Smoking Cessation: Prescription of E-cigarettes

Tuesday 2nd November 2021 Lords Chamber

Commons Urgent Question

The following Answer to an Urgent Question was given in the House of Commons on Monday 1 November.

“Covid has been a stark reminder that our underlying health and lifestyle determine how resilient we are to new risks and diseases. Covid did not strike evenly. People who smoked, were overweight, or struggled with chronic conditions fared worse. We are determined to level up health for a society that is not just healthier but fairer.

Smoking rates are down to 13.9%—the lowest on record—but tobacco continues to account for the biggest share of avoidable premature death in this country. It contributes half the difference in life expectancy between richest and poorest. Action against smoking is therefore at the heart of our mission to level up. Our goal is for England to be smoke free by 2030. To support this goal, we have an ambitious tobacco control plan, and will soon publish a new plan with an even sharper focus on tackling health disparities. Our new Office for Health Improvement and Disparities will support this vital mission nationally and locally.

Ministers from my department have long been clear, including in this place, that we support e-cigarettes as part of a gateway process for stopping smoking. Last week, the Medicines and Healthcare products Regulatory Agency updated its guidance on licensing as medicines e-cigarettes and other inhaled nicotine-containing products. The updated guidance sets out the steps needed to license an e-cigarette as a medicinal product, as well as quality, safety and efficacy standards.

Having e-cigarettes as a licensed product will enable them to be available on prescription, which I know will give health professionals greater confidence in their use. I am happy to update the House further when we are closer to having a licensed product. We will continue to consider e-cigarettes, and indeed any other innovative ways of improving the health of our nation, so that we can end disparities and level up to a healthier and fairer country.”

15:17

[Baroness Thornton (Lab)]

My Lords, the MHRA in 2017 said that it was going to ensure that,

“the route to medicinal regulation for e-cigarette products is fit for purpose, so that a range of safe and effective products can potentially be made available for NHS prescription.”

Over four years later, it has now just updated the guidance; there are still no products for prescription. The new guidance only says that the MHRA will support companies to get medicinal licences, and it could take another two years before we see people able to access e-cigarettes for prescription. That seems a very long time indeed. I hope that the DHSC will chase up the MHRA and facilitate this to happen more quickly than it is at the moment.

My second point concerns other tobacco products, including Snus and heat-not-burn tobacco products. Will the Minister confirm, for the avoidance of doubt, that the MHRA’s guidance refers only to e-cigarettes, and the Government are not considering other options involving tobacco products?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

I thank the noble Baroness for her questions. It is really important that we look at how we can reduce smoking in this country. The point about the e-cigarettes and the MHRA’s wish to licence products is that it wants to move smokers on to a pathway away from smoking cigarettes and on to e-cigarettes since they are seen as a safer option. It does not want to encourage people to smoke e-cigarettes, but to move them off cigarettes and on to e-cigarettes. At the moment, the MHRA does not feel comfortable licencing any of the existing products, and therefore wants to have conversations with manufacturers and others to see if there can be a product produced that it feels comfortable licencing so that it can be available for prescription. Moreover, by having that MHRA stamp of approval, it may well encourage others to buy it over the counter.

[Baroness Walmsley (LD)]

My Lords, it is three years since the change of rules that allowed medicinal cannabis to be available on NHS prescription, but there have been only three NHS prescriptions in that time. How confident is the Minister that smokers will be able to benefit from regulatory change when children with intractable epilepsy cannot? Do not both of these situations require further training for doctors to ensure their confidence to prescribe?

[Lord Kamall (Con)]

The hope is that we will be able to move current cigarette smokers to e-cigarettes, but I am afraid that I will have to write to the noble Baroness on her specific question.

[Earl Cathcart (Con)]

My Lords, I used to smoke over 50 cigarettes a day but, in 2014, I transferred to using e-cigarettes. I have not had a puff of tobacco since, and I find that my health and breathing are so much better now. This is surely a very good thing; it should be encouraged.

[Lord Kamall (Con)]

I thank my noble friend. He is indeed looking incredibly healthy and is a living advert for the path away from cigarettes to e-cigarettes. Noble Lords across the House are keen for this to happen. The MHRA has advised that it is 18 to 20 months away from approving a medicinal licence for e-cigarettes in the UK. However, I take the points of many noble Lords; I will push the MHRA, and I hope that they will too.

[Lord Patel (CB)]

My Lords, it is correct that only MHRA-approved e-cigarettes should be available on prescription. The reason for that is that many e-cigarettes currently sold on the market contain dangerous products; there have been reports of deaths occurring due to lung complications. So is it not right that the sale of e-cigarettes not approved by the MHRA should be banned?

[Lord Kamall (Con)]

E-cigarettes are a pathway out of cigarettes; these e-cigarette products exist now, even before we have one approved via the MHRA. It is important not to ban existing products because we need to make sure that people move along that pathway. The hope is that, once there is an MHRA-licensed product, people will be encouraged to buy it, both on prescription and over the counter.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister has mentioned the MHRA a considerable number of times, which is a great tribute to the work that it is doing. Can he tell us why it is facing budget cuts at a time when we need our independent regulator in this country to be doing all it can to regulate and encourage new innovative products, including pharmaceutical products, to the market?

[Lord Kamall (Con)]

As the noble Lord will know, some of the issues are related to leaving the EU, but it is interesting to learn from conversations with the MHRA that it is hugely excited about its ability to be more global in its outlook and to be a centre of expertise that many people across the world will want to learn from. With respect to international engagement, as well as making sure that it updates its guidelines to take account of medical technology there will be ongoing reorganisation and changes, and it hopes to be fit for purpose for many years to come.

[Lord Naseby (Con)]

My Lords, is the Minister aware that, as I understand it, there is a problem with the MHRA budget? This is important work. Furthermore, is it not a fact that the industry itself is supporting this work?

[Lord Kamall (Con)]

It is very important that we get the MHRA to approve these e-cigarette products. The MHRA is seen as a jewel, to which many experts from other countries look. One of my roles is international health diplomacy, and many people I talk to from other countries are very impressed with the work of both NICE and the MHRA. We can use that in our international health diplomacy.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, does the noble Lord believe that encouraging and giving the green light to e-cigarettes may well send a signal to youngsters who might think it is cool to start inhaling foreign gases into lungs which are not designed for them?

[Lord Kamall (Con)]

The noble Lord raises a very important concern about e-cigarettes. From conversations I have had with the MHRA and others, I understand that, at the moment, there is no evidence in the UK that young non-smokers are adopting or taking up smoking e-cigarettes. Most users of e-cigarettes use them as a pathway away from cigarettes.

[Lord Vaux of Harrowden (CB)]

My Lords, to follow up on that point, e-cigarettes are sold using flavours such as dragon berry, bubblegum, gummy bears and unicorn juice, in colourful packaging with cartoon characters—all clearly aimed at children. If we are considering licensing e-cigarettes, could this also be an opportunity to tighten up the packaging and branding rules to ensure that that stops?

[Lord Kamall (Con)]

There are a number of factors that will be looked at when licensing e-cigarettes, including incentives to customers—flavours, et cetera—to take up these products. I will have a discussion with the MHRA to ask that question in more detail, if the noble Lord would like to write to me.

[Lord Rennard (LD)]

My Lords, e-cigarettes are undoubtedly part of the way forward to achieving a smoke-free Britain. But why has it taken so long to get to this point and to begin fulfilling what was in the 2017 tobacco control plan and to adopt the recommendations of the 2018 Select Committee, chaired by Sir Norman Lamb, which highlighted the significant benefits of having medicinally licensed e-cigarettes which could be prescribed? How do we know that licensing will now proceed in a timely manner?

[Lord Kamall (Con)]

The MHRA has been quite clear that it wants to be in a position to license a product as soon as possible—it says 18 to 24 months. Noble Lords may well want to push the MHRA on that, and that is part of your Lordships’ role. But it is important that we make sure that, when we license a product, both consumers and public health experts can have faith in it.

[Lord Cormack (Con)]

My Lords, I understand from my noble friend Lord Patel that some of the devices and products to which he referred do not bear health warnings on their packaging. Why is that so? Surely that at least should be on all of them.

[Lord Kamall (Con)]

I thank my noble friend for pointing that out, and I will investigate. Not being a user of e-cigarettes or cigarettes, or of any sort of narcotics or alcohol, I am afraid that I am not really an expert myself. I will look into that and write to my noble friend.

[Baroness Finlay of Llandaff (CB)]

Can the Minister confirm that the nicotine levels will be looked at, given that the nicotine level in some e-cigarette products is very high and that nicotine is the addictive substance both in cigarettes and in the continued use of e-cigarettes? The commercial incentive for tobacco producers to produce flavoured, palatable and highly addictive products should not be pandered to.

[Lord Kamall (Con)]

The noble Baroness raises an important point about nicotine itself being a very addictive substance. I am sure that the MHRA will be looking at the guidance, but if the noble Baroness would like to write to me, I can confirm that.