Evidence Is In on Vapes as Smoking Cessation. Now We Need Urgency.

    In a comment published in Nature Medicine, four leading researchers marshal the evidence that vapes can be used as a smoking cessation tool. Professors Neal Benowitz, Ann McNeill, Nancy Rigotti and Kenneth Warner begin by citing the Cochrane Database of Systematic Reviews that concluded: “There were high rates of certainty that [smoking] quit rates were higher in people randomized to nicotine [electronic cigarettes] than those randomized to nicotine replacement therapy.”

    It contains an important section that details governmental support for vaping in the United Kingdom and New Zealand.

    This makes sense because vaping devices deliver nicotine much faster than patches or gums, and mimic the pleasurable rituals of smoking. Now, according to the United States Centers for Disease Control and Prevention, people who smoke are more likely to use vapes in quit attempts than any other products, including smoking cessation medications. And this is happening even as misinformation and junk science about vaping aboundas well as frenzied attacks by organizations like the Campaign for Tobacco-Free Kids, Truth Initiative and Parents Against Vaping E-Cigarettes.

    The comment contains an important section that details high-level, governmental support for vaping in the United Kingdom and New Zealand. Both countries are light-years ahead of the US in advocating the use of vapes and focusing on vulnerable populations with the highest smoking rates, like unhoused people, people with mental health diagnoses and Indigenous populations. In government-funded stop smoking campaigns, both countries enthusiastically recommend vaping and advise health care providers to counsel patients to try it. Some mental health hospitals in both the UK and New Zealand have vape shops located inside, to make the transition from smoking to vaping easy and convenient.

    Most health care providers in the US, on the other hand, are vehemently opposed to tobacco harm reduction (THR). They wrongly believe, despite the FDA authorizing several vapes as “appropriate for the protection of public health,” that there is insufficient evidence that vaping helps people quit smoking. Many don’t accept that vaping is vastly safer than smoking cigarettes, either.

    The comment includes a table that contains guidance for health care professionals to help people quit smoking with vapesa valuable resource when research has shown, incredibly, that 80 percent of US physicians believe nicotine directly causes cancer.

    The comment would have been much stronger if the four authors had included a call to action emphasizing the deadly consequences of not endorsing the evidence-based intervention of vaping. Instead they ask for “greater consideration to the potential of e-cigarettes for increasing smoking cessation.” That tone is too cautious and lacks the required urgency.

    Vaping devices—together with other THR optionsare the closest thing we have to a magic bullet. Our urgent task is to get them into the hands of people who smoke.

    Almost half a million people die from smoking-related diseases every year in the US. It is the epidemic that no one talks about anymore. The evidence is in, and health care providers have a critical role to play in helping patients quit. It should be considered malpractice if they don’t recommend vaping.

    The comment should also have driven home the point that access to safer nicotine products is about the right to health.

    The authors write, “E-cigarettes are not the magic bullet that will end the devastation wrought by cigarette smoking but they can contribute to that lofty public health goal.” This massively understates how vaping can prevent so much smoking-related suffering, has already reversed harm from cigarette smoking, and has saved millions of lives around the world by enabling people to quit.

    Vaping devices—together with other THR options like oral snus and heated tobacco productsare the closest thing we have to a magic bullet. Our urgent task is to get them into the hands of people who smoke.



    Photograph by Lindsay Fox/E-cigaretteReviewed via Wikimedia Commons/Creative Commons 2.0

    • Helen is Filter‘s senior editor and a multimedia journalist. She is on the methadone, vaping and nicotine train. Helen is also a filmmaker. Her two documentaries about methadone are Liquid Handcuffs and Swallow THIS. As an LCSW, she has worked with people who use drugs for over two decades. Helen is an adjunct assistant professor and teaches a course about the War on Drugs at NYU. She lives in Harlem.

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