E-cigarettes PCRS Position Statement

• Healthcare professionals should be prepared to help their patients to quit tobacco smoking and should be knowledgeable about e-cigarettes so they can answer questions if asked or be able to direct people to the most up to date source of information.  Pragmatic guidance on how healthcare professionals can support individuals in stopping tobacco smoking can be found in the PCRS Pragmatic Guide for Clinicians on Diagnosis and Management of Tobacco Dependency. 
• Patients should be offered the most effective and least harmful methods to support a quit attempt including very brief advice, behavioural support, pharmacological intervention (bupropion, varenicline) and nicotine replacement therapy (NRT, usually a combination of short- and long-acting options).
• For people wishing to support their quit attempt with NRT, short- and long-acting options should be discussed including gum, sprays, vapourless nicotine delivery systems, inhalators, microtabs and patches.
• People wishing to use an e-cigarette to support a quit attempt should be offered alternative options and supported in the choice they make.
• People currently using an e-cigarette to support a quit attempt and unwilling to use alternative NRT options should be supported to continue their quit attempt using their preferred strategy. Patients should be informed of additional therapies if they continue to smoke tobacco whilst using their e-cigarette.
• All individuals using e-cigarettes to support a quit attempt should be supported in cutting down the level of nicotine at a rate that still enables them to abstain from smoking tobacco with a view to ultimately stopping nicotine as well. Most nicotine replacements are usually stepped down in strength around 6–8 weeks, depending on patient cravings/withdrawal symptoms. This should not be done at the expense of relapsing to smoking and patients should be supported in longer-term NRT if they so choose

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