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England could be the first country in the world to prescribe e-cigarettes medicinally to help reduce smoking rates.
England could be the first country in the world to prescribe e-cigarettes medicinally to help reduce smoking rates.
Public Health England, an executive agency in the UK’s Department of Health and Social Care, has long advocated for smokers to switch to e-cigarettes. Their research has found that vaping is 95 percent less harmful than cigarettes.
No other country has embraced vaping for harm reduction to this extent and the United Kingdom’s health services are the foremost experts in this field. The results speak for themselves. The UK has outperformed EU countries in smoking cessation.
As reported in guidelines released on the Health and Social Care Portal of UK.gov website, medical regulators will work with vape manufacturers to fully assess the safety and efficacy of their products. The goal is to get electronic nicotine delivery systems (ENDS), commonly known as vapes and e-cigarettes, into the hands of smokers. By offering it as a prescription, the poorest and most marginalized smokers will now have access to e-cigarettes.
The UK’s science-based approach to smoking cessation contrasts sharply with the binary choice of total nicotine abstinence or nicotine replacement therapy promoted by medical authorities in the United States. Any discussion of cessation or harm reduction using ENDS devices is prohibited in the US.
Public Health England has advocated electronic cigarettes as an alternative to combustible cigarettes for close to a decade. But the ability to prescribe e-cigarettes will for the first time allow underserved and marginalized groups, who are far more likely to smoke than the wealthy, to access tax subsidized cigarette alternatives with a doctor’s prescription.
Taxpayer dollars. The National Health Service (NHS) is paid for by taxpayer dollars. It is a massive operation and has skin in the game. It is not operated for profit. The pharmaceutical industry and anti-vaping lobbyists have far less sway in the UK, where bucket loads of cash cannot buy favorable outcomes as easily.
The National Health Service, which is the UK’s national health care provider, is no pushover. They are a conservative organization and extremely wary of controversial treatments.
They are also very quick to discard health modalities determined to be ineffective or overpriced. E-Cigarettes would not be promoted if they did not make sense with the bean counters.
Keep in mind that while the NHS is on the cusp of offering prescription vapes, they refuse to cover dietary supplements, chiropractic medicine, homeopathy, naturopathy, herbal medicine, natural medicine, and other alternative treatments. This isn’t some impulsive operation looking to grab headlines.
Tellingly, the NHS jettisoned alternative natural health treatments despite the vehement complaints of wealthy luminaries, lobbyists, and Prince Charles himself.
At the same time, the NHS has long hosted the “Using E-Cigarettes to Stop Smoking” resource page.
The only goal of the massive national health institutions of the UK are to provide effective and affordable treatment options for their citizens.
Public Health England and the National Health Service would scrap support of e-cigarettes immediately if they did not have proof that they worked.
The full scope of the process is being finalized, but the pathway for prescription vapes is going to be open soon. Research and applications will be submitted to the Medicines and Healthcare products Regulatory Agency (MHRA). This is the same channel that every drug and medical device must pass through.
Once approved, clinicians would be able to prescribe e-cigarettes to a patient to help them quit smoking.
According to the UK.gov press release, “E-cigarettes contain nicotine and are not risk free, but expert reviews from the UK and US have been clear that the regulated e-cigarettes are less harmful than smoking. A medicinally licensed e-cigarette would have to pass even more rigorous safety checks.”
E-cigarettes are the most popular smoking cessation method in England. The NHS reports that in 2020, “E-cigarettes have been shown to be highly effective in supporting those trying to quit, with 27.2% of smokers using them compared with 18.2% using nicotine replacement therapy products such as patches and gum.”
Vapers working with the Stop Smoking services offered by the NHS have the highest smoking cessation rate of any group: 68 percent.
This major breakthrough for UK smokers and vapers can be traced to a study first published in February 2019 in the New England Journal of Medicine (NEJM) study.
A massive study facilitated through the Stop Smoking offices of NHS, researchers found vaping was twice as effective as nicotine replacement therapy (NRT) for smoking cessation. What is nicotine replacement therapy? It is the patch, nicotine gum and similar synthetic nicotine products manufactured by the pharmaceutical industry.
Billions have been poured into the development of NRT over the last four decades. Compared to vaping, where even a hint of the word cessation will bring regulators to your front door in the US, pharmaceutical companies have worked tirelessly to improve NRT and develop a whole infrastructure around using these products. They have created intricate protocols to titrate nicotine levels. The admirable goal is to facilitate total cessation. Unfortunately, when pitted toe-to-toe with a very basic electronic cigarette NRT came up second best in a two horse race.
The NEJM study found that what was essentially a 2013 era vape starter kit proved twice as effective as nicotine replacement therapy. We are talking about a classic e-cig loaded with freebase nicotine. A device that cost maybe $10 at the time.
In response to this groundbreaking study, the NHS and Public Health England examined new ways to incorporate e-cigarettes into a comprehensive harm reduction and smoking cessation program. With the goal now to get e-cigarettes into the hands those unable to afford making the switch, prescription vaping products were inevitable.
As readers are painfully aware, the US has taken a quite different approach to vaping. As teen vaping rates increased in the US, the UK did not encounter this issue possibly due to a cap on nicotine strengths at 20mg, politicians became obsessed with denying access to e-cigs, no matter the cost to adult vapers and smokers.
Total nicotine abstinence or NRT remain the only approved games in town. An inexplicable obsession with vaping flavors still clouds the debate, even after the 2019 Youth Tobacco Study conducted by the CDC found that flavors are not one of the primary reasons that teens vape.
The NEJM study pulled the rug out from under the US approach. Not surprisingly, the goal posts were promptly moved.
Critics of vaping seized on the fact the NRT patients who successfully quit smoking were more likely to be totally abstinent from nicotine. That far more people were successful quitting with e-cigarettes was ignored or even decried as detrimental because this meant this meant there were now more vapers!
It was illuminating to see how quickly the health and lives of those who successfully moved from combustible to electronic cigarettes was dismissed.
One tired old myth of the anti-vaping lobbywas destroyed by the NEJM study: the debunked theory that e-cigarettes are a gateway drug to combustible cigarettes.
A true zombie myth that refuses to die, this specious argument had already been debunked a dozen times. The fact it still appears on the Orwellian-named Truth Initiative website is evidence they are either not arguing in good faith or woefully uninformed.
The retraction and controversy surrounding a bogus vaping heart disease study written by their scientific advisor Stanton Glantz, reported on in the USA Today, suggests that the former rather than the latter may be the case.
Buried in the media coverage on teen vaping from 2017 to 2019 was the fact that former FDA chief Scott Gottlieb stated that it would be a net positive if all current smokers switched to vaping. Nary an interview or press release did not acknowledge this fact. Yet these quotes were studiously ignored in main stream media coverage of his appearances.
Consider this quote from an FDA press release: “While it’s the addiction to nicotine that keeps people smoking, it’s primarily the combustion, which releases thousands of harmful constituents into the body at dangerous levels, that kills people.”
A fair debate on vaping in the US is unlikely. With $160 million dollars, Michael Bloomberg has bought the energies and advocacy of dozens of politicians and government offices. As the Stanton Glantz scandal demonstrated, the possibility that scientific outcomes were also purchased is not out of the question.
The mysterious outbreak of lung disease in the fall of 2019 is another good example of how the media has skewed coverage of vaping.
The cause of the lung disease was identified by Labor Day by Leafly Magazine: vitamin E acetate used in black market THC cartridges.
Even the state of New York Department of Health, a true enemy to adult nicotine vaping if there ever was one, posted warnings about that vitamin E acetate was responsible and to avoid THC cartridges on September 5, 2019,
Scroll through news coverage at the time and you will find countless articles suggesting that perhaps commercially available nicotine vapes were responsible.
There were outliers.NPR reported the sharp spike in lung disease hospitalizations pointed to a single culprit and commercially available nicotine products were not associated with any of the incidents.
The state of Michigan was a bit more careless in their response to vaping lung disease. The Michigan Department of Health and Human Services did not ban vitamin E acetate from THC cartridges until the end of November.The Detroit Metro Timesreported that they neglected to mention THC cartridges were involved at all until well into October. This intentionally obtuse approach falsely shifted the blame to nicotine products and the generic “e-cig”.
Governor Gretchen Whitmer campaigned for cannabis legalization and accepted donations from lobbyists from the powerful industrial hemp and cannabis industries. Was she repaying a favor when Michigan completely failed to provide clear guidance to its citizens regarding the outbreak of vaping lung illnesses. There is no question that it took an unacceptably long period of time for THC cartridges to be called into question by the Michigan Department of Health and Human Services.
The CDC was also slow, not until December 2019 did they finally make it clear that commercially available nicotine products were not responsible.
Even coverage of the CDC announcement was skewed. But the buried lede speaks for itself.
“Pure THC oil has a viscosity like that of vitamin E acetate. Cutting THC oil with vitamin E acetate has been reported to be common in the illicit market.9-11 The FDA reports that most case-associated THC product fluids contain vitamin E acetate, at an average concentration of 50% by weight, ranging from 23 to 88%.8 By contrast, the FDA detected no vitamin E acetate in 197 case-associated nicotine products analyzed to date. The viscosity of vitamin E acetate makes it undesirable as an additive to nicotine solutions; the propylene glycol and vegetable glycerin in nicotine solutions create a fluid with a much lower viscosity than that of vitamin E acetate.”
Centers for Disease Control, ” Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI”, 12/20/2019
Thanks to the strict PACT Act, combustible cigarettes and e-cigarettes manufactured by Big Tobacco and sold at gas stations are the only options available to smokers and vapers who choose not to embrace total nicotine abstinence.
Mad Vapes has no interest in selling our products to individuals who do not already smoke or vape. We are hard at work to supply the best vaping products to adults over the age of 21 who already vape or smoke.
We have industry leading age verification technology to prevent the sale to minors. In any event, research has shown that most underage vapers were obtaining their vapes from peers. Tobacco 21 laws addressed this issue and are largely to thank for the decline in vaping rates.
Will the United States ever embrace a humane and compassionate approach to smoking and vaping? It seems unlikely at this juncture. The wealthiest Americans have long since quit smoking. Smokers and vapers have no access to levers of power. Compare the fate facing vaping with the way alcohol is treated. According to the CDC, 3500 minors die each year from underage drinking. An additional 130,000 end up in the emergency room. Nary a peep about that epidemic.
Wealthy Americans imbibe just as frequently as any other group. It is not hard to connect the dots here. Vaping is viewed as an alien and disreputable habit by the people making the rules. Imposing obstacles on users has no impact on anyone in the immediate social circle of the wealthy and influential backers of the anti-vaping movement.
It is a bit strange that the PACT Act leaves the vaping market open to e-cigarettes that have access to shelf space at gas stations. Big Tobacco and their partners control this space.
The product most typically associated with underage vaping, Juul, will surely benefit as small and independent vaping companies get driven out of business by harsh new rules. The words regulatory capture come to mind.
Regulatory capture is a theory that often plays out in practice in the United States. It occurs when government agencies are dominated by the biggest stakeholders in the industry they are meant to regulate and not by public interest.
An unrelated form of corruption would be when elected officials grandstand and menace to influence the decisions of regulatory agencies. Current US Senators badgering the FDA to reject PMTAs certainly seems to cross that line. The Supreme Court case Pillsbury v. The FTC in theory bars exactly this type of meddling.
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