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Electronic cigarettes: Community Pharmacists’ Perception. Ana Marques Gomes Mpharm, MRPharmS Shereen Nabhani Gebara, PharmD, BCOP. Multidisciplinary research group. Collaboration between Pharmacists, Pharmaceutics expert and Analytical Chemists Currents projects include - PowerPoint PPT Presentation
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Marques Gomes & Nabhani-Gebara | June 2014
Electronic cigarettes: Community Pharmacists’ Perception
Ana Marques Gomes Mpharm, MRPharmSShereen Nabhani Gebara, PharmD, BCOP
Marques Gomes & Nabhani-Gebara| June 2014
Multidisciplinary research group
Collaboration between Pharmacists, Pharmaceutics expert and Analytical ChemistsCurrents projects include
Public perception study (Poster presentation)Role of e-cigarettes in the patient care pathwayAnalysis of content and distribution patterns of e-cigarettes and e-refills
Marques Gomes & Nabhani-Gebara| June 2014
E-cigarettesRuyan 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".
Marques Gomes & Nabhani-Gebara| June 2014
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.
Design
Marques Gomes & Nabhani-Gebara| June 2014
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.
Regulations
Marques Gomes & Nabhani-Gebara| June 2014
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 productsThere 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?
Marques Gomes & Nabhani-Gebara| June 2014
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 date
Nicotine 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: 1629-37
What is the evidence?
Marques Gomes & Nabhani-Gebara| June 2014
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?
Marques Gomes & Nabhani-Gebara| June 2014
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 useTo gauge their perception on the upcoming MHRA regulationsTo find out their training needs to be able to counsel patients
Marques Gomes & Nabhani-Gebara| June 2014
Methods
Self-completion questionnaire was designed
Drop off-pick up method
Data was entered and analysed using MS Excel.
Marques Gomes & Nabhani-Gebara| June 2014
RESULTS & DISCUSSION
Marques Gomes & Nabhani-Gebara| June 2014
Sample Profile
92/154 participants: 66% male; 34% female
11% of sample from big chains; the rest is small, independent
49% - Full time
37% - Locum
5% - Part time
5% Manager
3% - Superintendent
Marques Gomes & Nabhani-Gebara| June 2014
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.
Marques Gomes & Nabhani-Gebara| June 2014
Adverse effects≈ 20% of our sample came across side effects from e-cigarettes reported by patients
Marques Gomes & Nabhani-Gebara| June 2014
Perception on use
Ranking:
1. Smoking Cessation Aid
2. Relapse prevention
3. Public use (‘dual use’)
4. Social, recreational use
Marques Gomes & Nabhani-Gebara| June 2014
Safety 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 users
E-cigarettes do not cause any side effects
Marques Gomes & Nabhani-Gebara| June 2014
0
10
20
30
40
50
60
70
80
90
100
2 1
1012
9
19
14
35
8
41
46
52
62
27
52
32
38
27
37
13
42
9
52
913
1
7
15
2
8
2 1 1 0 1
Strongly Agree Agree
Neutral Disagree
Strongly Disagree
Perc
enta
ge o
f Pha
rmac
ists
(%)
Marques Gomes & Nabhani-Gebara| June 2014
Comparative Effectiveness
Marques Gomes & Nabhani-Gebara| June 2014
Perception of regulations
97% of pharmacists are in support of the regulations announced
for 2016
Major benefits from regulations were ranked as:
1. Reassurance of safety for users
2. Regulated as an established NRT
3. Increase profit for retail pharmacy
4. Prevent the possibility of misuse
Marques Gomes & Nabhani-Gebara| June 2014
Stricter regulations are required for:
Marques Gomes & Nabhani-Gebara| June 2014
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 counselling
Marques Gomes & Nabhani-Gebara| June 2014
Training content
SafetyDosage instructionsAdverse eventsImplementation into smoking cessation patient care pathway
Marques Gomes & Nabhani-Gebara| June 2014
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
Marques Gomes & Nabhani-Gebara| June 2014
Acknowledgements
Research GroupDr Gianpiero CalabreseDr Reem KayyaliDr Steve Barton
Zohra Yasmin
Marques Gomes & Nabhani-Gebara| June 2014
Thank you for your attention