Harm Reduction

Nicotine is the addictive element of tobacco but it is the tar and other toxins in tobacco smoke, not nicotine, that cause most of the harm. This section focuses on non-tobacco nicotine products such as nicotine replacement therapy and electronic cigarettes. For information on attempts to reduce the harm from tobacco products see the Tobacco Products Regulation  page.

Tobacco harm reduction within a regulated framework, encouraging smokers to use non-tobacco nicotine containing products, is supported by the UK government, most of the public health community, the MHRA and NICE (For information on the use of nicotine replacement therapy as an aid to smoking cessation see: Smoking cessation & treatment page).

Since 20th May 2016 electronic cigarettes are now regulated by the revised EU Tobacco Products Directive.  Exceptions will be where therapeutic claims are made or products contain over 20 mg/ml of nicotine, when they will require medicines authorisation under Directive 2001/83/EC. For more details about the two systems of regulation see the ASH Briefing: The impact of the introduction of the EU Tobacco Products Directive on e-cigarette regulation in the UK – listed below.

The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for assessing the safety, quality and efficacy of medicines, and authorising their sale or supply in the UK.  Companies wishing to bring to market a device containing nicotine as a medicine must apply to the MHRA for a licence.

The National Institute for Health and Care Excellence (NICE) issues evidence-based guidance on the most effective ways to prevent, diagnose and treat disease and ill health. NICE has published guidance on tobacco harm reduction. While recognising that quitting smoking is always the best option for smokers, the NICE guidance supports the use of licensed nicotine containing products (NCPs) to help smokers not currently able to quit to cut down and as a substitute for smoking, where necessary indefinitely.  Products containing tobacco are not covered by this guidance.

Public Health England (PHE) has published an independent evidence review on electronic cigarettes which concluded that the devices are significantly less harmful than smoking. The review also found no evidence that electronic cigarettes act as a route into smoking for children or non-smokers. In addition to the evidence review PHE has published its position on electronic cigarettes. PHE and other public health organisations, including ASH, have issued a consensus statement on e-cigarettes.

ASH Briefing on electronic cigarettes

Electronic cigarettes are marketed as a cheaper, safer alternative to conventional cigarettes. As they do not produce smoke, research suggests that electronic cigarettes are relatively harmless in comparison with smoking. This briefing reviews the safety of e-cigarettes and how effective they are as an aid to stopping smoking. ASH briefing on electronic cigarettes

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ASH response to CAP consultation on advertising of e-cigarettes

ASH’s response to a consultation on the updating of the CAP’s advertising code for e-cigarettes following implementation of the EU Tobacco Products Directive in the UK.   Oct. 2016

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The impact of the EU Tobacco Products Directive on e-cigarette regulation in the UK

This briefing examines the impact of the EU Tobacco Products Directive on e-cigarette regulation in the UK.

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ASH response to MHRA consultation on e-cigarette fees

ASH’s response to MHRA proposals on electronic cigarette fees.

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ASH response to DH consultation on proposed implementation of advertising rules for e-cigarettes

ASH response to a Department of Health consultation on proposed implementation of advertising rules for e-cigarettes.

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Will you permit or prohibit e-cigarette use on your premises?

This briefing has been produced by ASH and CIEH following approaches by organisations considering permitting or prohibiting the use of electronic cigarettes by their staff, clients or customers, or generally on their premises.  

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ASH/NCSCT letter re prescribing nicotine containing products

A joint letter from ASH and NCSCT to local councils regarding the prescribing of nicotine-containing products whilst ensuring compliance with Article 5.3 of the FCTC.        

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Electronic cigarettes: A review of their efficacy and potential for harm reduction

Presentation given by Dr Maciej Goniewicz, Queen Mary University of London, at an APPG meeting on harm reduction.

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ASH response to consultation on age of sale for electronic cigarettes

ASH response to a Department of Health consultation on age of sale for electronic cigarettes.

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Discussion Paper on harm reduction and electronic cigarettes

A discussion paper produced by ASH for Smoking Still Kills conferences in Autumn 2014.

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Developing an organisational approach to the use of electronic cigarettes on your premises

This document provides advice to those thinking of developing a policy on the use of electronic cigarettes in the workplace. It is based on feedback from work with seven local authorities undertaken in partnership with the Chartered Institute of Environmental Health.

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Foster care, adoption and electronic cigarettes

A joint briefing from ASH and the Fostering Network.

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