Report Reaffirms Vaping Benefits

The Royal College of Physicians (RCP) was the first major public health institution to support vaping as a means to quit smoking when it published a report in 2007. Three years later it remained the only reliable source of information about relative safety. The RCP published Nicotine Without Smoke in 2016, which concluded that vaping was an effective way to stop tobacco use. Now, in 2024, it has published E-cigarettes and

harm reduction – An evidence review.

The E-cigarettes and harm reduction: An evidence review is a new report looking at how vaping can help to prevent smoking related death, disability and inequalities from tobacco use. It builds on the work conducted for 2007’s Harm reduction in nicotine addiction and 2016’s Nicotine without smoke.

 

So, what does the new review tell us about how much we now know about the science of vaping – and do the RCP’s proposals to government ministers tell us anything about where vaping will go in the future?

 

Nicotine

The RCP says: “People who smoke are addicted primarily to the nicotine in tobacco, which drives sustained use of smoked tobacco products and the subsequent devastating harm to health caused primarily by non-nicotine constituents of tobacco smoke, including tar particles and carbon monoxide.”

 

The experts repeat that by all current evidence, nicotine poses “little risk to health”. For a short period of time after consuming nicotine, a person may feel “enhanced cognitive effects” like being able to focus on a task better. They will also experience slightly raised heart rate and blood pressure, but these return to normal as nicotine is broken down and leaves the blood system.

 

With cigarettes and vapes on a continuum of risk, the RCP says the two products sit at either end of the graph – with tobacco being at the very harmful end and, “it is likely that e-cigarettes and oral nicotine products fall close to the lower end of this spectrum”.

 

Smoking and vaping trends

There has been a constant decline in the number of people who smoke, but that was reversed during the covid pandemic as lockdowns drove higher rates – especially in 18–24-year-olds.

 

Despite widely spread fears of a teen vaping “epidemic”, the RCP states categorically: “Vaping remains overwhelmingly an activity of smokers and ex-smokers, who represent around 93% of all people who use vaping products”.

 

How effective are ecigs for quit smoking attempts?

Despite people opposed to the idea of vaping saying otherwise, the evidence is overwhelming. The RCP points to findings gathered from multiple randomised controlled trials and the Cochrane Living Review clearly demonstrating that vapes “are more effective at helping people quit … than nicotine replacement therapy.”

 

They say that vapes work for sections of society who usually struggle the most with stopping smoking:

• pregnant women
• people experiencing mental health problems
• smokers who are not motivated to quit
• people experiencing homelessness
• prison populations

 

They noted that targeting smokers in NHS emergency departments and social housing with the offer of free vape starter kits has shown promising results.

 

The health impact of vaping

The RCP says it is clear that cigarettes are exceptionally dangerous and kill.

 

Research has shown that vapes:

• Deliver similar levels of nicotine to the blood compared to smoking
• Produce fewer toxins and in much reduced concentrations
• Produce lower levels of markers of oxidative stress and inflammation to those in smokers

 

Research remains too limited in the areas of heavy metals and secondhand exposure to make claims of harm.

 

Legislation

By the time the report came out, the UK Government had already voted to implement the Tobacco and Vapes Bill.

 

Encouraging uptake of vaping for smoking cessation

The RCP says that the Government needs to do more to encourage smokers to switch to vaping, mirroring the call from the Kahn Inquiry two years ago.

 

The organisation says that placing accurate information in or on cigarette packs should be used and an eye needs to be kept on the cost: “The price of e-cigarettes is likely to be an important determinant of their consumption; higher prices are generally associated with lower use.”

 

In conclusion

Professor Sanjay Agrawal, the RCP’s special adviser on tobacco, said: “We know that e-cigarettes are at least twice as effective for quitting smoking than simply doing it on your own. It’s therefore crucial that they are made available for adults to successfully quit smoking for good.

 

“But we can’t ignore the huge rise in children and young people taking up vaping nor their environmental impact. Vaping might be safer than tobacco but has its own risks. We’re recommending regulation to create a much-needed safety net – protecting young people from vaping but allowing their use for people to stop smoking.”

 

The RCP’s report states that e-cigarettes are not harmless but “they are demonstrably less harmful than smoked tobacco” to users and bystanders.

 

The RCP restates that its position is to support a risk-based approach to harm reduction by advocating for vaping. It says this is “ethically and scientifically sounder than a precautionary approach”, one that supports bans on vapes and ignores the dangers of smoking.

 

The RCP Proposes

The RCP laid out a list of proposals for the government to consider in order to maximise the benefits vaping offers as part of a harm reduction approach to public health.

 

The proposals include:

• More research should look at the long-term effects of nicotine use
• Laws should be made to prevent vapes from producing a dry hit or operating at really high temperatures
• Vapers should be told about the benefit of vaping cooler – like in direct to lung
• We need to know more about how people transition in and out of vaping
• The UK should combine survey results with other countries
• Vapes should be promoted more to smokers
• Vapes should be promoted more to groups who struggle to quit smoking
• Vapes should be offered to smoking patients by the NHS
• More research needs to be done on which vape eliquids work best
• Research methods for studying vaping health risks needs to be standardised
• People need educating about the real risk of vaping to combat the misinformation people read and hear in the media
• Eliquid flavours must continue to be available for adults
• Pro-vaping messages should go in and on cigarette packs