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Do e-cigarettes have a place in pharmacy?

Do e-cigarettes have a place in pharmacy?

It’s a rapidly growing, but controversial, market

The e-cigarettes market has largely grown from the ground up. The market for e-cigarettes grew by an incredible 340 per cent in 2013 to an estimated £193 million, says Mintel, up from £44 million in 2012. The burgeoning popularity of e-cigarettes appears to have had a knock-on effect on the smoking cessation market, too, slowing growth to 1.7 per cent in 2013. Annual growth in the smoking cessation market was around six to 10 per cent from 2009 to 2012.

Mintel’s recent ‘Smoking Cessation and E-cigarettes’ report says that 45 per cent of aspiring quitters have used e-cigarettes in a quit attempt, despite this not being a licensed smoking cessation product. This, they suggest, puts e-cigarettes just behind non- prescription NRT products (50 per cent) as the second most popular smoking cessation method.

Multiples including Morrisons, Co-operative Pharmacy, Lloydspharmacy and Boots, are selling e-cigarettes. However, independent pharmacy appears to be split on whether or not they want to stock e-cigarettes, for a wide range of reasons, as this month’s P3 Business Group responses (see comments, left and on this page) reflect.

Consumer view

A survey by retail market research company Canadean Consumer has found that, despite their popularity, many UK consumers remain unconvinced about the safety of e-cigarettes. In a survey, only 35 per cent of people believed e-cigarettes were safer than normal cigarettes and 44 per cent of the remainder were ‘unsure’. Similarly, more than half (56 per cent) thought e-cigarettes contain toxins and harmful ingredients and 42 per cent have worries about nicotine addiction.

Some consumers also expressed concern about the marketing of e-cigarettes: 40 per cent of those surveyed believed e-cigarettes glamorise smoking and 44 per cent thought they could encourage younger people to take up smoking.

The e-cigarette issue is now receiving more coverage from the wider media. The new EU regulations for e-cigarettes have polarised opinion, while pharmacists find themselves in an even greater predicament as the commercial potential collides with the unknown effect on long-term health.

Professional view

Royal Pharmaceutical Society guidance is that ‘e-cigarettes should not currently be sold or advertised from pharmacies’. GPhC has referred pharmacists to guidance from RPS and MHRA. The Pharmacists’ Defence Association says it believes that e-cigarettes should not be sold from a pharmacy until a suitable licensed product is available and ‘urges the GPhC to review its premises standards policy to reduce the potential conflict between commercial decisions and professional autonomy.’

Selling unlicensed e-cigarettes through pharmacies may legitimise these products and confuse the public concerning their effectiveness and safety, says the PDA. They also point out that many e-cigarette brands are owned by tobacco companies: ‘Stocking them indirectly supports an industry responsible for over 100,000 deaths each year in the UK.’

The Royal Society for Public Health has warned against allowing e-cigarettes to be marketed as a ‘fashion accessory’. With different designs and flavours available, as well as celebrity endorsements, e-cigarettes are rapidly coming to be seen as trendy lifestyle choices.

Referring to changes in attitude to tobacco use and marketing controls put in place over the years, Shirley Cramer, chief executive of RSPH says, ‘We are concerned that a modern-day Marlboro Man situation may be born where some suppliers use any possible means to make e-cigarettes attractive to users. The public health community has worked hard to bring in smoking bans ensuring that public places such as restaurants and workplaces are now smoke free zones, but e-cigarettes are becomingCommonplace and it is a worry that the young in particular could become desensitised to the use of e-cigarettes and as a result, cigarettes.’

Market moves

An updated EU Tobacco Products Directive will impose tight regulation on the content and marketing of e-cigarettes with the introduction of maximum limits on nicotine concentration levels (20mg/ml) and cartridge or container volumes (2ml). E-cigarettes will also be required to deliver the nicotine doses at consistent levels throughout the cartridge’s lifespan, as well as be tamper- proof to protect from accidental exposure. Packaging must not contain any promotional elements and will feature health warnings.

Big tobacco was quiet when the e-cigarette craze began to take off three years ago, but is now using its clout to gain a foothold in an industry still dominated by smaller companies. Imperial Tobacco recently launched a high-profile lawsuit against its rivals over patent infringement.

Iain Quinn, founder of I Love Vapour, believes that vaporisers can be a useful smoking cessation aid. He supports e-cigarette regulation, but claims restricting them to the weaker versions may drive some ‘vapers’ back to cigarettes.

Managing director of Nicolites, Nikhil Nathwani, says: ‘We have always supported the concept of regulating the industry as it provides a safety framework protecting consumers from inferior products.’ The brand says it is stocked by Sainsbury’s, Asda, Tesco, Morrisons, Superdrug, The Cooperative and ‘over 10,000 independent pharmacies and convenience stores’.

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