Use of e-cigarettes (known as €vaping€) is becoming increasingly popular, with an estimated one to two million users in the UK. E-cigarettes are also known as vapourisers or electronic nicotine delivery systems, and there are three main types: 1. Disposable products (nonrechargeable) 2. Electronic cigarette kits that are rechargeable and have replaceable, pre-filled cartridges 3. Electronic cigarettes that are rechargeable and have a tank or reservoir that has to be filled with liquid nicotine.

E-cigarettes are targeted at adult smokers as a cheaper and healthier alternative to smoking. Although they are not marketed as smoking cessation aids (as this would make them medicinal by function and require marketing authorisation), people do use them to support a quit or cutdown attempt. So far, there is little formal evidence that they are effective in helping with smoking cessation and we do not know about their long-term safety.

Currently, electronic cigarettes are only covered by consumer product regulation and there is no standardisation of products. In May 2016, the EU Tobacco Products Directive comes into effect in member states. Electronic cigarettes containing up to a certain concentration of nicotine will come under the Directive, which will require products on sale to conform to certain standards (relating to ingredient purity, dose delivery, child-proof packaging, etc).

For products containing higher levels of nicotine, manufacturers and importers will have to decide to opt into medicines regulation and require authorisation by the MHRA as over-the-counter medicines. There are several advantages associated with the products becoming medicines that might be attractive to companies (e.g. the ability to make health claims, the potential for products to be prescribed). In the meantime, the MHRA is encouraging companies to obtain marketing authorisation.

So far, unlicensed e-cigarettes have no formal role in tobacco harm reduction approaches. That said, the NICE guidance states that even though people should be told that e-cigarettes are not regulated by the MHRA and so their effectiveness, safety and quality cannot be assured, they should be advised that these products are likely to be less harmful than cigarettes.

Nonetheless, the message should be that licensed NCPs are an effective way of reducing tobacco harm and should be the product used in any harm reduction approach.