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In the spotlight: e-cigarettes

It’s hard not to notice the recent increase in the popularity of electronic cigarettes. Also known as e-cigarettes or vapourised cigarettes, people are using these small devices more and more to quit, cut down or replace tobacco for good.

But how safe and effective they are still can’t be assured, so should we be using them at all? Here, we explain more about e-cigarettes and take a closer look at the current guidelines and evidence that’s out there.

Dr Paul Zollinger-Read


  • What is an e-cigarette? What is an e-cigarette?

    A typical e-cigarette is made up of three main parts: a battery, an atomiser (heating system) and a cartridge containing nicotine. These replaceable cartridges contain nicotine in a liquid called propylene glycol or glycerine and water. The level of nicotine can vary and some cartridges are flavoured. Some look like cigarettes, but more and more are starting not to.

    Over the past few years, e-cigarettes have rocketed in popularity. It’s estimated that around 1.3 million people currently use e-cigarettes in the UK. In 2010, the number of smokers who had tried e-cigarettes was 9 percent. This rose to 35 percent in 2013.

  • Are e-cigarettes safe? Are e-cigarettes safe?

    This is still a grey area that has triggered a lot of debate. This is because there is no evidence on the long-term safety of e-cigarettes as yet. But according to the National Institute of Health and Care Excellence (NICE), there is little evidence to date that suggests e-cigarettes can cause any harm. And especially in comparison to smoking.

    Recent guidelines from NICE support the use of licensed nicotine products, such as nicotine patches, gum and sprays, as a way to cut down, quit or use as a substitute for smoking. E-cigarettes are still under question until more safety research is carried out.

    If you smoke, it’s mainly the burning of a cigarette and inhaling its toxins and carcinogens (cancer causing substances) that causes illness and poor health. Not the nicotine. Nicotine is a drug that causes you to become addicted to smoking. Because of this reason, NICE concludes that it’s safer to use licensed nicotine containing products than to smoke.

    The concern with e-cigarettes, however, is that they are currently unregulated products in the UK. E-cigarettes are thought to be far less harmful than tobacco. But at the moment there is no long-term evidence on their effectiveness, quality and safety. This is why there is often such debate around e-cigarettes.

  • Are there plans to regulate e-cigarettes? Are there plans to regulate e-cigarettes?

    Yes. The Medicines and Healthcare Products Regulatory Agency (MHRA) wants all nicotine containing products regulated in the UK. This will happen when the European Commission’s new Tobacco Products Directive (legislation) comes into effect, which is expected to be in 2016.

    This doesn’t mean that you will no longer be able to buy e-cigarettes, but rather, you’ll benefit from improved safety and quality requirements. There will be new rules on packaging and labelling to make sure that you know exactly what’s in them and any potential hazards of using an e-cigarette.

    And regulation is good news. Because e-cigarettes are evolving so quickly and becoming so popular, their safety and quality is essential. If you look into buying an e-cigarette at the moment, it’s likely that it won’t display its contents, how to use it properly or how to dispose of it safely. One study also found that e-cigarettes frequently leak, which can be a hazard to you, your children and pets. This is because we still don’t know what the long-term effects are of handling nicotine or getting it on your skin. And the contents of the cartridge can be toxic if consumed.

    Until the Tobacco Products Directive comes into effect in 2016, the UK government has said it will work on getting nicotine containing products licensed as medicinal products.

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  • What is a safe dose range for an e-cigarette? What is a safe dose range for an e-cigarette?

    Again, the long-term safety and effectiveness of e-cigarettes still hasn’t been looked into thoroughly. But it’s important to know that the maximum threshold of nicotine is 20mg per millilitre. Anything above this, and it shouldn’t be classed as a consumer product. You may be able to buy e-cigarettes at higher dosages but these are only OK if they’re approved as a pharmaceutical product.

    The variation of nicotine content and how the nicotine is delivered from product to product also shows why regulation will be a real benefit.

  • Is the vapour from e-cigarettes safe for non-users to inhale? Is the vapour from e-cigarettes safe for non-users to inhale?

    We can’t say for sure until there is long-term research available on the safety of e-cigarettes. However, if you use an e-cigarette, what you exhale is mostly water vapour and therefore thought to be far less harmful than second-hand smoke from cigarettes.

  • I'm finding it hard to give up smoking. Should I try e-cigarettes? I'm finding it hard to give up smoking. Should I try e-cigarettes?

    Giving up smoking is the best thing you can do for your health. In general, stopping in one step (sometimes called 'abrupt quitting') offers you the best chance of staying smoke free. But if you’re struggling to do this, nicotine products can help you cut down, stop and importantly reduce the harm that smoking can cause. NICE supports licensed nicotine containing products such as gum, sprays and patches, which have been shown to help people quit. There are also smoking cessation services that can offer the support you need to stop smoking for good.

    If you decide to use e-cigarettes, it’s important to be aware that their effectiveness, safety and quality cannot be assured as yet. However, they are likely to be less harmful than cigarettes.

    You can read more and keep up to date with developments on regulating e-cigarettes on the MHRA’s website and the European Commission’s website.

  • Resources Resources

    Further information


    • Electronic cigarettes. Action on Smoking and Health (ASH)., published March 2014
    • Tobacco: harm-reduction approaches to smoking. National Institute for Health and Care Excellence (NICE), June 2013.
    • Nicotine containing products. Medicines and Healthcare Products Regulatory Agency., published 31st December 2013
    • E-cigarettes myth buster. European Commission., published 26 February 2014
    • Revision of the Tobacco Products Directive. European Commission., accessed 26 March 2013
    • Trtchounian A, Talbot P. Electronic nicotine delivery systems: is there a need for regulation? Tob Control 2011; 20:47–52. doi:10.1136/tc.2010.037259
    • Smoking cessation services: guidance. National Institute for Health and Care Excellence (NICE), February 2008.
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