A new debate is raging in the UK, as to whether people should be allowed to vape in their hospital beds, and/or if e-cigarettes should be given out for free on the NHS.

The NHS is the British National Health Service, where medical care is free at the point of delivery. The cost is paid through taxes by all taxpayers. There are set charges for prescription medication, but in comparison to the USA where thousands of people are regularly bankrupted by medical charges, British health care is essentially free.

For those of us that have to pay for health insurance, this may seem like a no brainer, but it’s causing quite a stir.

The suggestion for free e-cigarettes has come from a not so surprising quarter, according to Public Health England, (PHE). PHE is the same body responsible for independent analysis regarding e-cigarettes and the subsequent 95% safer opinion.  Their latest report on vaping states many wonderful things about vaping, including that it helps people get away from tobacco, it is safer than smoking, it doesn’t lead to youth smoking, and more. It basically re-enforces what they said in 2015; it’s the best way forward to get people off cigarettes.

However, this year they went a few steps further.

They wrote:

NHS Trusts
To become truly smoke free, Trusts should ensure:

  • – e-cigarettes, alongside nicotine replacement therapies are available for sale in hospital shops
  • – vaping policies support smokers to quit and stay smoke free
  • – Smoking shelters be removed
  • – Front-line staff take every opportunity to encourage and support patients to quit
  •  

The government’s new Tobacco Control Plan for England includes a commitment to ‘maximize the availability of safer alternatives to smoking’. It makes clear that e-cigarettes have an important part to play in achieving the ambition for a smoke free generation.”

There are many dissenting voices about this suggestion of e-cigarettes on the NHS, and many with good reason.

First, there is the opinion that this feels like an assault on freedom of choice, and that perhaps Tobacco control is trying to take control of the vaping market through the medicinal route.

Many of you will remember that the FDA tried to take control of e-cigarettes via the medicinal route in 2010. They failed. They were successful though when using the tobacco route, and currently we have the deeming regulations as a result.

Should there be medicinal e-cigarettes in the UK? These e-cigarettes could then be de-facto quitting devices, instead of recreational products that help steer people away from tobacco, which could then change the conversation. If enough people then see e-cigarettes as a medical device, there is a, very slim, chance that the regulators in the UK could then start to tighten the regulations until all e-cigarettes must have medical licenses. Like the FDA, the UK’s MHRA in 2010 wanted e-cigarettes to be regulated as medical devices. Hence the concern.

What about the loss of choice?  One of the main reasons vaping is so successful is due to the huge choice in devices and e-liquids. One size does not fit all.  Medical devices will have to be very simple, and similar, due to the hoop jumping they need to go through to be licensed.  They will be limited in style and scope, and as such, may not be as beneficial.

They could also turn out to be a bad investment.

Which leads us to the issue of no credible medical devices.

The one that has a license for the UK to be sold as a medical device, from British American Tobacco (BAT), is, to put into common vernacular said to be garbage. I haven’t tried it, so it is difficult to corroborate this claim. It is therefore best to leave it to BAT who state they are having ‘production difficulties’ and hence have no medical device available.

This once again brings into focus what exactly was approved by the MHRA in the UK, and a huge amount of curiosity as to why they cannot reproduce in large quantities to sufficient standards.

BAT insisted it was able to make a product complying with rules on particles and nicotine, but that scaling up the manufacturing process had caused technical problems.

It said rapid developments in the technology for e-cigarettes had left the eVoke out of date. David O’Reilly, group scientific director at BAT, said:

“We were never really interested in prescription products. At that time, the medicinal route was the only route to market, but smokers do not see themselves as patients.

‘Now there are additional routes to market, and we are devoting significant time and resources to extending consumer choice and delivering ever better next-generation tobacco and nicotine products.”

Perhaps there just isn’t enough money in it for them to pursue the technical problems?

Then we have the industry itself.

IBVTA – the industry body of note in the UK writes, The experience of IBVTA members across the UK is that the smokers who do the best in terms of cutting down or switching completely are the smokers who take personal responsibility for their own start-up costs. They feel empowered because they have done it themselves and are therefore more likely to persevere with vaping.”

Basically, if you have invested your money in it, you make more of an effort.

Then we have the vaper that sees their civil liberties being eroded by a nanny state that is throwing tax money where it is not needed.

People who have stopped smoking by switching to e-cigs have done so precisely because they don’t have to attend a clinic and drink weak tea with some dreary stop smoking adviser. They use e-cigs because they made their own decision, spent their own money, and choose their own device.”

The general saying is that if you can afford to smoke, you can afford to vape. Spending valuable NHS resources on vape gear instead of incubators for premature babies is a tough one to square.

The evidence that e-cigarettes are helping the British public is compelling, “The report, by experts from King’s College London and the UK Centre for Tobacco and Alcohol Studies, the University of Stirling and Cancer Research UK, suggests e-cigarettes are helping up to 57,000 smokers a year to quit.”

This is no small number.

Smoking rates are falling dramatically and in the UK they are very welcoming of vaping. It just seems a stretch too far to allow e cigarettes on prescription when the public are doing fine without the NHS footing the bill and possibly changing vaping for the worse.

A free market economy built vaping, it should be allowed to continue shaping it. What do you think?

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