The UK’s Push for Prescription-Only Vaping Could Backfire

Neil McKegney points out in his article that providing e-cigarettes only by prescription could have negative impacts on public health.

He responded to discussions in the UK and elsewhere regarding the rising rates of e-cigarette use, particularly the proposal to limit e-cigarettes to prescription access only. In the UK, Shadow Minister for Health and Social Care Wes Streeting recently announced that the incoming Labour government would consider implementing such restrictions to reduce youth e-cigarette use.

There is clear evidence that e-cigarettes are popular among smokers and can help them quit. However, alongside this positive evidence, the number of young people using these devices is rising, regardless of whether they smoke.

While providing e-cigarettes only by prescription may seem like an effective way to reduce youth use of these devices, the reality may be quite different. The fact that young people (including some who are below the legal purchasing age) are using e-cigarettes highlights that access to these devices is not solely through legal sales.

Even in a scenario where e-cigarettes are available only by prescription, some young people may still obtain these devices through illegal means. Regardless of the impact on youth e-cigarette use, providing e-cigarettes only by prescription would limit access for adult smokers. If such a policy were implemented, some adults would certainly seek prescriptions from doctors for these devices. However, others may be less willing to see a doctor. Some of these individuals might obtain e-cigarettes through illegal channels, while others may continue to smoke.

McKegney further points out another reason why providing e-cigarettes only by prescription could have negative effects. Research shows that even individuals who previously had no intention of quitting smoking may increase their chances of quitting by using e-cigarettes. Analyzing data from the respected American study, the Tobacco and Health Population Assessment, Professor Karin Casa and colleagues at Roswell Park Comprehensive Cancer Center found that even adult smokers who had no prior interest in quitting exhibited impressive quit rates after using e-cigarettes. This phenomenon of "unexpected quitting" has also been observed in other studies, such as research by Professor Ricardo Polosa and his colleagues in Catania, which showed that simply providing smokers with access to e-cigarettes helped many quit, even if they had not previously expressed an interest in quitting.

In terms of e-cigarette regulation, a common challenge is how to balance the needs of young people who should not be using these devices with the needs of adult smokers who may benefit from using them. While providing e-cigarettes only by prescription may reduce some young people's use of these devices, unfortunately, it may have the same or even greater impact on adult smokers.

The public health goal of reducing smoking is too important to implement policies that may not be as effective in reducing youth e-cigarette use as anticipated, while actually limiting access for adult smokers. The challenge for manufacturers, regulators, and health educators is to find a way to reduce young people's access to these devices while ensuring that any adult smokers who wish to use e-cigarettes can do so with minimal difficulty. Requiring adult smokers to see a doctor for an appointment before legally obtaining e-cigarette devices sets up significant barriers to broader adult use of e-cigarettes and the potential for broader intentional or unintentional quitting. This is a restrictive regulation that needs serious consideration before implementation.