We live in a curious world. I was out doing my Christmas shopping yesterday and came across a legal high stall right in the middle of Glasgow's Buchanan Street. The packaging and brand title were lurid, the stall was huge - much bigger than any I'd seen before in a similar spot - and they were brazenly giving out free samples of their highly addictive product to anyone who was curious.
You'd imagine I'd be furious at this attempt to ensnare the Glasgow Christmas punter, but I wasn't. I was quite content, and later on I was cursing my failure to pick up some samples for a couple of my good friends.
The legal high in question was of course nicotine, and the samples being handed out were of a particular e-cigarette brand whose name I don't remember. The arrival of e-cigarettes - and I suspect this is the first Christmas they'll be under more than a few Christmas trees around the country - is going to cause a great many people to do a great deal of head scratching as they ponder a great many difficult questions.
I keep writing the word 'great' perhaps because e-cigs are certainly great news for existing tobacco addicts. Cigarettes are hideously unhealthy. Nicotine for the most part really isn't (though I learned in a past life that high doses can turn mice temporarily into cute, immobile hand warmers). If we've found a way to deliver nicotine - and nothing else of concern - into the lungs of those who are addicted to it in a manner that is safe and appealing than we should be celebrating and promoting it's use to all those who are unable to quit their cancer sticks.
But who should be promoting their use, to whom, and how? This question needs to be asked with urgency. It's all very well weaning people off cigarettes with a cheaper, healthier alternative, but how do we as a society feel about non-smokers becoming smokers (vapourers?) of these new products.
This question is made more pressing by the observation of the promotional activity that is occurring across the pond. Here's 'movie star' Katherine Heigl puffing on an e-cig with David Letterman and using the words, 'But it's not bad for you. It's a fun addiction!' : http://www.youtube.com/watch?v=bMLSSK038Vg
And here's a television advert telling people to "Take back your freedom with blu" http://www.youtube.com/watch?v=9pxuBgfbid0
Nicotine is one of the most addictive of all drugs, so many people seduced by the likes of Heigl and the attractive blu man to use e-cigs as their first smoke/vapour experience will be surrendering their freedom and submitting themselves to an expensive habit. Maybe it's not as expensive as tobacco, but it'll still be an unnecessary and persistent financial pressure.
Should a substance with such addiction potential be marketed in such ways? I believe not. It's a harm reduction product that should be prescribed and sold in pharmacists or on regulated websites, after appropriate agencies have subjected the devices to rigorous safety tests. The stall on Buchanan Street should be an NHS, anti-smoking stall, helping people to start the new year "smoke" free, not a private company pushing unregulated, addictive legal highs to all and sundry.
But e-cigs do have to be available to the general public, and they should be more available than cigarettes. If I'm offered the trade of e-cigs being available in corner shops if tobacco products no longer are, that is a deal I would happily embrace.
Like so many drugs, the availability of safe nicotine might also be an excellent opportunity to better treat or prevent some very costly and traumatic medical conditions.
This is where the neuroscientist in me comes out. Schizophrenia and psychosis in alzheimers have been linked to the alpha-7 nicotinic receptor gene, nicotine improves attention and reduces impulsivity in schizophrenia, and might even be protective against later development of the disease: http://journals.psychiatryonline.org/article.aspx?Volume=160&page=2216&journalID=13
Regardless of whether nicotine is therapeutic in schizophrenia, smoking certainly isn't. People with the condition die much earlier on average than the rest of the population, and they generally smoke like chimneys. Their health needs to be protected by diverting them to e-cigarettes as soon as possible.
Nicotine might also help memory in early dementia, but there is a long way to go in researching nicotine's therapeutic or even cognitive enhancement potential.
For the moment, it's worth remembering that legal or illegal, you can't protect people from the harms of drugs if they are insufficiently regulated. Government needs to step up and get to grips with this issue.