Europe Is All Confused About What E-Cigs Actually Are

With various talks on the table regarding the regulation of e-cigarettes in the UK and Europe, the status of vaping is getting increasingly confused. Just like in the US, where the technology is completely banned in some places and completely unregulated in others, there’s still no consensus among legislators, scientists, and even manufacturers, on what e-cigs actually are. Are they a bad habit? A medical device? Just a bit of fun? With new regulations on the way, it's time we figured this out.

In the UK, the government is currently pushing through a ban on e-cigarettes for under-18s in England, and similar measures are expected to be adopted in Wales and Scotland. Meanwhile, the EU, which refused a proposal to regulate e-cigs as medical devices last year, is revising the Tobacco Products Directive to include regulation on e-cigs. And against that already complicated backdrop, some e-cigarette companies are now trying to license their products as medicines anyway.

At the core of the debate on all these proposals is the dichotomous way in which e-cigs can be perceived: as a healthier alternative to conventional cigarettes and a tool to help people quit smoking, or as a new way of getting people hooked on nicotine that hasn't seen much research into potential health risks. Put simply, are e-cigs a good thing, or a bad thing?

In the UK, it seems no one can agree. The under-18s ban seems to bracket vaping in the same category as smoking.  Like cigarettes, e-cigs would still be available to buy in grocery stores and suchlike, but not to kids. That's in contrast to other nicotine-containing products that are seen as "anti-smoking therapies," such as nicotine gum and patches. These are licensed as medicines, generally sold in pharmacies, and available to teens as well as adults on the NHS.

Welsh health minister Mark Drakeford recently put forward the case in Wales that e-cigs are pretty much like cigarettes with the argument that they could attract more people to smoke—though he did acknowledge the potential benefits for those quitting tobacco. “They can be a useful tool for people who are already heavily addicted to smoking,” he told BBC Wales, but added, “I am far more worried that the e-cigarette movement is renormalising smoking; it is reglamourising smoking—it contains nicotine and nicotine is highly addictive. What we don’t want is for e-cigarettes to be a gateway to real cigarettes.”

EU plans to regulate e-cigs under the Tobacco Products Directive echo this assimilation of e-cigs with cigarettes; after all, e-cigs don’t even contain tobacco. This view of e-cigs posits them as the alcopop of the tobacco industry; a trendy starter habit that could get kids into "real" smoking. And it holds some weight; a study by the Center for Disease Research in the US found more school kids were trying vaping as it became more popular.

But this has to be seen in balance with smokers who quit tobacco in favour of e-cigs, and the EU proposals have drawn criticism from a group of scientists who argue that, far from a gateway into smoking, vaping should be seen as a gateway out of smoking. In an open letter to EU Health Commissioner Tony Borg and MEPs, 15 scientists said plans to limit the amount of nicotine in an e-cigarette could prevent smokers from using the devices to quit. The EU directive sets out that e-cigs should have a maximum of 20mg/ml of nicotine, but the scientists dispute that 50mg/ml is in fact closer to a real cigarette, and suggest that heavily dependent smokers won’t switch to e-cigs if they can’t get a high enough nicotine dose from them.

They ended their letter, “If wisely regulated, electronic cigarettes have the potential to obsolete cigarettes and to save millions of lives worldwide. Excessive regulation, on the contrary, will contribute to maintain the existing levels of smoking-related disease, death and health care costs.”

It seems that some of the large e-cig brands want to push this line that e-cigs are good for health too, as the Guardian uncovered this weekend that manufacturers including Nicolites and Nicoventures were applying for a medical license even though the EU ruled they don’t have to. That’s probably because being regulated along the same lines as nicotine gum and patches brings some key competitive advantages to being regulated like cigarettes: marketing and advertising.

It’s also perhaps an advance step to get ahead in the UK market, where e-cigs are set to be licensed as medicines by 2016 regardless of activity in the rest of Europe, and where the Advertising Standards Agency has plans to reconsider its rules for e-cigarette ads this year.

But this stands in opposition with concurrent plans to regulate e-cigs like tobacco products, complete with cigarette-like age restrictions, health warnings on packaging, and a ban on flavours like menthol. Could we end up with a ridiculous scenario in which some e-cig brands—those with the forward thinking (and money) to get medical licenses early on—are treated as a separate entity to those that aren't yet licensed? One as a medicine, the other as a tobacco product? It's time we decided what this technology really is once and for all.