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Exclusive: E-cigarettes should not be available on prescription, say GPs

The vast majority of GPs do not believe that e-cigarettes should be prescribed for patients trying to stop smoking, a GPonline survey has found.

Almost 70% of GPs rejected the idea that NHS e-cigarette prescriptions should be made be available for patients wanting to quit smoking.

A small proportion (17%) of GPs backed the idea of prescribing e-cigarettes, while 14% of the 448 doctors who responded said they weren’t sure.

A report from the Royal College of Physicians, published earlier this year, advised GPs to promote e-cigarettes ‘as widely as possible as a substitute for smoking’.

The report said the use of e-cigarettes was a viable harm reduction strategy. After its publication, the RCGP called on NICE to investigate whether e-cigarettes should be prescribed to patients.

E-cigarette safety

Many GPs felt there was not enough long-term data on the safety of e-cigarettes to justify prescribing them. One GP said: ‘To my mind it is still smoking and we do not know the harm these vapours are doing.’

Another said: ‘If people can afford to smoke they can afford to buy the e-cigarette to quit. The NHS should not bear the burden of everything. We have to prioritise.’

A GP who backed prescribing e-cigarettes said: ‘Yes they should be available on prescription, but it is difficult to evidence what strength or prescription would be beneficial across a standard population.’

Another said: ‘These certainly have a role in encouraging smoking cessation, but I feel that making them available on prescription serves to medicalise this issue rather than better promoting patient self-management and responsibility.’

However, 37% of GPs said that they were likely or very likely to recommend e-cigarettes to patients who are trying to give up smoking, compared with just 28% who said they were either unlikely or very unlikely to recommend them. The remaining 35% said they were ‘neutral’ on whether to recommend e-cigarettes.

Smoking cessation

One GP said: ‘I don’t have any information on long-term consequences so feel unable to recommend them, but if a patient asked, I would agree that evidence based on short-term use suggests that they are less harmful than cigarettes, with the qualification that this does not mean they are safe.’

Another said: ‘I am not convinced that they are safe, but I know that a cigarette isn’t.’

A spokeswoman for NICE said its public health guidance on reducing harm from smoking recommends licensed nicotine-containing products, and e-cigarettes licensed by the Medicines and Healthcare products Regulatory Agency would come under this category.

‘We haven’t produced guidance that looks at e-cigarettes specifically,’ she said.

‘As is usual process, the DH or Public Health England would have to officially refer the products to us before we can appraise them.’

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