Electronic cigarettes: - PowerPoint Presentation

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Electronic cigarettes: Community Pharmacists’ Perception

Ana Marques Gomes Mpharm, MRPharmS

Shereen Nabhani Gebara, PharmD, BCOPSlide2

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-refillsSlide3

E-cigarettes

Ruyan

Ltd.

(

Mr

. Hon Lik, Co-founder) introduced it in China in 2004 as an aid for smoking cessation and replacement.

Ruyan America's Chairman

,

Mr. Hon Lik

“I used to be a big smoker myself and knowing the harmful effects associated with it very well, I told myself I couldn’t go on 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 literally means "Resembling smoking".Slide4

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.

DesignSlide5

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-electronic-cigarettes [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.RegulationsSlide6

Grana,

et al.

E-Cigarettes

: A Scientific Review

Based

on analysis of 82 studiesNicotine and toxins, including carcinogens, were identified in the exhaled aerosolThe nicotine content of the cartridge e-liquid revealed poor concordance of labelled contentMajor injuries have resulted from e-cigarette use, including explosions and firesCytotoxicity 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

Why regulation?Slide7

Bullen

C,

et al

.

RCT Investigating whether e-cigs are more effective than nicotine patches or

placebo e-cigarettes at helping smokers to quitn= 657 Verified abstinence at 6 months after quit dateNicotine e-cigarettes group (7.3%) vs Patches (5.8%), p-value= 0.46Placebo 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: 1629-37What is the evidence?Slide8

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 onlyno aid Higher self reported abstinence with e-cigarette

Brown J, et al. Addiction 2014 Accepted Article What is the evidence?Slide9

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 patientsSlide10

Methods

Self-completion questionnaire was designed

Drop off-pick up method

Data was entered and

analysed

using MS Excel. Slide11

RESULTS & DISCUSSIONSlide12

Sample Profile

92/154 participants: 66

% male; 34% female

11% of

sample

from

big chains; the rest is small, independent

49% - Full time

37% - Locum5% - Part time5% Manager3% - SuperintendentSlide13

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.Slide14

Adverse effects

≈ 20% of our sample came across side effects from e-cigarettes reported by patients Slide15

Perception on use

Ranking

:

Smoking Cessation Aid

Relapse prevention

Public use (‘dual use’)

Social, recreational use Slide16

S

afety

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 usersE-cigarettes do not cause any side effectsSlide17
Slide18

Comparative EffectivenessSlide19

Perception of regulations

97% of pharmacists are in support of the regulations announced for 2016

Major benefits from regulations w

ere ranked as:

Reassurance of safety for users

Regulated as an established NRT

Increase profit for retail pharmacyPrevent the possibility of misuseSlide20

Stricter regulations are required for:Slide21

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

counsellingSlide22

Training content

Safety

Dosage instructions

Adverse events

Implementation into smoking cessation patient care pathway Slide23

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

Slide24

Acknowledgements

Research Group

Dr Gianpiero Calabrese

Dr Reem Kayyali

Dr Steve Barton

Zohra YasminSlide25

Thank you for your attention