By Darush Attar-Zadeh

The number of smokers in the UK may be falling, but smoking remains one of the biggest causes of death and related illnesses in British people. Reducing the prevalence of smoking will save the NHS up to £890 million a year.

Studies show that a person is more likely to quit smoking with NHS support and pharmacotherapies, including NRT, varenicline, buproprion and e-cigarettes/vapes. Research also shows that pharmacotherapy and counselling through pharmacy can increase smoking cessation success and thatyou are four times more likely to quit with expert support. With NHS funding in decline, pharmacists play a vital role in offering readily accessible patient education and guidance. 

Pharmacists can create a point of difference by tailoring advice to the individual no matter whether they are using NRT or vapes/e-cigarettes, or a combination of these aids. 

Explore the options

Vapes/e-cigarettes help people cease or reduce smoking tobacco. These products are under ongoing review and we do not fully know the long-term health impact of their consumption. They’re widely viewed by the key UK health bodies as a positive option and not a magic-bullet solution. 

The Tobacco Products Directive, which came into force in 2014, has banned certain ingredients, including colourings, caffeine and tourine, from vapes. Some flavours, such as cinnamon, have also been removed from the vaping list due to their harmful effects. For many, the switch to vaping/e-cigarettes addresses the hand-to-mouth sensorial habit that they associate with tobacco smoking. Smokers’ expectations, however, need to be managed because the nicotine hit will not be as rapid as smoking tobacco. 

With NHS funding in decline, pharmacists play a vital role in offering readily accessible patient education and guidance

NRT products have been available for many years and have undergone rigorous regulatory safety and clinical testing to become licensed products, so they are now considered a safer option and less harmful overall. They contain varying strengths of nicotine and pharmacists are in a great position to advise on strength, dosing, treatment duration and technique. The patch is a long-acting product and can release nicotine for up to 24 hours. The lozenges, gum, microtabs, inhalator and sprays are shorter-acting products.

NRT, vapes/e-cigarettes all offer a cleaner, therapeutic form of nicotine compared to tobacco. Most importantly, when compared to smoking tobacco, the health risks are negligible and worth taking either alone, or as an adjunct to NRT, when considered responsibly and logically.

The role of NRT in pharmacy:

• Take ownership as the medical expert (vape shops wouldn’t generally have clinical staff who know about potential drug interactions with smoking) and advise on managing long-term conditions and the impact of nicotine withdrawal. Reassure and give the patient confidence. Find out their motivations to quit. Help them work out their goals to ensure they have a high level of commitment during a smoke-free journey and help prevent relapse
• Offer very brief advice routinely to patients
• Highlight that it’s not the nicotine that kills, but the tar and other poisonous chemicals that arise from combustion
• Educate patients on the rigorous safety and efficacy testing of NRT products, but do not discourage them from vaping if this is of interest to them. We should be cautiously positive and suggest it as one of the available effective stop smoking aids. About half of people who vape are dual users (they are still smoking). This is where NRT can support the shift to come off cigarettes entirely
• Address underdosing. Recommend NRT products to sit alongside their vaping consumption in order to help them to reach their cleaner form of nicotine dosage in order to fully quit. For highly dependent users, who we are yet to fully tackle getting help to quit smoking, a combination of NRT alongside vapes/e-cigarettes could help them stop smoking
• Signpost patients to local stop smoking services and the support available. In pharmacy, offer carbon monoxide readings and offer NRT over the counter to supplement the vape they may be taking.

Support from the pharmacy and understanding individual patient needs and triggers can go a long way in supporting smokers to quit. Vapes, e-cigarettes and NRT all have a place in the market, but it’s key to identify what’s appropriate for each patient.