Following on from yesterday's post looking at how switching to e-cigs has benefited his health, long time vaper, Terry Walker, has also come up with a Harm Reduction proposal incorporating the use of e-cigs as means of helping smokers to quit.
Introduction
In 1962 The Royal College of Physicians reported the link between smoking and lung cancer, heart disease and gastrointestinal diseases.
In 2007 the Tobacco Advisory Group of the RCP argued for the application of harm reduction strategies for tobacco dependence. In 2015 Public Health England stated that using e-cigarettes was considered 95% less harmful then tobacco.
In 2016 RCP reported one of its key recommendations as “in the interests of public health it is important to promote the use of e-cigarettes, NRT, and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK”.
With this changing perception within the medical fraternity regarding “vaping”, it becomes obvious that e-cigarettes could prove an extremely valuable tool in the anti-smoking field, thus reducing NHS operating costs (2.7£billion/annum) in terms of the number of patients requiring treatment for smoking related illnesses. However it will be difficult to overcome objections by the non-smoking public that their taxes should not fund smoker’s pleasures.
With this in mind this proposed programme seeks to minimise costs by advocating the prescribing of introductory, one-off kits of medically approved e-cigarettes, as opposed to wholesale funding via repeat prescriptions.
(The following notes refer to nicotine containing products, not those containing fruit flavourings.)
Phase 1
Obviously the best outcome would be if patients were able to stop smoking WITHOUT resorting to e-cigarettes, therefore the use of patches/medicines etc. should be tried first.
Phase 2
If these methods prove unsuccessful, e-cigarettes could be considered over a trial period of say 1 year.
NICE should ask for expressions of interest from companies wishing to enter into a bulk supply contract.
They should examine costs for a kit containing one battery, one charging unit and say 20-30 cartridges. A small number of contracts should be chosen.
Phase 3
Under normal conditions GPs should be advised to give a prescription for 1 kit only per patient. Choice of nicotine strength should be made available.
This type of kit should be sufficient to determine if the patient responds successfully, and is able to give up the use of tobacco entirely. In some instances this will be so and no further action will be required. For those who cannot give up nicotine entirely, and still wish to enjoy the tactile and psychological effects of e-cigarettes, then they should do so at their own cost.
GPs should be allowed to trial the prescription programme, say for one year, during which they should monitor the effects on their patient by the use of, say monthly report back forms. This information should be reported to NICE who can then analyse the results and take a view on the cost effectiveness of the scheme in reducing the use of tobacco.
A decision could then be made as to the funding of further trials.
(In view of the current financial deficiencies in NHS funding, this proposal may have to be postponed but should not forgotten.)
-Terry Walker