Guidance on electronic cigarettes
Although the popularity of smoking cigarettes has been in steady decline since the 1970s, approximately one fifth of the UK adult population still smoke cigarettes and rates are higher for patients with a mental illness. Smoking remains the leading cause of preventable death in the UK and the benefits of smoking cessation outweigh any other health intervention.
Electronic cigarettes (e-cigarettes) provide an alternative to smoking tobacco and are becoming increasingly popular. However, their clinical use is controversial because they are not licensed medicines, and there have been reports of problems with quality and safety with some of the products available.
However, it was conceded that the vaporization of nicotine had the potential to reduce some of the harm associated with smoking, as “vaping” does not involve the burning of tobacco, which results in the production of tar and associated carcinogens.
As such, e-cigarettes may have a role in replacing cigarettes when the patient is committed to smoking and unwilling to consider licensed alternatives. This has led to some hospitals deciding to permit their use.
A risk assessment must be undertaken before e-cigarettes are permitted in hospitals. For instance, the devices could be taken apart and used for self-harm, or the nicotine liquid could be swallowed.
If a decision is made to use an e-cigarette clinically, it must be treated as an unlicensed medicine. Prescribers should document the rationale and consent in the patient’s care notes.
For smoking cessation treatment, medicines in section 4.10.2 of the BNF should be used.
Tobacco smoking can affect the exposure to some drugs. Therefore, if a patient stops smoking, the doses of any prescribed medication that they take may need to be adjusted.
Please ask your visiting pharmacist for advice to help you check whether smoking has any effect on your patient’s medication. They also can provide you with practical advice on what to do should patients decide to stop smoking.
Ashtons now has a range of e-cigarettes available. For further details about the range, please visit orders.ashtonshospitalpharmacy.com or call us on 0845 222 3550.
Photo by Michael Dorausch (Flickr: Electronic Cigarette Smoking) [CC BY-SA 2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons