The Risk of an Own Goal
Making e-cigarettes available only on prescription may be a net negative for public health, writes Neil McKeganey.
By Neil McKeganey
In response to the rising level of vaping there have been discussions in the U.K. and elsewhere about making e-cigarettes available on prescription only. Within the U.K. Wes Streeting, shadow secretary for health and social care, recently announced that an in-coming Labour government would consider such a restriction as a way of reducing youth vaping.
There is now clear evidence that e-cigarettes are both popular among smokers and that they can help smokers to quit. Alongside such positive evidence there is also the downside of rising numbers of young people using these devices irrespective of whether they are smoking.
Whilst making e-cigarettes available on prescription may seem like an effective way of reducing youth use of these devices, the reality could prove very different. The fact that young people—including some below the legal age of purchase—are vaping underlines the reality that there are more routes to obtaining these devices than legal sale.
It is entirely possible that even in a situation where e-cigarettes were available on prescription only that some young people would still source these devices through illicit routes. Whatever the impact on youth vaping, making e-cigarettes available only through prescription would reduce adult smokers access to these devices. In the event that such a policy were implemented, some adults would certainly go to their doctor seeking a prescription for these devices. Others, however, would be less inclined to go to their doctor. Some of those might source their e-cigarettes through illicit supply whilst others would simply continue to smoke.
There is a further reason why making e-cigarettes available on prescription only may have a downside. Research has shown that using e-cigarettes can increase the likelihood of smoking cessation even when the individual had no prior intention of quitting. Analyzing data from the widely respected Population Assessment of Tobacco and Health study in the United States, Professor Karin Kasza and colleagues from the Roswell Park Comprehensive Cancer Center found that adult smokers who had no prior interest in quitting smoking still stopped smoking in impressive numbers following their use of an e-cigarette. Such “accidental quitting” has been found in other studies, with Professor Riccardo Polosa and colleagues in Catania, amongst others, showing that simply providing smokers with access to e-cigarettes helps many to quit even where they have expressed no prior interest in quitting.
As is so often the case when it comes to regulating e-cigarettes, the question is one of how to balance the needs of young people, who ought not to be using these devices, with the needs of adult smokers who may benefit from their use. Whilst making e-cigarettes available on prescription only may reduce some young peoples’ use of these devices, regrettably it may have the same if not greater effect on adult smokers.
The public health goal of reducing smoking is too important to implement a policy that may be less effective than one might hope in reducing youth vaping whilst actually reducing adult smokers access to these devices. The challenge facing manufacturers, regulators and health educators is one of finding a way to reduce youth access to these devices whilst at the same time ensuring that any adult smoker wishing to use an e-cigarette can do so with the least possible difficulty. Requiring adult smokers to seek an appointment with their doctor before they can legally access an e-cigarette device is to place a huge barrier in the way of wider e-cigarette use by smokers and wider intended and accidental quitting on the part of those adult smokers. This is a restrictive regulation that needs to be given serious consideration before being implemented.
