Gerry Horkan (Fianna Fail)
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I thank Senator Conway-Walsh and move on to No. 4 in the name of Senator Catherine Noone, who has four minutes. I think the Minister of State, Deputy Finian McGrath, is dealing with this matter as well. It is about e-cigarettes

Finian McGrath (Dublin Bay North, Independent)
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Sorry, I am.

Gerry Horkan (Fianna Fail)
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The Minister of State was in a rush to get away. I was wondering where he was off to. I know e-cigarettes is a topic close to his heart. I hope he was not off for a smoke. I call Senator Noone.

Catherine Noone (Fine Gael)
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The Minister of State, Deputy McGrath, has seen the debate. I know it is an issue close to his heart, pardon the pun. In light of international studies that have found that smokers who use e-cigarettes tend to smoke less and have increased attempts to quit, what research is being conducted here to test the effectiveness of e-cigarettes in helping Irish smokers quit the habit?

The Minister of State knows that the Healthy Ireland framework is aiming for a tobacco-free Ireland by 2025. That means achieving a smoking rate of less than 5%. The current smoking rate in Ireland is 22%. The HSE welcomes any aid to quitting smoking but due to the lack of conclusive evidence of the long-term effects, it has not recommended e-cigarettes as an aid. I am not an expert in this area. However, besides the fact that I think they look a bit ridiculous, they do seem to be effective. We should have some policy on them.

E-cigarettes in the UK have been endorsed as a quitting tool. There has been a drop in smoking rates there of 4.8% since 2012. Public Health England has stated that e-cigarettes are 95% less harmful than traditional smoking. That is obviously significant. In the UK, one person switches to e-cigarettes every three minutes. The UK now has the second lowest smoking rate in Europe. Public Health England stated that the use of e-cigarettes is associated with increased quitting success rates and has hastened the decline in smoking.

In Ireland in 2017, the Health Information and Quality Authority, HIQA, reported that e-cigarettes are twice as popular and twice as effective at helping people to quit compared with patches, gum and other devices. Of the people who quit smoking last year, 37% used e-cigarettes according to Healthy Ireland. Smoking rates in Ireland have been slow to decrease. It was 23% in 2015 and 2016, and 22% in 2017. I appreciate that wanting to quit smoking is a personal issue for people. However, if we, as a Government, are seeking to attain a tobacco free Ireland, it appears that our nearest neighbour is having a lot of success in this area, notwithstanding the research that needs to be carried out. I would be interested in us at least having a policy on it.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Noone for raising this very important issue. I will be responding on behalf of the Minister for Health, Deputy Simon Harris. The Senator will be aware that smoking is the greatest single cause of preventable illness and premature death in Ireland. It kills almost 6,000 people a year. Our primary objectives, set out in the 2013 policy document Tobacco Free Ireland are to denormalise smoking and to protect children from the dangers of tobacco consumption. That policy sets a target for Ireland to be tobacco free - that is having a smoking prevalence rate of less than 5% - by 2025. The Government and I remain committed to making Ireland tobacco free.

Tobacco Free Ireland contains a number of recommendations to assist smokers in quitting tobacco use. One of those recommendations is to examine the evidence regarding outcomes of the use of nicotine replacement therapy and other approaches. The Department requested that HIQA undertake a health technology assessment of the clinical and cost effectiveness of the pharmaceutical and non-pharmaceutical smoking cessation products and services. That assessment was published in 2017. It found that all pharmacological interventions were effective compared with no treatment. A prescription-only drug called varenicline was the most effective drug on its own.Using a combination of varenicline and nicotine replacement therapy was the most effective pharmacological intervention and people using this combination were over 3.5 times more likely to quit than those who were in a control group and did not receive this treatment.

Group behavioural therapy, individual counselling, intensive advice and telephone support were all found to be effective behavioural interventions, with group therapy found to be the most effective of these interventions. The addition of behavioural intervention to a pharmacological intervention improved the effectiveness of the intervention. The HIQA assessment recommended that smoking cessation services should seek to increase the uptake of varenicline, either alone or in combination with nicotine replacement therapy for smokers who want to use pharmacological support.

Although the health technology assessment found that results for e-cigarettes are promising, there is currently a lack of evidence to recommend their use as a smoking cessation aid, and currently no e-cigarette product is licensed as a medical product in Ireland. The safety of e-cigarettes is an evolving area of research. It is potentially safer than smoking but evidence on long-term safety has yet to be established. In the absence of additional evidence confirming the effectiveness of e-cigarettes, the HIQA assessment recommended that the HSE smoking cessation services should seek to increase the uptake of the combination nicotine replacement therapy treatment among those for whom varenicline is not tolerated or preferred.

The results of the HIQA health technology assessment will inform the development of the national clinical guidelines on smoking cessation interventions currently being undertaken by the Health Service Executive in conjunction with the national clinical effectiveness committee. It has also informed policy decisions on potential improvements to the provision of smoking cessation services in the public health service. The Department will continue to monitor the emerging research on all such products so as to inform decisions around any future additional regulation in the area. I thank the Senator for raising this very important matter.

Catherine Noone (Fine Gael)
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I know the Minister of State did not draft it but I find the response somewhat unsatisfactory. For some time there has been talk that there is not enough evidence in this regard but our nearest neighbours have plenty of evidence to make a policy decision on this issue. I understand these other methods are good and I am personally in favour of the idea of group behavioural therapy, individual counselling, intensive advice and telephone support. This can all obviously be very good. Even on the way here I met one of my colleagues with an e-cigarette in her hand and I stopped to chat to her about it. She said she previously had pleurisy but has not had a cold or any kind of a cough for four or five years when she used to have them very regularly. I thought she looked a lot better and she seemed very happy about the change. It is clearly something that works for people but we have no policy in place. People are using these all the time. The response is somewhat unsatisfactory and I will inquire further into the matter. There seems to be enough evidence for our nearest neighbours and I do not see why we cannot collate evidence. I do not see what the problem is.

Finian McGrath (Dublin Bay North, Independent)
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It is a policy matter. I know many people on e-cigarettes and they have found them very effective. I take the Senator's very valid point because the method works. There is a broader debate and it is essential that I bring the Senator's point to the Minister, Deputy Harris, and the HSE. Having spoken with people, I know this method seems to be effective and it has an impact. The Senator mentioned a 36% reduction in the UK, which is dramatic. If something is out there like that as evidence, the process should be supported. I will bring that strong message back to the Minister.