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
18 | drinkanddrugsnews | February 2018 www . drinkanddrugsnews . com
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 Nobody is suggesting that e- cigarettes are harmless 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 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 three- month 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 Res X\ \‘X[H[]]XBHX]وBY[[][HZHHۂوX8$[\[H\B\\Y ^\’\[Z\N[[Yۙ]XX\H N MQQHPSHTTTYH]HY[[X^[YHH\[وY]]]K][]HY[[ܝ[]HœYX[X\^HY\][][ۈ\X]8$HX][HYK]\Y\[^\Y[\و]\\\][HYX[ۈY[ Y]\\[Z[[HXZHH\[\[ۈ]H[^\Y[HX]8$YHZ[[ܙH][X]X[\YHYY[[[ۈ^\Y[H[\]HYBHH\[KHX^H[ۈ[Y]H]ܚ[[BY[وYX[ۈ8$\HY[XH[\[\]\Z[H[[\X[]\[ܘ][ۈ8$\Y[[\\][ۈ܈B^\Y[HوX][[\ݙKXZ[\H\[\[ۜ\[\\[[X]H[B[\\Y܈HX[]K[ܚYY\H[[\›\\H\H[[][H[K\Y[\HY\[8$Y\^H\H\H[Y\X]][Y\Y[\ZH[[]]X[]H8$˜]\H\\\\][\[]\[\B[HHو[YH]XY HXYHH\Y[8$[\YY ][[[ۘ[B[\Y[[KH[[HXYY[H[Y]H]^H[ YHY]H\[YY\[HH[B[H؈H]]X]\\[\XHH[[[ۜ]YH]Z\X] [و\\XYH\[ܙH\ٝ[B[P[^YBH[]]XK[و\HX\\K]\H[[\\ JK[X\[X\وXH\[[ZYY\H[[ PB[[Y[][[\H\]\H܈ۘ\H\BZ[Y[8&][H]HۙHY\[O&H[\BY[H[ܙYXHY]]HYY\\HYYX\\X[]HH]X]H[Y]BH\\\]HH؝\\[HX[YH\Y\B][8$\\\[ۋYX[ۋ[\\Hܛ\XYY[\BH\[XZ[ۈHY[[Z\[Z[HY[X\›XZ[Z[YH\X]K]8&\[[\H[HH\[\[[\Y][ۜ]HH[]]HY[]\H\ܝ]K[[[\ܝ[H]\YZ]]H\H[[][HܚYY[X\[HY[Y\[[\[][B\\][ۈ[Hܛ[][]][[HZHHۈقX˂\XX[ۜ\H\X]HX]و\Y[ ]X]HX]]]HۙHYܙH8$[\ٙ\[ۘ[[\ۘ[]\ˈ\XX[ۜ[[HX]\HH\B[[[ۘ[H]][YKو\K\\\H\H[ L \[ٙ\[ۘ[[وH[YH8$]]8&\[Y[X\]H\H[ۛH[X[\[Z\\H[X[\X܋Y\\YY[[X[\K[\[[\H\ܚX\[\Y[X\و[SB˙[[Yۙ]˘