of THR
• Smoke not nicotine primary cause of death and disease
• Quitting completely best option
• Smokers switching to alternative nicotine sources can substantially reduce harm
• Need to minimise risks of uptake by youth and never smokers
Solid foundations in England:Building support for harm reduction policy
• MHRA remit to protect public health – liberalises NRT regulation from 2005 on
• RCP harm reduction report 2007 • Beyond Smoking Kills 2008 – harm reduction
principles endorsed by over 100 health orgs• DH tobacco strategy endorses harm reduction
2010 and 2011
Principles into practice: e-cigarettes – a disruptive technology
% of smokers who have tried and are using 2010 - 2015
Principles into practice: e-cigarettes
% of ex-smokers and never smokers who have tried and are using 2010 - 2015
Aids used in most recent quit attempt
10
N=10078 adults who smoke and tried to stop or who stopped in the past year
E-cigarette use for quitting is still increasing somewhat
Aids used in most recent quit attempt
11N=9783 adults who smoke and tried to stop or who stopped in the past year; 2009 is Jul to Dec
E-cigarettes have grown the use of moderately effective aids to cessation from 24% to 35%; use of most effective methods has decreased from 4% to 3%
At stable quit attempt rate of 37% this contributed 0.05% to the decreased prevalence (~20,000 additional ex-smokers)
Approx odds of success relative to nothing and NRT-OTC:
1.5 Moderately effective
3.0 Most effective
Least effective
Moderately effective
Most effective
Courtesy of Prof John Britton, Nottingham
Cigarette smoked
Study conclusion: “e-cigarettes used under real-conditions emit toxicants, including PM2.5”
E-cigarette puff
Children who have never smoked rarely use electronic cigarettes
14
Youth smoking in England
15
Yet controversy abounds
Why the controversy?
Historic goals of tobacco control are to eliminate:
•Harm caused by tobacco
•Nicotine addiction
•Tobacco industry
Answer: ecigs threaten the consensus
Historic goals of tobacco control are to eliminate:
•Harm caused by tobacco
•Nicotine addiction
•Tobacco industry
Harm reduction policy in England:Building on our foundations
While ecigs banned in many jurisdictions not in UK:•DH tobacco strategy endorses harm reduction 2010 and 2011•NICE guidance Tobacco Harm Reduction 2013•PHE report and position statement 2015•Prisons going smokefree allow ecig use October 2015•UK pursuing twin track regulatory approach – opt in for medicines regulation•If not regulated as medicines then will come under the EU Tobacco Products Directive from 2016
Twin track regulatory approach from 2016
20
Tobacco Products Directive regulation of electronic cigarettes
MHRA licenced Nicotine Containing Products (NCPs) including e-cigs
Products not available on prescription Products available on prescription
20% VAT 5% VAT
Cross border advertising banned by 2016; up to Member States to decide on domestic advertising (billboards, Point of Sale, buses etc.)
Advertising allowed – under OTC rules so no celebrity endorsement or free samples and must be targeted at adult smokers etc.
Products widely available Products available on general sale (GSL)
Can’t make health claims Can make health claims
Upper limits for nicotine content will be set and likely to be in force by 2017.
MHRA regulation is flexible; there are no upper limits.
30% health warning on packs about nicotine on front and back of packs
No health warnings on packs
Member States retain powers e.g. on flavours, domestic advertising.
Flavours require a marketing authorisation
Children and Families Bill allows for age of sale of 18 for nicotine products.
Age of sale 12 but can be varied by product so could be higher for electronic cigarettes.
Lessons learnt
• Harm reduction has great potential to reduce the death and disease caused by smoking
• Electronic cigarettes have a role to play
Highly controversial so:• Building and disseminating evidence base
essential if sensible policies are to prevail• It’s working in England to date… question is how
do we ensure this continues in the new regulatory environment?
And finally….
www.ash.org.uk [email protected]
And finally….
www.ash.org.uk [email protected]