E-cigarettes (electronic cigarettes) are battery-powered devices designed to look and feel like cigarettes. They are filled with a liquid that usually contains nicotine, flavourings and other chemicals. They are considered a safer option to smoking tobacco for people addicted to nicotine.
Why do people use e-cigarettes?
E-cigarettes are designed to be a safer way to deliver nicotine than cigars/cigarettes/pipes. I gave up pipes and cigars 20 years ago but I still miss them. We all need our props. It's now Liquorice Allsorts® but at least they don't give me lung cancer and I'm down to 20 a day.
Read more about nicotine addiction.
What are they?
E-cigarettes come in various shapes or sizes but basically consist of a reservoir for a liquid that is heated up to form a vapour. Some are disposable whilst others are refillable. The liquid comes in all kinds of flavours.
Learn more about the types of e-cigarettes.
What are the benefits?
E-cigarettes are 95% safer than ordinary fags. This even applies to pregnant women. They're meant to be used instead of tobacco and not as well as. They are at least as good as other forms of nicotine replacement therapy. You're better off not going it alone but getting the help of a smoking cessation counsellor. When they first came out there was a concern that young people would buy them and then move on to tobacco but this doesn't seem to have happened,
Find out more about the benefits of e-cigarettes.
What are the risks?
There don't appear to be any significant short-term risks and if you're a smoker you've got nothing to lose in trying them They haven't been on sale long enough to say they are completely safe in the long term. Time will tell.
Read more about the risks of e-cigarettes.
The small print
This is the bit about regulations. E-cigarettes are regulated by the Tobacco and Related Products Regulations 2016. This ensures that the e-cigs you buy conform to accepted standards. None of the brands on the market has yet been put through the Medicines and Healthcare products Regulatory Agency (MHRA) licensing process. This means they're not currently available on prescription, but watch this space.
Read more about the regulation of e-cigarettes.
What is nicotine addiction?
Nicotine is a substance that is inhaled from tobacco. It gets into the bloodstream and stimulates the brain. Most regular smokers are addicted to nicotine.
If you are a regular smoker, when the blood level of nicotine falls, you usually develop withdrawal symptoms such as restlessness, increased appetite, inability to concentrate, irritability, dizziness, constipation, nicotine craving, or just feeling awful. These symptoms begin within a few hours after having the last cigarette. If they are not relieved by the next cigarette, withdrawal symptoms become worse. If you do not smoke any more, the withdrawal symptoms peak after about 24 hours and then gradually ease over about 2-4 weeks.
So, most smokers smoke regularly to feel 'normal' and to prevent withdrawal symptoms.
About 2 in 3 smokers want to stop smoking but, without help, many fail. The main reason why so few smokers succeed, even though they want to stop smoking, is because nicotine addiction is strong and difficult to break. This is where e-cigarettes and other forms of nicotine replacement therapy (NRT) can help.
What are e-cigarettes?
E-cigarettes (electronic cigarettes) are devices designed to create the sensation of smoking without involving the use of tobacco. They are also known as 'e-cigs' and 'cigalikes'. They were invented in China in 2003 and have become increasingly popular all over the world. They have a container which acts as a reservoir and is filled with liquid. There is a tiny battery at the bottom. The battery powers a coil which heats up a liquid that produces a vapour. The idea is to suck on the mouthpiece of the device to inhale the vapour. This is then breathed out (exhaled) in what is supposed to look like smoke (although in reality it resembles a cloud of steam). Smoking an e-cigarette is often referred to as 'vaping'.
The liquid used to fill the reservoir of an e-cigarette usually contains nicotine, flavourings, and other chemicals. In addition to those that resemble cigarettes (e-cigalikes) there is an increasing variety of types, including tanks, boxes and atomisers. The main difference is that some (mainly the cigalikes) are disposable whilst others are refillable. More recently, variable voltage batteries have come on the market which can control the concentration of the vapour,
Liquid refills can be bought separately and come in every conceivable flavour from aniseed to rhubarb and custard. Some people buy non-nicotine liquids, presumably because they just like the taste.
You may also see the term 'dripping' which basically means removing the heating coil from a device and dripping the refill liquid directly on to it. This provides denser vapour clouds which some people feel provide a more intense sensation, particularly at the back of the throat.
How are e-cigarettes used?
Current evidence suggests that e-cigarettes are 95% safer than tobacco. The research done so far suggests that they are at least as effective as nicotine patches or gum in helping people stop smoking. One study suggests that daily use of a tank device is the best option for most people.
E-cigarettes are not intended to be used alongside ordinary cigarettes but are intended to replace them. They are best used as part of a stop smoking programme. Free face-to-face support can be obtained from local NHS advisers.
Who uses e-cigarettes?
A recent survey found that about 2.8 million adults in Great Britain use e-cigarettes. 1.3 million of these have completely stopped smoking. When they were first launched, there was a concern that young people who had never smoked would experiment with e-cigarettes and then move on to smoking tobacco. This does not seem to have happened. Among the under-18s, whilst experimentation with e-cigarettes is fairly common, regular use is rare. Most people who use e-cigarettes have previously smoked tobacco.
What are the risks of e-cigarettes?
E-cigarettes are not risk-free although it can't be repeated often enough that they are much less risky than cigarettes. As well as nicotine, they contain potentially harmful chemicals but at much lower levels than those found in cigarettes.
The short-term risks of e-cigarettes are therefore minimal compared to cigarettes so if you are currently a smoker you would do well to start using them instead. If you have never been a smoker, it is pointless to take on the risk of using them, however small.
Current advice from the NHS is that, along with other forms of nicotine replacement, e-cigarettes are much less risky in pregnancy than smoking tobacco.
Unlike passive smoking, there is no evidence that the vapour produced by e-cigarettes is dangerous to bystanders.
Because they are relatively new on the market, the long-term safety of e-cigarettes is not yet known. They are being monitored but information will need to be gathered over several years before any conclusions can be reached.
Are e-cigarettes regulated?
Since May 2016, e-cigarettes have come under the regulations of the Tobacco and Related Products Regulations 2016. These ensure that the e-cigarettes you buy will have been assessed for quality and consistency and that sufficient information about them is made available to the public. The size of tanks and refills is now also restricted to ensure that people do not use excessive amounts of nicotine.
Since October 2015 it has become illegal for retailers in England and Wales to sell e-cigarettes to people under the age of 18 years or to adults buying them on behalf of people under the age of 18 years.
Are e-cigarettes available on prescription?
Unlike other forms of nicotine replacement, e-cigarettes are not yet available on prescription. This is because although they are regulated by the Government, none of the products is yet registered with the Medicines and Healthcare products Regulatory Agency (MHRA). Registration with the MHRA for any pharmaceutical product is a long and expensive process and none of the manufacturers has yet considered it worthwhile to go down this route. However, there is talk that the Government may make it easier for e-cigarettes to be registered in the future. If this ever happens, you'll hear about it in the media.
What do I do if I think I have had a side-effect to e-cigarettes?
As mentioned above, e-cigarettes are low-risk in the short term but they are relatively new products which are still being monitored. The manufacturers and the Government rely on reports from members of the public about any safety concerns. This is known as post-marketing surveillance.
Since 20th May 2016 the MHRA has collected safety concerns about e-cigarettes and their refill containers through its Yellow Card Scheme.
You can do this online at the following web address: www.mhra.gov.uk/yellowcard.
Further reading & references
- Hartmann-Boyce J, McRobbie H, Bullen C, et al; Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016 Sep 14;9:CD010216.
- E-cigarettes: an evidence update; Public Health England, August 2015
- E-cigarettes: regulations for consumer products; GOV.UK, Feb 2016
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Laurence Knott
Dr John Cox