I propose to take Questions Nos. 121, 122 and 124 together.
The recently published Healthy Ireland 2018 survey found that the prevalence of smoking in Ireland has declined from 22% in 2017 to 20% in 2018 which is to be welcomed.
The Tobacco Free Ireland (2013) policy document contains a number of recommendations to assist smokers in quitting tobacco use. One of those recommendations is to examine the evidence regarding the outcomes of the use of Nicotine Replacement Therapy ('NRT') and other approaches.
My Department requested HIQA to undertake a Health Technology Assessment ('HTA') of the clinical and cost effectiveness of pharmaceutical and non-pharmaceutical smoking cessation products and services. The HTA was published in 2017 and found that all the pharmacological interventions were effective compared to no treatment and that a prescription only drug called varenicline was the most effective drug on its own. However, the HTA also found that using a combination of varenicline and NRT was the most effective pharmacological intervention and that people using this combination were over three and a half 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 a behavioural intervention to a pharmacological intervention improved the effectiveness of the intervention.
The HTA recommended that smoking cessation services should seek to increase the uptake of varenicline, either alone or in combination with NRT, for smokers who want to use a pharmacological support.
In relation to e-cigarettes and vaping, although the HTA 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 at present no e-cigarette product is licensed as a medicinal product in Ireland. The safety of e-cigarettes is an evolving area of research; while potentially safer than smoking, evidence on its long-term safety has yet to be established. In the absence of additional evidence confirming the effectiveness of e-cigarettes, the HTA recommended that the HSE smoking cessation services should seek to increase the uptake of combination NRT treatment among those for whom varenicline is contraindicated, not tolerated or not preferred.
The results of the HTA are informing the development by the HSE, in conjunction with the National Clinical Effectiveness Committee, of national clinical guidelines.
The Department of Health is aware of, and actively monitoring, publications by authoritative bodies internationally on the use of e-cigarettes as a smoking cessation tool. Analysis of emerging research on all products, and the findings of Healthy Ireland 2018 in relation to e-cigarette usage in Ireland, will continue to inform decisions around any future additional regulation in this area.