The guidance reflects a broader shift towards tobacco harm reduction, recognising that while nicotine products may not be entirely risk-free, the overwhelming burden of disease comes from inhaling the toxic chemicals created by burning tobacco rather than from nicotine itself. In the United States alone, cigarette smoking is responsible for more than 480,000 deaths each year, while globally tobacco use claims more than eight million lives annually, according to World Health Organization data.

Clinicians need practical guidance

Healthcare providers are rightly encouraged to discuss the full range of evidence-based options, including nicotine replacement therapies such as patches, gum, lozenges and inhalers, prescription medications including varenicline and bupropion, behavioural counselling and, where appropriate, nicotine-containing e-cigarettes. Importantly, the guidance stresses that these recommendations apply specifically to adults who currently smoke cigarettes and are not intended to encourage nicotine use among people who have never smoked or among young people.

Why do smokers find vaping effective?

Traditional cessation medications primarily address nicotine withdrawal, while vapes also replicate many of the behavioural aspects of smoking. For long-term smokers, the familiar hand-to-mouth movement, inhalation, visible aerosol and rapid nicotine delivery help satisfy both the physical dependence and the behavioural rituals associated with cigarette use. This combination may explain why many smokers who have been unable to quit using patches or gum successfully transition away from combustible cigarettes after switching to vaping.

Yet not all medical organisations share the same position. Some US health organisations continue recommending only FDA-approved cessation medications, citing concerns about the long-term effects of vaping and the presence of residual toxic compounds in aerosol.

Helping smokers make informed choices

Ultimately, the new recommendations do not position vaping as a universal solution or a replacement for established cessation therapies. Rather, they acknowledge that smokers differ, and that successful quitting often requires multiple approaches.

For clinicians, the message is straightforward: provide patients with accurate, balanced information about the benefits and risks of every evidence-based option.

The Cost of Bad Science: How Flawed Studies And Anti-Nicotine Bias Are Shaping European Tobacco Policy

Source link

The debate on vaping policy in the United Kingdom is at a critical juncture. A motion to expand indoor smoking restrictions — also called “smoking bans” — to include vaping has, of course, sparked outrage from harm reduction advocates, public health experts and business leaders. Emerging research indicates that restricting access to certain vaping products has unintended consequences, including a potential resurgence in smoking.

Inaccurately lumping vaping with smoking

The government’s proposal would treat vaping in the same way as smoking, across indoor public spaces — workplaces, pubs and clubs, even specialist vape shops. This, critics say, is a fundamental misunderstanding of these products’ risk profile. In fact, public health messaging has been grappling with a fundamental problem for ages: relative risk. Combustible cigarettes continue to be one of the largest preventable causes of death, yet vaping is broadly recognised as a far lower risk option for adult smokers. That distinction disappears when both are regulated the same way.

Experts say the proposed restriction would contribute to a misconception gaining ground among the public — that vaping is just as dangerous as smoking, a belief that has been associated with slower switching rates among smokers.
It is also important to note that several independent assessments — including one by Public Health England (PHE) — have concluded that second-hand vapour poses little risk to those around the user.” This begs a critical question: In the face of very low exposure risk, what is the scientific basis behind expanding smoke-free laws?

Encouraging former smokers to revert to smoking?

The proposal arrives at a moment when advances in driving down smoking rates have been closely linked with greatly reducing accessibility to lower-risk alternatives. A grassroots campaign led by the New Nicotine Alliance reiterates that limiting where people can use vape products may prevent smokers from switching — or, worse still, drive former smokers back to cigarettes. This concern is not theoretical. Research from the University of Bristol, published in PLOS Global Public Health, suggests that such a policy restricting access to certain vaping products could lead to adverse outcomes. And some young adult vapers say they might smoke more cigarettes or relapse to smoking as a result of the UK’s disposable vape ban.

Although many participants reported they would switch to reusable devices, the findings point to an important risk: When barriers are raised for safer alternatives, not all users make a smooth transition. Some default to the most available, even if that is the most damaging choice. For harm reduction advocates, this highlights a key principle: the demand for nicotine does not evaporate when products are banned. On the contrary, behaviour is modified — at times in ways that thwart public health objectives.

Economic costs and no health gains

Besides serious public health concerns and scarce evidence that such restrictions would offer measurable health benefits, the proposed ban also has serious economic implications.

Besides serious public health concerns and scarce evidence that such restrictions would offer measurable health benefits, the proposed ban also has serious economic implications. The government’s own impact assessment estimates businesses could face costs of up to £532 million. Hospitality venues, in particular, may take a hit. Many already regulate vaping through internal policies that more closely serve their customers. A broad legal ban would eliminate that flexibility and create new compliance burdens.

Additionally, lessons from other regulatory encroachments indicate that overly restrictive policies can create parallel, illegal markets. If legal access is limited, informal supply chains tend to grow to meet demand. The Bristol study hinted at this dynamic, too, with some participants predicting that restrictions might have the opposite effect, driving underground trade in prohibited products. Whereas some thought that enforcing the law could further reduce illegal sales, even this ambiguity highlights how complex consumers’ behaviour tends to be. At the same time, policies that limit the availability or convenience of vaping may inadvertently advantage cigarettes, which are widely available. But it also creates a paradox: the most damaging product is often the one that’s easiest to get and use.

A significant difference in risk that is not being considered

Policies that do not take this gradient seriously risk oversimplifying a problem and potentially making it more difficult to reduce deaths from smoking-related disease. The new Nicotine Alliance’s Save Vaping campaign is calling on policymakers, businesses and the public to get involved in the consultation process. But at stake is not just a particular policy, but something deeper — the overall approach to tobacco control in the UK.

Regulation should be risk-proportionate, evidence-based, and in keeping with the principles of harm reduction. This means acknowledging the role of vaping as a smoking cessation tool through smoking minimisation policies and keeping access to safer alternatives for adult smokers.

It’s time to align policy with science and reality

The trick for policymakers is not to downplay risk, but to put it in its proper perspective. While treating all nicotine products as if they posed the same risks may seem precautionary, it may also have unintended consequences that ultimately kill people.

The UK is at a turning point regarding nicotine regulation. On one side is an increasing body of scientific data supporting harm reduction. On the other hand, a policy approach risks conflating fundamentally disparate products. If the aim is to mitigate smoking-related harm, then access to less hazardous substitutes must continue to be an important part of any strategy.

Source link

New guidelines around THC levels, dosages, and eligibility, aim to bring more clarity and consistency to the practice of prescribing cannabis-based medicines in the UK. 

Almost seven years since medical cannabis was legalised in the UK, around 180 specialist consultants are now actively prescribing. But almost all of this is done through private clinics, and there are currently no mandated training requirements for clinicians who wish to prescribe cannabis-based medicines. 

With over 40 clinics now prescribing these products – but only around half registered with the Care Quality Commission – doctors have reported significant variations in practice throughout the UK.

In its annual report, the CQC also raised a number of concerns about some of the prescribing practices at private clinics, warning of gaps in oversight, clinical justification, and compliance with advertising rules.

It comes following the publication of figures which show a 130% increase in the number of private prescriptions between 2023-2024, with industry sources suggesting around 75,000 patients are now accessing these treatments. 

The concerns have led to calls for more robust and standardised guidelines around prescribing practices to ensure patients are receiving the best standard of care, and that clinicians are confident they are prescribing compliantly. 

In its updated Good Practice Guidelines, the Medical Cannabis Clinicians Society sets out the responsibilities of prescribers and providers, as well as offering recommendations around dosing, outcome measures, and the use of flower and oil-based products.

This includes a recommendation that any prescription of more than 2g of flower per day, or any product containing THC levels over 25%, should be subject to a peer approval process.

“Such doses should not normally be prescribed initially but built up to slowly, with careful documentation of the effects,” the guidelines state. 

“It is not appropriate for a patient to demand a specific product. There always needs to be a discussion between the patient and the prescriber.”

The MCCS has also attempted to provide some clarity on which conditions qualify for treatment with medical cannabis, and what is meant by the requirement for patients to have tried two previous treatments – neither of which are stipulated in the legislation. 

Elsewhere, it is not recommended that producers use “recreational” strain names, such as ‘Girl Scout Cookie’ and ‘Gorilla Glue’ – which the MHRA has previously expressed concerns about – as they do not assist in the ‘acceptance of the medical value of the plant’. 

Clinicians are also advised to move away from a reliance on the terms ‘sativa’ and ‘indica’, as this is not a ‘clinical distinction’.

Prof Mike Barnes, chair of the MCCS, commented: “Sadly, although entirely legal, the NHS sector has failed to embrace this new medicine. There are no mandated training requirements for prescribers and the Medical Cannabis Clinicians Society (MCCS) is aware of significant variations in clinical practice.

“The aim of these guidelines is to help both prescribers and our patients access this valuable medicine in a safe and sensible manner.”

Prof Barnes, will discuss the Good Practice Guidelines in more detail at Cannabis Health Symposium on Tuesday 25 November, in a session designed to build prescriber confidence and empower healthcare professionals to enable patient access whilst upholding high standards of care and compliance. 

Source link