Drink and Drugs News DDN Feb2018 | Page 18

letters and Comment

Should e-cigarettes be provided free to smokers who cannot or will not quit , asks Neil McKeganey

Free to breathe

WHILE SMOKING RATES HAVE STEADILY DECLINED in recent years , there are still around 9m people smoking in the UK and approximately 120,000 smoking-related deaths per year . Although tobacco control has been one of the highlights of global public health , the challenge of further reducing smoking prevalence becomes harder , not easier , over time .
Those smoking now are doing so in the face of the known harms of smoking , decades of smoking bans , graphic health warnings , tax hikes on tobacco products , age restrictions on the sale of tobacco products , advertising bans and widespread social opprobrium directed towards smokers . If the UK is going to succeed in further reducing smoking prevalence it is going to have to do something radically different to what it has done in the past . One thing the government might now consider is providing smokers with free access to e-cigarettes .
E-cigarettes have been characterised by Public Health England as at least 95 per cent less harmful than conventional cigarettes . We know from research in the US that smokers using e-cigarettes are more likely to have attempted to quit , and that those quit attempts are more likely to have been successful . There is also growing evidence that providing smokers with access to e- cigarettes has a beneficial impact , even if those smokers have not previously committed to quitting . Recent research from the University of South

Nobody is suggesting that e- cigarettes are harmless

Carolina , for example , found that nearly a third of smokers provided e-cigarettes for free had reduced their smoking by at least 50 per cent over the threemonth period the researchers were monitoring them .
Nobody is suggesting that e-cigarettes are harmless , but if they are much less harmful than the alternative and can have a beneficial impact – even for smokers not already determined to quit – why aren ’ t we doing all we can to reduce the barriers to vaping ? Charging smokers a price for using e-cigarettes is one of the barriers that is starting to look decidedly inappropriate .
There is an inverse relationship between smoking and deprivation , with the highest levels of smoking , and the highest levels of smoking-related harm , found in the poorest communities . There is probably nothing that would have a greater impact on reducing health in - equalities than reducing smoking among the poorest sectors of society . On that basis it makes no sense to attach a financial barrier to smokers ’ access to e- cigarettes – especially where that barrier is going to be greater in the communities where levels of smoking are at their highest .
Providing free e-cigarettes to smokers who cannot quit , or who will not quit , may be the equivalent of investing millions in flu vaccinations or providing statins to those at risk of future health problems . These are programmes that are funded in the expectation of future savings . There are few savings greater than those that can be achieved by reducing smoker numbers . The cost of providing smokers with free access to e-cigarettes may be a cost that is easily justifiable if it results in a further reduction in smoking prevalence .
Dr Neil McKeganey is director of the Centre for Substance Use Research , Glasgow

Facing the inevitable

CliniCal eye
The death of a client can hit you like a ton of bricks – unless you are prepared , says Ishbel Straker
2017 BROUGHT ME MANY SURPRISES ; some have been amazing , some a whirlwind of negativity , but all have been an opportunity to reflect and learn . My biggest revelation was death – not the fact that people die , but our differing experiences of it as nurses within the addiction field .
Throughout our nursing training we make the assumption that we will experience death – some being more traumatic than others , some needing hands-on experience and others that we see from a distance . We may then go on to believe that working in the field of addiction – where clients place themselves at risk daily and allow physical deterioration – our mental preparation for the experience of death will improve .
Making these assumptions is dangerous and will leave you unprepared for the reality . Shock and grief are odd things and as nurses we are not immune to them . Our clients are different – yes , they are risky and yes , death at times seems like an inevitability – but our role as nurses is to prevent this , so when it happens there can be a lot of blame attached .
We become close to our clients – boundaried , but emotionally invested in them . We want them to succeed and we believe that they will . If we did not have this belief system we would not be doing the job we do , but it leaves us vulnerable to the emotions that come with their death . All of this is made far more stressful by
the inevitable , and of course necessary , root cause analysis ( RCA ), unearthing fears of possible Nursing and Midwifery Council ( NMC ) involvement even when there is no cause for concern . We are trained to think , ‘ what could I have done differently ?’ and these thoughts can be incredibly negative if left to fester .
So how do we safeguard our ability to cope with death ? I believe the first step is to have a robust system to manage this after the event – supervision , reflection , and perhaps a group debrief to ensure the focus remains on the client and their family members , to maintain some perspective . It ’ s also to ensure any RCA systems and investigations do not have a punitive feel but are supportive , and most importantly it is to admit that we are not immune to grief , shock and fear when a client dies and understand that all the preparation in the world will not prevent it hitting you like a ton of bricks .
Our reactions are not just about the death of this client , but about the deaths that have gone before – in both our professional and personal lives . Our reactions can also be about where we are emotionally at that time . Of course , as nurses we are all 100 per cent professional all of the time – but it ’ s good to remember that we are still only human .
Ishbel Straker is a clinical director , registered mental health nurse , independent nurse prescriber and board member of IntANSA
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