Is nicotine itself harmful?

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2 January
13:15
12 January
17:12

How one frames the question here will frame the answer. Is nicotine completely safe? No, but then nothing is completely safe. The function of nicotine in a tobacco plant is as an insecticide, so in relatively large doses it’s harmful, however it’s not harmful in the doses you get in cigarettes, in nicotine replacement therapy [nicotine patches, gum, lozenges etc] and in electronic cigarettes

So the short answer is no, but that doesn’t give the entire story. The harmful thing about nicotine is that it’s addictive and keeps people smoking. Most of the people who use e-cigarettes are smoking as well – they’re dual users, either for periods of temporary abstinence or in an attempt to quit – but they will often gravitate towards quitting, because using an e-cigarette is far more pleasant, less harmful and cheaper than smoking. 

The current evidence review both from Public Health England and the Royal College of Physicians is that e-cigarettes are at least 95 percent less harmful than smoking. If you ask what the harmful bit is in e-cigarettes, the answer is that there isn’t any – talking on the telephone’s not completely safe, so it’s incorrect to say that anything’s safe. What we need to say is how much safer using e-cigarettes is than smoking. Studies have followed users of nicotine replacement therapies for five years or more and found no evidence of health implications whatsoever of long-term nicotine use, so it’s likely that there won’t be any long-term health implications of e-cigarette use. 

"Tar causes cancer and carbon monoxide is implicated in coronary heart disease and lung disorders as well, but e-cigarettes simply heat a solution that gives a vapour."

In e-cigarettes you’ve got propylene glycol, nicotine and food flavourings, so there’s no reason to suspect that there is anything that’s going to be harmful, and the key thing is that there’s no combustion. When you burn tobacco there’s estimated to be 4,000-plus chemicals, about 60 of which are carcinogens, and you’ve got carbon monoxide. Tar causes cancer and carbon monoxide is implicated in coronary heart disease and lung disorders as well, but e-cigarettes simply heat a solution that gives a vapour.

A report by the US Surgeon General in December 2016 spoke of e-cigarettes as a danger but it was largely lambasted by academics. There are ideological differences in how to deal with public health and how to achieve prevention and harm reduction. Because of our experience in this country going back 30 or 40 years with HIV, I think we’re more open to harm reduction. So in some people’s ideal, puritanical world everyone will be nicotine-free as well but in other people’s view nicotine is a recreational drug that doesn’t look to have any health implications that we know about. 

"Any time I see someone in the street using an e-cigarette I don’t think “It would be better if they got off that,” I think “There’s another person not smoking.” 

And it kind of misses the point, anyway. What we have with e-cigarettes is that they give something to smokers that nicotine replacement therapy hasn’t even come close to – they’re a public health phenomenon, popular with smokers in ways that nicotine gum and lozenges and patches can only dream of. When you talk to smokers, they say the experience is very similar, you’ve got the vapour to exhale, but also all these wonderful flavours and it’s not harmful to their health and it’s cheaper. Any time I see someone in the street using an e-cigarette I don’t think “It would be better if they got off that,” I think “There’s another person not smoking.” 

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