Oil & Gas UK has produced the following advisory notes on managing the use of both tobacco nicotine and e-cigarettes offshore.
The advice recommends that the industry is consistent with well-established public health measures to reduce tobacco smoking and that unless, and until, they become medically regulated, e-cigarettes should not permitted offshore
However the decision on whether or not to permit e-cigarettes rests with member companies – it is not an Oil & Gas UK decision.
The offshore oil and gas industry should work towards greater consistency with public health measures on reducing tobacco use.
Ongoing discussion on the merits or otherwise of e-cigarettes inevitably leads to comment and questions in relation to the industry attitude to tobacco cigarettes. Substance abuse policies across the oil and gas industry typically prohibit use of drugs for anything other than legitimate medical reasons. However, use of nicotine as a recreational drug is unusual in that the typical substance abuse policy approach is generally not applied to nicotine in the form of tobacco cigarettes.
Nicotine is a substance found in tobacco. It was introduced to Europe from the Americas by the Spanish in the 16th Century, and was first used as an insecticide in farming. Nicotine is toxic to humans as well as insects (it causes an increase in heart rate and blood pressure, it can cause the occupational disease ‘green tobacco sickness’ in tobacco harvesters, and the lethal dose in humans is 40-60 milligrams). Nicotine is also an addictive substance, and has been used as a ‘recreational drug’ (mostly in the form of smoking tobacco, but also as chewing tobacco and snuff) from the 1500s onwards. Since the mid-20th century nicotine has been replaced as an insecticide by other agents, and its use as a recreational drug by smoking has fallen steadily.
In 1948 (around the end of the second world war) 82% of UK men smoked tobacco, but this has fallen over time (more rapidly once the link between smoking and lung cancer was recognised in the 1960s), such that by 2013, just under 20% of both men and women smoked in the UK.
Cigarette companies are well aware of this – the website of BAT (British Allied Tobacco), for example, states ‘we think that individual smokers will consume fewer cigarettes each, and smaller percentages of populations will smoke. While cigarette sales in developed countries continue to decline year on year, sustained volume growth is widely predicted in emerging markets. As a result, the overall value of the tobacco market continues to grow’.
Use of nicotine by smoking in the UK has fallen due to a determined, consistent and prolonged public health effort involving gradually tighter controls of tobacco nicotine sales, use and advertising. Despite this, international tobacco companies have been able to maintain and grow revenue by increasing sales in developing countries where these public health efforts are absent, and more recently, by turning to e-cigarettes as a nicotine delivery system in developed countries where smoking tobacco has declined.
Nicotine is a highly addictive drug, with 95% of users being addicted within six months of starting use. However, nicotine produces only a mild physical withdrawal syndrome when compared with other substances such as alcohol or heroin, and addiction is mainly psychologically-driven. Studies consistently show that most smokers wish to stop, and common experience confirms that many can do so with appropriate encouragement and assistance.
Substance misuse policies in the offshore industry
Substance misuse policies are virtually universal in the industry, and effectively prohibit use of all drugs (whether legal or not) for non-medical purposes. Both alcohol and ‘legal highs’ are examples of legal drugs the use of which is not permitted offshore.
An exception to this general rule is nicotine, in the form of smoking. Nicotine use as tobacco is permitted offshore, and tobacco cigarettes are sold on offshore installations, often at reduced prices compared to onshore shops. While cigarettes are required to be stored ‘out of plain sight’ in supermarkets and shops, this practice is not usual offshore.
Cardiovascular disease (heart attack and stroke) are now the leading cause of both major illness and death on offshore installations, and it is therefore surprising that the offshore oil and gas industry fails to be consistent with the public health policies which have reduced smoking and hence related illness and deaths onshore. There is no justification on health grounds for this exceptional treatment of tobacco nicotine by the industry.
1. The offshore industry should be consistent with national public health policies on smoking reduction – failure to be consistent is not in the best interests of the health and wellbeing of the offshore workforce.
2. In relation to tobacco nicotine, to be consistent with national public health strategies the industry should:
a) Avoid the sale of cigarettes at ‘less than shore shops’ prices.
b) Implement the same ‘non-visibility’ policies at point of sale of cigarettes as apply to onshore shops.
It is expected that these measures (a and b) could be implemented within a short timescale, without significant difficulty.
c) Work towards the discontinuation of cigarette sales on offshore installations
There is no reason why smokers cannot take their own cigarettes, for personal use, offshore as part of their normal baggage.
d) Work towards the ultimate discontinuation of smoking tobacco on all offshore installations.
It is recognised that implementation of this measure (d) would require adequate time for preparation and adaptation of those workers who continue to smoke. However, the commissioning and introduction to service of a new installation would offer a natural opportunity to introduce this measure, without disadvantage to existing personnel.
3. Operators and employers should continue to offer existing, established methods of support for stopping smoking. E-cigarettes currently offer no advantage over these.
E-cigarettes should not be permitted on offshore installations unless and until e-cigarettes become available as medically-regulated products.
Introduction and update
General indications are that sales and use of e-cigarettes continue to increase in the UK, and Oil & Gas UK continues to receive enquiries from members and others regarding an industry position on e-cigarettes. E-cigarettes continue to be promoted as a ‘stop smoking’ aid, and the e-cigarette manufacturers’ association continues to oppose regulation of e-cigarettes, fearing that this would reduce sales. The only medical study on whether e-cigarettes actually do help smokers to stop remains a Lancet study in late 2013.
E-cigarettes are not a better way to stop smoking
The argument is frequently advanced that e-cigarettes are an aid to smokers who wish to stop smoking. The Lancet study of late 2013 remains the only properly-conducted investigation of this proposition, and showed that e-cigarettes are not more effective than existing nicotine replacement therapies (gums, patches, and inhalator) in helping smokers to stop. Existing nicotine replacement therapies are medically-regulated (for dose consistency, presence of other ingredients etc.); e-cigarettes are not, although those containing more than 20mg/l nicotine will require medicines licensing through the UK Medicines and Healthcare Products Regulatory Agency (MHRA) from 2016.
What difference does ‘medically regulated’ make?
Because existing nicotine replacement therapy products are medically regulated, they have a known and fixed dose of nicotine, no unknown or additional ingredients, and a ‘treatment schedule’ has been worked out for them. By contrast, e-cigarette products are of varying and non-standardised doses of nicotine, they contain and/or produce other substances, some of which are known toxins (for example, ‘tobacco specific nitrosamines (TSNAs)’), and there is no worked-out ‘treatment schedule’ of optimum effectiveness. Medically-regulated e-cigarettes would be of known, predictable, nicotine strength and sold only to those on a medical treatment plan.
E-cigarettes are not the only ‘harm-reduction strategy’
E-cigarettes are promoted as a means of harm reduction – the person continues to take nicotine and avoids the other chemicals in tobacco smoke. Existing medically-regulated nicotine replacement products (gum, patches, and inhalator) can just as easily be used as harm reduction products for the same reason. However, existing nicotine replacement products are less popular with smokers because they do not produce the same ‘hit’ as tobacco cigarettes or e-cigarettes.
1. Unless and until e-cigarettes become available as a medically-regulated product (as is the case for existing nicotine-replacement therapies) their use should not be permitted on offshore installations.
2. Operators and employers should continue to offer existing, established methods of support for stopping smoking. Nicotine vapour devices (e-cigarettes) offer no advantage over these.
3. The industry should work towards greater consistency with public health measures on reducing tobacco use offshore.