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s2smodern

Neil McKeganey, Christopher Russell | 28 April 2016

The publication by the Royal College of Physicians of a report “Nicotine without Smoke: Tobacco Harm Reduction” approbating the use of e-cigarettes as a route out of smoking conventional cigarettes affirms a finding that has been highlighted by researchers for a number of years now. This report is welcome nevertheless as an objective contribution to a debate that has become increasingly personalised and divisive with tobacco control advocates repeatedly advising that e-cigarettes should be regulated as least as tightly as conventional cigarettes.

That view is now looking both dangerous, in its potential to undermine the use of what is seen as a much less harmful product, and ideological in being rooted in a view that appears to be driven more by an antipathy towards the tobacco industry than a regard for smokers themselves.

However there are other aspects of the use of e-cigarettes which are unlikely to be resolved even by the welcome publication from the Royal College. Describing e-cigarettes as a smoking cessation tool is accurate but it is by no means the whole story. It should come as no surprise to anybody given the rapid growth in the use of e-cigarettes that vapers actually enjoy these devices. Their enjoyment in this respect can only be partially understood in terms of the dependence upon nicotine since in many instances vapers are using e-cigarettes with flavoured liquids containing no nicotine. In interviews with vapers researchers within the Centre for Substance Use research are hearing repeated accounts that whilst the desire to cease smoking is the reason why many individuals initiate vaping nevertheless their continued use of these devices has more to do with pleasure and enjoyment than self medication. This being the case the question arises as to how if at all we should be seeking to regulate a pleasurable activity, in contrast to a smoking cessation activity?

If we see a growth in the use of e-cigarettes by non smokers attracted not to the devices as a safer way of consuming nicotine but for reasons of pleasure should we see that as a negative leading us to seek to outlaw their decisions in this respect? Should we be seeking to make e-cigarettes harder to access because people like using them? And if so what is it about individual’s deriving pleasure from these products that should be seen as so reprehensible.

The second issue is no less tricky. If e-cigarettes prove to be helpful in enabling smokers to quit but also in reducing the likelihood of individuals even beginning to smoke (more of a roadblock to smoking than a gateway) would it still be appropriate to view the use of these devices by non smokers as a negative? We know that smoking conventional cigarettes is hard to stop once the habit has developed. If we are determined to further reduce the level of smoking in society this will require not only that we increase the rate of smoking cessation but also that we successfully reduce the rate at which individuals are beginning to smoke. E-cigarettes may well have a valuable role in reducing smoking incidence - it may not be a co-incidence in this respect that recent data from the US shows reduced smoking rates amongst young people at the same time as they are seeing increased e-cigarette use. If these devices are proving to be an effective means of reducing smoking onset, as well as increasing smoking cessation, then perhaps we should welcome their use by non-smokers rather than perceive such use as an unwanted outcome of the growing accessibility of these devices.

Neil McKeganey Ph.D, Christopher Russell Ph.D
Centre for Substance Use Research
Glasgow