Marques Gomes & Nabhani-Gebara |
June 2014
Electronic cigarettes:
Community Pharmacists’ Perception
Ana Marques Gomes Mpharm, MRPharmS
Shereen Nabhani Gebara, PharmD, BCOP
Marques Gomes & Nabhani-Gebara| June 2014
Multidisciplinary research group
Collaboration between Pharmacists, Pharmaceutics
expert and Analytical Chemists
Currents projects include
Public perception study (Poster presentation)
Role of e-cigarettes in the patient care pathway
Analysis of content and distribution patterns of
e-cigarettes and e-refills
Marques Gomes & Nabhani-Gebara| June 2014
E-cigarettes
“I
used Ltd.
to (Mr.
be aHon
big Lik,
smoker
Ruyan
Comyself
knowing the
founder)and
introduced
it inharmful
China
effects
withsmoking
it very
in 2004associated
as an aid for
well,
I told and
myself
I couldn’t go on
cessation
replacement.
like that. I tried nicotine patches
but […] I missed the effect of the
sudden impact, the act of
smoking, the sensation of
smoking. So I started thinking of
a way to create vapor containing
nicotine, similar to cigarette
smoke but not as harmful for the
organism.”
Ruyan America's Chairman,
Mr. Hon Lik
Ruyan
literally
"Resembling smoking".
means
Marques Gomes & Nabhani-Gebara| June 2014
Design
40 years later
-http://www.thevapestore.com/pages/how-does-it-work
[Accessed on line in April 2014]
-Patent no. US3200819 A. Gilbert Herbert A. 17 Ago 1965.
Marques Gomes & Nabhani-Gebara| June 2014
Regulations
Over 2 million consumers now regularly use electronic cigarettes
In 2013, the MHRA announced they will be regulated by 2016
The Royal Pharmaceutical Society and The Chief Pharmaceutical
officers in the UK strongly supported the MHRA’s decision
The EU Parliament voted for a dual supply route: medicinal
products (if marketed as quitting aids) and tobacco products
-http://www.ash.org.uk/media-room/press-releases/:over-2-million-britons-now-regularly-use-electroniccigarettes [Accessed on line in May 2014]
-Sukkar E. PJ online (1 March 2014), 292, 223-4.
-Ridge KW, et al. Opinion/Letter section. PJ online (3 May 2014), 292, 473.
Marques Gomes & Nabhani-Gebara| June 2014
Why regulation?
Grana, et al.
E-Cigarettes: A Scientific Review
Based on analysis of 82 studies
Nicotine and toxins, including carcinogens, were identified in the
exhaled aerosol
The nicotine content of the cartridge e-liquid revealed poor
concordance of labelled content
Major injuries have resulted from e-cigarette use, including explosions
and fires
Cytotoxicity varied among products
There is little evidence of harmful effects in the short to medium term
from repeated exposure to propylene glycol
Grana, et al. Circulation 2014; 129: 1972-86
Marques Gomes & Nabhani-Gebara| June 2014
What is the evidence?
Bullen C, et al.
RCT Investigating whether e-cigs are more effective than nicotine
patches or placebo e-cigarettes at helping smokers to quit
n= 657
Verified abstinence at 6 months after quit date
Nicotine e-cigarettes group (7.3%) vs
Patches (5.8%), p-value= 0.46
Placebo e-cigarettes (4.1%), p-value= 0.44
Concluded that among smokers wanting to quit, nicotine e-cigarettes
might be as effective as patches for achieving cessation at 6 months.
Identified no difference in adverse events
Bullen C, et al. Lancet 2013; 382: 1629-37
Marques Gomes & Nabhani-Gebara| June 2014
What is the evidence?
Brown et al.
A large cross-sectional survey of the English population.
n= 5863 adults who had smoked within the previous 12 months and
made at least one quit attempt during that period with either
e-cigarette only
NRT bought OTC only
no aid
Higher self reported abstinence with e-cigarette
Brown J, et al. Addiction 2014 Accepted Article
Marques Gomes & Nabhani-Gebara| June 2014
Aim and objectives
The aim of this study was to gauge community pharmacists’
current experience and perceptions of electronic cigarettes
Objectives:
To evaluate the community pharmacists current experience
with e-cigarettes
To gauge their perception on safety and current use
To gauge their perception on the upcoming MHRA regulations
To find out their training needs to be able to counsel patients
Marques Gomes & Nabhani-Gebara| June 2014
Methods
Self-completion questionnaire was designed
Drop off-pick up method
Data was entered and analysed using MS Excel.
Marques Gomes & Nabhani-Gebara| June 2014
RESULTS & DISCUSSION
Marques Gomes & Nabhani-Gebara| June 2014
Sample Profile
92/154 participants: 66% male; 34% female
11% of sample from big chains; the rest is small, independent
49% - Full time
37% - Locum
5% - Part time
5% Manager
3% - Superintendent
Marques Gomes & Nabhani-Gebara| June 2014
Sample Profile
Number of patients currently enrolled on smoking cessation
services
73% of surveyed pharmacies sell e-cigarettes.
Of these only 3% of all e-cigarettes sales are nicotine-free.
Marques Gomes & Nabhani-Gebara| June 2014
Adverse effects
≈ 20% of our sample came across side effects from e-cigarettes
reported by patients
Marques Gomes & Nabhani-Gebara| June 2014
Perception on use
Ranking:
1. Smoking Cessation Aid
2. Relapse prevention
3. Public use (‘dual use’)
4. Social, recreational use
Marques Gomes & Nabhani-Gebara| June 2014
Safety and effectiveness
The design of e-cigarettes encourages smokers to give up
Nicotine delivery is more efficient with e-cigarettes than
NRTs
Manufacturing of e-cigarettes is unreliable
E-cigarettes are safe for users
E-cigarettes do not cause any side effects
Marques Gomes & Nabhani-Gebara| June 2014
100
Strongly Agree
Percentage of Pharmacists (%)
90
Agree
80
Neutral
70
Disagree
62
60
Strongly Disagree
52
52
52
50
46
42
41
38
40
37
35
32
30
27
27
19
20
9
10
2
8
2
1
8
10
12
13
9
9
2
14
13
1
15
7
1 1
0
1
0
E-Cigarettes are E-Cigarettes Do Not Manufacturing of EE-Cigarettes
E-Liquid in
The Design od E- Nicotine Delivery via
Safe to Inhale Cause Any Adverse
Cigarettes is
Encourage Smoking Cartridges May Be
Cigarettes
E-Cigarettes is More
Effects
Unreliable
in Non-Smokers
Toxic
Encourage Smokers Efficient than NRTs
to Give Up Smoking
Marques Gomes & Nabhani-Gebara| June 2014
Comparative Effectiveness
Marques Gomes & Nabhani-Gebara| June 2014
Perception of regulations
97% of pharmacists are in support of the regulations announced
for 2016
Major benefits from regulations were ranked as:
1. Reassurance of safety for users
2. Regulated as an established NRT
3. Increase profit for retail pharmacy
4. Prevent the possibility of misuse
Marques Gomes & Nabhani-Gebara| June 2014
Stricter regulations are required for:
Marques Gomes & Nabhani-Gebara| June 2014
Training needs
83% of the survey pharmacists said they felt ready to stock and
supply e-cigarettes under the new regulations.
There’s a need for training to support counselling
Marques Gomes & Nabhani-Gebara| June 2014
Training content
Safety
Dosage instructions
Adverse events
Implementation into smoking cessation patient care
pathway
Marques Gomes & Nabhani-Gebara| June 2014
Conclusion
Widespread availability in pharmacies
Regulations welcomed
E-cigarettes perceived as effective with a
potential role as a smoking cessation aid
Side-effects have been reported
Training needs
Marques Gomes & Nabhani-Gebara| June 2014
Acknowledgements
Research Group
Dr Gianpiero Calabrese
Dr Reem Kayyali
Dr Steve Barton
Zohra Yasmin
Marques Gomes & Nabhani-Gebara| June 2014
Thank you for your attention