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Regulator paves way for NHS e-cigarette prescriptions in England

E-cigarettes may soon be prescribed on the NHS to help smokers quit under radical plans by ministers to slash smoking rates in England.

The Medicines and Healthcare products Regulatory Agency (MHRA) has published updated guidance that paves the way for medicinally licensed e-cigarette products to be prescribed for tobacco smokers who want to stop smoking and switch to vaping instead.

The move could see England become the first country in the world to prescribe medicinally licensed e-cigarettes. Almost 64,000 people die from smoking every year. About 3.6 million, or 7% of adults in Britain, are thought to use e-cigarettes.

Doctors, medical leaders and health campaigners welcomed the move. “I am convinced this will be a gamechanger,” said Sir Norman Lamb, the former health minister who chaired the Commons science and technology committee’s inquiry into e-cigarettes in 2018. His committee concluded that there would be “significant benefit” to having medicinally licensed e-cigarettes that could be prescribed, he said.

Prof Linda Bauld, the Bruce and John Usher chair in public health at the University of Edinburgh, said it was “excellent news”.

“While there is good evidence that e-cigarettes available as consumer products can help smokers to quit, we also know that up to one in three smokers in the UK has not tried these devices,” she said.

“Smokers have concerns about safety and misperceptions about the relative risks of e-cigarettes compared with tobacco. For some, cost is also perceived as a barrier. The option of having approved devices that could be prescribed would reassure smokers about relative risks and also assist in reaching those least able to afford e-cigarettes.”

E-cigarettes contain nicotine and are not risk-free. “The liquid and vapour contain some potentially harmful chemicals also found in cigarette smoke,” the NHS says – though these chemicals are found at much lower levels in e-cigarettes.

Public health experts have also raised concerns about young people in particular becoming hooked on vaping despite never having smoked. Tobacco companies have turned to creating the devices.

However, expert reviews have concluded that regulated e-cigarettes are less harmful than smoking. A medicinally licensed e-cigarette would have to pass even more rigorous safety checks, the Department of Health and Social Care said.

Manufacturers can now approach the MHRA and submit their products to the same regulatory approvals process as other medicines available on the NHS. If an e-cigarette gets MHRA approval, doctors could then decide on a case-by-case basis whether it would be appropriate to prescribe an e-cigarette to a patient to help them quit smoking.

Dr June Raine, the chief executive of the MHRA, said the evidence was “clear” that e-cigarettes are less harmful to health than smoking tobacco and that e-cigarettes can help people quit smoking for good. “The updated guidance on licensing requirements we have published today is a strong first step towards availability of safe and effective licensed e-cigarette products.”

The NHS said the National Institute for Health and Care Excellence (Nice) would have to give the green light to e-cigarettes before they could be rolled out on the health service. A spokesperson added: “The NHS will not be prescribing e-cigarettes unless Nice recommends them for use.”

Smoking remains the leading preventable cause of premature death. While rates are at record low levels in the UK, there are still about 6.1 million smokers in England. There are also alarming differences in rates across the country, with smoking rates in Blackpool (23.4%) and Kingston upon Hull (22.2%) vastly higher than rates in wealthier areas such as Richmond upon Thames (8%).

E-cigarettes were the most popular aid used by smokers trying to quit in England in 2020. The number of e-cigarette users grew from about 700,000 in 2012 to 3.6 million in 2019, falling to 3.2 million in 2020 before rising again in 2021 to 3.6 million.

Sajid Javid, the health secretary, said: “Opening the door to a licensed e-cigarette prescribed on the NHS has the potential to tackle the stark disparities in smoking rates across the country, helping people stop smoking wherever they live and whatever their background.”

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