Tobacco harm reduction

Smokers who aren’t willing or simply cannot quit smoking face a future of pain and suffering50.

As health professionals, you have a responsibility to help these people with the best available strategies to improve health outcomes51.

 

Learn how smokers are made

The biggest myth: there isn’t enough evidence

Health professionals are busy people, working long shifts in high stress environments. We understand that research is the last thing you want to do on your days off. VAEP was developed to make learning about tobacco harm reduction easy for health professionals and the public.

This image is a screen shot from a medical data base. The search results for “e-cigarettes or vaping or vape or electronic delivery systems” provided over 22,000 published articles on vaping.

Myth 2

We don’t know if vaping is less harmful than smoking

The multiple-criteria decision analysis (MCDA) is a decision-making tool that takes into account multiple factors and enables comparison of related subjects. Twelve experts compared sources of nicotine using 14 criteria of harm. Cigarettes are the most harmful source of nicotine at 100%. Vaping was assessed at less than 5% the harm52.

Myth 3

Second hand vapour is dangerous

Over 9000 observations of the constituents of vapour were compared to universally recognized workplace exposure standards known as Threshold Limit Values (TLVs). All constituents were valued at <1% TLV, except two constituents acrolein amd formaldehyde were <5%53. It’s important to note  that acrolein and formaldehyde are normal constituents of exhaled breath54.

Myth 4

Nicotine causes disease

Nicotine is an addictive mild stimulant. It elevates mood, stimulates cognitive function and increases energy55. It’s physiological effects and therefore addictive effects are similar to caffeine56. It is not a carcinogen and without the adjunct chemicals, nicotine presents as less additive than cigarette smoke55. Nicotine is so safe you don’t need a prescription or to be age of majority to buy nicotine patches, gums etc.

Further

The Royal College of Physicians (RCP)

RCP has been an authority in medicine for 500 years. ‘Nicotine without Smoke’, released by RCP in 2016, is a 200+ page report investigating the scientific research on vaping. Some of their key recommendations: “… the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco…in the interests of public health it is important to promote the use of e-cigarettes57…”

Myth 5

Vaping is a gateway to smoking

During the last 6 years, vaping has been mainstream in Canadian society58. This is the first generation of youth that have experimented with vaping58. It is normal adolescent behavour to experiment with adult taboos59. 20% of youth have tried vaping in the last 30 days60. If vaping was a gateway to smoking we would observe an increase in youth smoking prevalence. As per the biennual Canadian Student Tobacco and Drug Survey, grade 12 smoking prevalence has decreased 63% in the last 6 years58,60.

Further

The Canadian Institute for Substance Use Research

at the University of Victoria released in January 2017 ‘Clearing the Air: a systematic review of the harms and benefits of e-cigarettes and vapour devices’61. Tim Stockwell, an investigator on this review, stated: “The public has been misled about the risks of e-cigarettes. Many people think they are as dangerous as smoking tobacco but the evidence shows this is completely false62.”

Myth 6

Flavours are to attract youth

Considering that one in four Canadians are obese, and that alcohol comes in thousands of flavours we can deduce that adults like flavours63. This is why nicotine gum, lozenges and sprays come in flavours64. When smokers are detoxing off the 7000 chemicals found in cigarette smoke and transitioning to just pharmaceutical grade nicotine, pleasing flavours encourage continuation of harm reduction65. Further, the novelty of flavours encourages the continued compliance with vaping65.

Myth 7

Vaping’s ineffective for cessation

Considering that Canadian public health officials have utilized millions of our tax dollars to only oppress tobacco harm reduction by disseminating fear-based narratives about vaping66, the vaping industry has been driven solely by consumer demand; smokers’ demand for an alternative that reduces harm67. If vaping was ineffective it would not exist. From 2015 to 2017, the preferred smoking cessation method for Canadian smokers was vaping at 32% vs 24% with patches and 16% with gum68. In the United Kingdom, 54% of successful smoking cessation attempts were with vaping69.

Further

Controlled clinical trials

In 2014, smokers that did NOT want to quit smoking were given eliquid and vape pens (which aren’t as effective at nicotine delivery as the current devices). At 2 months,  34% of the subjects reported smoking cessation. eCO levels decreased significantly and continine (nicotine metabolite) remained the same. At six months, 21% remained exsmokers compared to 6% cessation with patches70.

Myth 8

Approved cessation methods are effective

Prior to vaping, only 2.5% of smokers quit long term even though 52% attempted cessation annually71,72. They had a 4% success rate with cold turkey; 8% success with nicotine replacement therapy (NRT) such as patches or gum; if adjunct counselling was added, success can reach 16%71,73. Smoking cessation methods currently approved by Health Canada have an 84% failure rate at best! Of those successful ‘quitters’ 80% relapsed in the first month74. Psychoactives have adverse effects such as suicidal ideation, violent outbursts, depression and psychotic episodes75.

Myth 9

Vaping is ineffective for smoking cessation

A significant aspect of smoking is the ritualistic behaviour of bringing a smoke to the mouth; tasting the smoke with a drag; feeling sensations in the throat and lungs with a full inhale; and observing the visible exhale76. The behaviour is repeated 240 times a day for a pack-a-day76 smoker; 87,600 times a year! This physical ritual is coupled with an immediate increase in serum chemicals61.  Further, smokers are proficient at maintaining therapeutic nicotine serum levels through inhalation77. Vaping uniquely satisfies this ritual and provides nicotine through the same route76.

Myth 10

Dual user isn’t quitting smoking

Utilizing vaping to transition from the most addictive product in Canada to nicotine-free is a process consisting of 4 stages61. The first stage is dual use which is when the smoker becomes familiar with how to use their vaping device to achieve therapeutic nicotine serum levels61. This may include trying different devices and eliquids to find what is right for them78. Stage two is smoking cessation and continued vaping61. Invariably, after a few months to adjust to the decrease of serum chemicals, vapers decrease their nicotine dose and some then titrate off of nicotine completely61.

Listen to the experts

Quotes from those that have done the research

“The most important

toxins in cigarette smoke are missing – those that remain are orders of magnitude lower.”

Dr. Konstantinos Farsalinos

“Vapers should

 be more concerned of the air they breathe in polluted cities rather than their vaping!”

Dr. Riccardo Polosa

“Saying e-cigs

 are 95% safer is not a medical claim, it’s a truth.”

Professor Hajek

“People smoke

 for nicotine but they die from the tar.”

Professor Michael Russell, 1976

Dr. Konstaninos Farsalinos

“The most important toxins in cigarette smoke are missing – those that remain are orders of magnitude lower.”

Dr. Riccardo Palosa

“Vapers should be more concerned of the air they breathe in polluted cities rather than their vaping!”

Professor Hajek

“Sayong ecigs are 95% safer is not a medical claim, it’s a truth.”

Professor Michael Russell, 1976

 ” People smoke for nicotine but they die from the tar.”

50. Polosa, R., Rodu, B., Caponnetto, P., Maglia, M., & Raciti, C. (2013). A fresh look at tobacco harm reduction: the case for the electronic cigarette.

51. Canadian Nurses Association. (2017). Code of ethics for registered nurses.

52. Nutt, D. J., Phillips, L. D., Balfour, D., Curran, H. V., Dockrell, M., Foulds, J., Fagerstrom, K., Letlape, K., Milton, A., Polosa, R., Ramsey, J., & Sweanor, D. (2014). Estimating the harms of nicotine-containing products using the MCDA approach.

53. Burstyn, I. (2014). Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks.

54. Filipiak, W., Ruzsanyi, V., Mochalski, P., Filipiak, A., Bajtarevic, A., Ager1, C., Denz1, H., Hilbe W., Jamnig, H., Hackl, M., Dzien, A., & Amann, A. (2012). Dependence of exhaled breath composition on exogenous factors, smoking habits and exposure to air pollutants.

55. Laugesen, M. (2013). Nicotine and health. New York, NY: American Council on Science and Health.

56. Royal Society for Public Health. (2015). Nicotine “no more harmful than caffeine”.

57. Royal College of Physicians. (2016). Nicotine without smoke: Tobacco harm reduction: A report by the Tobacco Advisory Group of the Royal College of Physicians.

58. Government of Canada. (2015). Canadian Student Tobacco, Alcohol and Drugs Survey.

59. Jackson, C. A.,  Henderson, M., Frank, J. W., Haw, S. J. (2012). An overview of prevention of multiple risk behaviour in adolescence and young adulthood.

60. Government of Canada. (2019). Canadian Student Tobacco, Alcohol and Drugs Survey.

61. O’Leary, R., MacDonald, M., Stockwell, T., & Reist, D. (2017). Clearing the Air: A systematic review on the harms and benefits of e-cigarettes and vapour devices. Victoria, BC: Centre for Addictions Research of BC.

62. University of Victoria: UVic News. (2107). Clearing the air around e-cigarettes. Retrieved Feb. 19, 2020 from https://www.uvic.ca/news/topics/2017+e-cigarettes-carbc-macdonald-stockwell+media-release

63. Statistics Canada. (2017). Canadian Health Measures Survey.

64. Aslani, A., & Rafiei, S. (2012). Design, formulation and evaluation of nicotine chewing gum.

65. Russell, C., McKeganey, N., Dickson, T., & Nides, M. (2018). Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA.

66. Government of Canada. (2019). The risks of vaping.

67. Institute of Economic Affairs. (2013). Free market solutions in health: The case of nicotine.

68. Government of Canada. (2017) Canadian Tobacco, Alcohol and Drugs Survey (CTADS).

69. Farsalinos, K., Polosa, R., Cibella, C., & Niaura, R. (2019). Is e-cigarette use associated with coronary heart disease and myocardial infarction? Insights from the 2016 and 2017 National Health Interview Surveys.

70. Adriaens, K., Van Gucht, D., Declerck, P., & Baeyens, F. (2014). Effectiveness of the electronic 
cigarette: An eight-week Flemish study with six-month follow-up on smoking reduction, 
craving and experienced benefits and complaints.

71. Nides, M., Leischow, S.J., Bhatter, M., & Simmons, M. (2014). Nicotine blood levels and short-term smoking reduction with an electronic nicotine delivery system.

72. Polosa, R., Rodu, B., Caponnetto, P., Maglia, M., & Raciti, C. (2013). A fresh look at tobacco harm reduction: the case for the electronic cigarette.

73. Shahab, L., Brose, L.S., & West R. (2013). Novel delivery systems for nicotine replacement therapy as an aid to smoking cessation and for harm reduction: Rationale, and evidence for advantages over existing systems.

74. Polosa, R., Rodu, B., Caponnetto, P., Maglia, M., & Raciti, C. (2013). A fresh look at tobacco harm reduction: the case for the electronic cigarette.

75. Institute for Safe Medication Practices. (2008). QuarterWatch Report: Strong Safety Signal Seen for Chantix (Varenicline).

76. Dawkins, L. (2013). Why is it so hard to quit smoking?

77. Farsalinos, K., Spyrou, A., Tsimopoulou, K. et al. Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices.

78. Farsalinos, K., Spyrou, A., Stefopoulos, C. et al. Nicotine absorption from electronic cigarette use: comparison between experienced consumers (vapers) and naïve users (smokers).