While the World Cup is currently taking place, the Scottish Government has marked the feast of sport taking place in Russia by scoring something of an own goal.

This week saw the publication of the Scottish tobacco control plan (TCP) led by Minister for Public Health and Sport, Aileen Campbell and – while there are many friendly references to e-cigarettes contained within it – it is somewhat schizophrenic when it comes to its approach to harm reduction overall.

NHS Health Scotland, which is referenced throughout the government’s plan, has come a long way with its position on e-cigarettes, from a deep mistrust and recommendations of vaping bans in all areas in 2014, to its current welcoming – if over-cautious – stance on the products.

The TCP document recognised that many smokers are now using e-cigarettes to cut down their combustible tobacco use or to quit entirely and boasts that stop smoking services are e-cigarette friendly. It even pledges “to develop guidance for health professionals and other relevant service providers so that they can offer basic advice on e-cigarette use as part of their support for smokers who choose to make quit attempts using e-cigarettes”.

This is all to be welcomed even though we feel that health professionals are not the best source of guidance on vaping products and that consumers should be consulted far more than we currently are. We have found that some stop smoking services are either unwilling or unable to support smokers who express an interest in e-cigarettes other than to nudge them down the path of licensed pharmaceutical products. For whatever reason, if the Scottish government truly wishes to reach a smoke-free future, they should be utilising the skills and knowledge of vaping consumers instead of placing faith in organisations who have scant understanding of the products.  

We also welcome moves to allow use of e-cigarettes in prisons and mental health settings. It is a no-brainer when there is no valid reason to ban use of vapour products which carry no health risk to others. Indeed, they should be seen as a positive benefit in potential tinder box institutions where a large majority smoke but are being told they will not be permitted to do so in the future. We understand a need for strict control on devices that can be sold in such a febrile environment, but it is sensible for the Scottish government to recognise that the benefits of allowing vaping can more than compensate for the potential risks.

However, these mildly promising changes are undermined by a prevailing caution towards e-cigarettes which borders on paranoia. Nothing illustrates this more than the TCP’s stated intention to “consult on the detail of restricting domestic advertising and promotion of e-cigarettes in law”. Currently, e-cigarette manufacturers can advertise their products domestically where the same is not permitted for combustible products. This is a powerful incentive for smokers to switch to safer alternatives which the Scottish government, inexplicably, seems to want to eradicate.

We are concerned that the NNA has worked hard with NHS Greater Glasgow and Clyde (NHSGGC) over the years in overturning vaping bans in hospital grounds. It would be helpful if this were to be extended to all Scottish hospitals following the lead that NHSGGC were brave enough to make having listened to the evidence.

However, the Scottish TCP seems to want to make a debate of something which should be a given. The plan pledges to “work with health boards and integration boards to try to reach a consensus on whether vaping should or should not be allowed on hospital grounds through a consistent, national approach”. There should be no debate about this. If the Scottish government is serious about reducing smoking, a clear incentive should be evident, so the only acceptable policy is for health boards to emphasise the difference between vaping and smoking by allowing e-cigarette use wherever possible.

We are also disturbed that the Scottish Government implies changes in regulation towards non-nicotine e-liquids and other harm reduction products such as heated tobacco which, although research is still ongoing, were described as carrying a fraction of the risk of smoking by the FSA’s Committee on Toxicity in December.

This all appears linked to the suspicion that NHS Health Scotland has about recreational use of nicotine as expressed in their latest literature where they state that “e-cigarettes are useful for public health and health service purposes only as a potential route towards stopping smoking”. This is an idealistic view since the market for nicotine – as opposed to smoking – will never just vanish, so a more enlightened tone would be far more beneficial to the public’s health in Scotland.

The TCP places great emphasis on e-cigarettes being a health product rather than a consumer product which smokers can enjoy over and above combustible tobacco. The government’s report details the massive organic rise in e-cigarette use – which is simply because people enjoy using them – but then speaks of an aspiration to see the development of a medically-licensed vaping product. This entirely misunderstands the subject matter.

Smokers are not ill, they do not require a medicine. The entire reason for the success of e-cigarettes is because they are pleasurable. That is what is driving the huge boon to public health in Scotland as well as the UK in general. Scottish authorities can never begin to comprehend e-cigarette use if it refuses to understand it is because they are not medical products. The reason that Scottish stop smoking services are e-cigarette friendly now is not because of the success of tobacco control policies, but because they have had to react to where consumers were going without their government’s help. Rather than try to stop that, we should be heartily encouraging it. Less caution; more enthusiasm.

As NNA lead in Scotland, I will be writing to Aileen Campbell to express our concerns on this TCP, as it is hopelessly confused. We will also be responding as an organisation to any consultations which arise and will be objecting strongly to any further restrictions on products which have driven an unprecedented decline in smoking prevalence not just in Scotland, but the UK and also most of the western world.

It is well past time that this antiquated and blinkered view of harm reduction was altered so that the reasons for success of risk reduced products were recognised and – instead of booting the harm reduction ball into the back of our own net – we began passing it up the other end of the pitch instead.

Andy Morrison

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