Stop Smoking Services & E-Cigs: What’s the Deal?

We’ve all seen the recent news about the lowest smoking prevalence on record and all that. Some quangos are of course claiming that this lowest rate is largely thanks to policies (read bans and tax hikes among other ludicrous measures, such as banning smoking in your car) and plain packaging (which while passed hasn’t become a reality nationwide yet).

With a few exceptions, the elephant in the room hadn’t been discussed and that is of course the role that e-cigarettes have played. Which brings about another item. Stop Smoking Services (SSS). We’ve been told that the number of people going into these places is in decline (some areas more than others). Now you would think that with such a decline in SSS attendance, there would be a similar decrease in the number of people quitting smoking (as in, the prevalence rate wouldn’t be the 16.9% it is now – rather it’d be close to the original 19.3% it was in 2012.

Now, I don’t have a problem with Stop Smoking Services. I’ve met Louise Ross from the Leicester SSS. I’ve met Nicky Coote-Woolmore from Harrow and Sairah Salim-Sartoni from Bristol. Each of them are truly wonderful people. I’ve not spent a huge amount of time with Louise or Nicky, but I did spend a lot of time with Sairah in Warsaw at GFN. Stop Smoking Services have a role to play. Historically, they’ve been there to help advise and guide smokers looking to quit smoking, but they’ve been armed only with the products that, as we know, are pretty thin in the efficacy stake – NRT.

Over the years, they have done a remarkable job in helping those wanting to quit smoking do just that, and I’m sure that both services operated by Louise & Nicky mimic Sairah where they find an option, or combination of options that work for the individual. Especially now with e-cigarettes being on the market and proving to be the most popular cessation aid.

This is where I begin to have a niggly problem with SSS. I don’t knock the work they do, but nine times out of ten when a positive article appears in the press there is always this cessation approach – the “they can help you quit smoking” – type line. Broadly speaking that statement is true, but e-cigarettes are substantially more than just a bloody quit aid.

I’ve never truly been comfortable with Stop Smoking Services endorsing e-cigarettes and I suspect I never truly will be. You’ll remember of course that our very own MHRA wanted control of e-cigs back in 2010. As in full-on med-license only products. True NRT. The community said “fuck off” and lo! The MHRA eventually did just that. The EU bought e-cigs into a tobacco products directive and gave them a dual route to market. Consumer and meds. Thus far, only two “e-cig” like devices have made the cut with an MA and both are made by BAT. Y’see the irony here?

Then of course, PHE released their report last year complete with the headlines that “e-cigs available on the NHS“. A med-ecig is, and always will be to my mind a fucking terrible idea. Both Lorien and Sarah had their say about it. Dave Dorn had some words to say about it too. I said a few words about it here and here. Therein lies a problem.

The medicalised slant that is always applied to e-cigs, be it as part of this medicines authorisation stunt or via SSS. Vaping is, first and foremost a consumer market. It has the side effect of helping folk to move away from combustible tobacco, but that is not its primary function. That does not mean it can’t do both, so let’s not pigeon-hole the product into one or the other category.

To me, an e-cigarette is first and foremost an alternative to combustible tobacco – some could say that you “smoke an e-cig” – which isn’t necessarily accurate, but that is more a linguistic thing. Vaping, like smoking is enjoyable. The thing is, add a medical slant to anything enjoyable and suddenly all the fun is sucked away leaving a sterile, boring activity.

Reducing the smoking rate has been an aim of various worldwide governments for years and the UK is no exception. Yet for all the “measures” imposed – the bans, the tax hikes, the upcoming plain packaging, the bans in cars and all the other ridiculousness only succeeded in starting a gentle decline in the rate. Sure there was a fairly heavy decline once the 07′ bans fully kicked in, but I would hedge my bets and say that those that decided to quit smoking back then were primarily social smokers that enjoyed the odd fag with a beer or two and a meal or a boogie. But post-2007 the prevalence rate stubbornly remained above 20% of the UK population but has now, with the increasing popularity of e-cigs dropped to 16.9%. Coincidence? I think not.

The success of that speaks for itself. A consumer driven product has done what governments, tobacco controllers and the public health lobby have failed to do. Leave the products alone and for fuck sake, stop adding a medical slant to them. If Stop Smoking Services were to remove the “you can quit” type rhetoric from their messaging that includes e-cigs, that would definitely go a long way to removing that medical slant, and public health can but out.

Valar morghulis.

(image credit alice-photo/shutterstock.com)

  • Jessica Harding

    Fantastic post Paul, and I agree with a lot of what you say, especially this: “let’s not pigeon-hole the product into one or the other category. “

    I do think that a good Stop Smoking advisor can offer a level of support which is unmatched by anything else currently on offer: in terms of individual attention and time, if nothing else. I’m speaking from personal experience as someone who did want to stop smoking and once “gave up” for 3 months with the help of the smoking cessation nurse at my GP surgery. I fell off the wagon when she ended my inhalator prescription – an example of one of the areas the SSS fall down on (the emphasis on quitting being another). Once I found vaping I still probably could have benefited from having an advisor but I was too worried they’d tell me I shouldn’t vape. There are a lot of people I know (anecdotal evidence!) who might take to vaping but haven’t because the current routes into it aren’t appropriate for them or the alarmist news stories have scared them off. They are people who (I think) would most benefit from vaping – older smokers who really like smoking. Us long term vapers are natural risk takers (we started vaping before it was endorsed by any health professionals) but many people aren’t.

    The challenge is for the SSS’ to “get” the pleasure principle, and that is a massive hurdle.

    And yes, it’s so bloody annoying that vaping still isn’t getting the credit!

    • To be fair, I could have gone on for much longer on the whole SSS support aspect. As we know, there is no such thing as a “one size fits all” solution – something myself and Sairah discussed at length in Warsaw. I suspect that – with regards to your specific scenario – SSS deem a particular timeframe to be the “most susceptible” to relapse and after that, any prescription, such as your inhalator, is ended. They don’t see relapse after a set time-frame as problem, yet it clearly is in a lot of cases.

      The current routes into vaping are woeful, which I have touched on in these pages on a few occasions. There’s one store in a 25 mile radius of where I live that stocks a wide range of “starter” (such a loose term now) and more advanced hardware to suit all. The staff are knowledgeable too (and friendly, which is always a bonus). That’s one out of at least a dozen. It does come back to the whole referral thing which is working very well in Bristol and Leicester (I believe it’s in Leicester anyway), however the main issue is the medical (or explicit “quit”) phrasing – at least for me.