Medicalisation, smoking and e-cigarettes: evidence and implications

Abstract

There is debate in the tobacco control literature about the value of a medical model in reducing smoking-related harm. The variety of medical treatments for smoking cessation has increased, health professionals are encouraged to use them to assist smoking cessation and tobacco dependence is being described as a 'chronic disease'. Some critics suggest that the medicalisation of smoking undermines the tobacco industry's responsibility for the harms of smoking. Others worry that it will lead smokers to deny personal responsibility for cessation, create beliefs in 'magic bullets' for smoking cessation, or erode smokers' confidence in their ability to quit. We argue that the medicalisation of smoking will have limited impact due to the emphasis on population-based interventions in tobacco control, the ambiguous place of nicotine among other drugs and the modest efficacy of current pharmacotherapies. These factors, as well as lay understandings of smoking that emphasise willpower, personal choice and responsibility, have contributed to the limited success of medical approaches to smoking cessation. While the rapid uptake of e-cigarettes in some countries has provided an option for those who reject medical treatments for smoking cessation, current regulatory developments could limit the potential of e-cigarettes to provide non-therapeutic nicotine for those who currently smoke tobacco.

Smokers’ Understandings of Addiction to Nicotine and Tobacco: A Systematic Review and Interpretive Synthesis of Quantitative and Qualitative Research

“…Historically, smoking has been more closely associated with a public health approach than an addiction medicine approach. 13 The increasing recommendation for health professionals to identify smokers and to provide them with pharmacological treatments such as NRT or prescription medications has medicalized smoking to some extent 14 . Also contributing to the medicalization of smoking is the increasing emphasis on the neurobiological aspects of smoking that create and maintain addiction.…”

Vaporised nicotine and tobacco harm reduction for addressing smoking among people living with HIV: A cross-sectional survey of Australian HIV health practitioners’ attitudes

“…Between 48% (Kandra et al, 2014) and 65% (Steinberg et al, 2015) of US physicians report being asked by patients about ecigarettes and such evidence has resulted in guidelines for practitioners responding to such requests (Mendelsohn and Gartner, 2015). Nonetheless, VNPs remain contentious (McNeill, 2016;Meernik and Goldstein, 2016) with opponents highlighting uncertainty around long-term safety, and expressing fear they will renormalise smoking, thus potentially encouraging uptake among young people (Morphett et al, 2016;van der Eijk, 2016).…”

Vape Club: Exploring Non-Profit Regulatory Models for the Supply of Vaporised Nicotine Products

“…They are regulated as tobacco, medicines, consumer products, or some combination of these [2]. Most Western democracies (e.g., UK, USA, Europe) follow a dual-track regulatory system, which allows VNPs to be sold either as consumer/tobacco products with some restrictions on sales and promotion, or as medicines if therapeutic claims are made [3]. …”

“…Theoretically, it is possible that a VNP may be approved as a therapeutic good at some point in the future. However, so far, there have only been two VNPs (one is an e-cigarette, the other is a pressurised aerosol device) that have received medicinal approval and neither of these were commercialised [3]. Most countries that have imposed medicines-only regulation on VNPs have changed or are in the process of changing their policy to dual-track regulation to allow VNPs to be sold either as a consumer product, or a therapeutic good if approved as a cessation aid.…”