“I Rarely Vape Until Cocktail Hour”—Patt Denning’s THR Journey 

    Dr. Patt Denning has been a leading harm reduction advocate for over 30 years. A co-founder of the Harm Reduction Therapy Center (HRTC) in Oakland/San Francisco, she is also a highly influential author. Her first book, Practicing Harm Reduction Therapy: An Alternative Approach to Addiction, redefined the field and was an instant classic. Her second—Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use, written with her partner Jeannie Little—also broke new ground and is a go-to guide for clinicians and people who use drugs.

    Denning and Little have educated thousands of people in the US and abroad through HRTC’s workshops. During the pandemic, HRTC parked its van at mobile drop-in sites, COVID-19 shelter-in-place hotels and COVID-19 Safe Camping Sites—providing free therapy, hot food and bottled water to the city’s most vulnerable residents. In a few months, they will open a new harm reduction-based drop-in center in San Francisco. Their tagline: Come as you are. Take what you need. Leave when you’re ready.

    Denning has worked with countless people who use illegal drugs and alcohol. But another focus for her is tobacco harm reduction (THR)—informed by her own experiences.

    “I practiced harm reduction for years. I would limit myself to how many [cigarettes] I could have a day—it was five,” she told Filter. “I told myself if I went over that, I would have to quit. And I didn’t want to quit. That lasted for years. Until it didn’t. My average for the last couple of years was probably a half a pack a day. Never got back up to a pack a day.”

    “My motivation to quit was not very high.”

    Denning realized something that many smokers do: They are ambivalent about quitting, despite all the nagging, shaming and warnings from friends, family, health care providers and public health organizations. Smoking’s “dirty little secret” is that it’s actually an enjoyable activity. The powerful rituals of smoking and the benefits of nicotine are such that many people don’t want to trade them for a life of abstinence.

    “The problem for me was that I really gave up on quitting smoking,” Denning said. “I had quit so many times. One time I quit for five years. That was the longest time. Sometimes I’d make it for a month or two, sometimes a week. It was just misery. And I thought, okay, I’m just going to die from fucking lung cancer. I’m not going to make myself miserable anymore. My motivation to quit was not very high. Maybe those products would have worked better for me if I was really trying.”

    About five years ago, at my urging, Denning gave e-cigarettes a try (full disclosure: She is a close friend). At first, she bought ones that were reminiscent of a real cigarette, with a tip that glowed red. “The first one I tried wasn’t very satisfying because it didn’t have enough vapor. It didn’t help me cut down on cigs. I kept at it for maybe a year, then gave up.”

    Next, she tried Juul’s pod system. “It was way too strong, I kept coughing.” When a lower-nicotine cartridge came out, she tried that, too. “But again, it wasn’t that satisfying.”

    Finding the right vape is almost never a one-and-done. It typically takes time and repeated experimentation to find the one that hits the sweet spot. Individual vapers will have completely different experiences of which products work, or don’t, for them.

    “Then I found a website; they had 40 million different kinds of products and I decided to try a disposable. I didn’t want to spend a lot of money buying a new vape that has a lot of start-up costs and then it just sits there.”

    When she tried it, “it was almost like smoking a cigarette. They taste like a cigarette, they pull like one, they have the same taste and feel of a cigarette. It was like, Oh my God, this is really great!”

    The rectangular shape of her chosen product, made by the lesser-known brand Zaero, took some getting used to, but she liked the “Virginia tobacco” flavor it came in—which is fortunate when the non-tobacco flavors that many vapers prefer have been hit by numerous bans.

    “I said to myself one day, ‘I wonder what it would be like to just vape?’ And I did, and I haven’t had a cigarette since.”

    “It has a good amount of vapor and it’s low in nicotine,” she said. “There are nicotine levels in several strengths, including zero, which I really like because it would be really cool to come all the way down and not be dependent on nicotine. And another benefit: With regular cigarettes I only smoked half of it and it felt like a waste of a cigarette. With a vape, I never feel like I’m wasting anything.”

    Like many smokers who switch, Denning was a “dual-user” for a while. This designation has elicited much criticism from THR opponents. It should not. Although some quit after using their first vape, most don’t. Continuing to smoke cigarettes and vape usually means the person is smoking less, similar to people who use a nicotine patch and keep smoking. Dual use is harm reduction and it doesn’t mean that a person can’t make a total switch. Denning did.

    “I said to myself one day, ‘I wonder what it would be like to just use Zaero for one day?’ And I did, and I haven’t had a cigarette since.” That was about five months ago. “I’m astonished. I would spend a lot of time out on the front porch smoking and I finally realized, ‘Patt, you can go out to the porch and vape.’”

    She established some vaping rules for herself. “I don’t carry an e-cig when I go out and I rarely vape until about 5 pm—cocktail hour.” Occasionally, she has cravings for a real cigarette. Her favorites always used to be “reward” cigs. “For example, I did a staff training and it went really well and afterwards in my car I immediately reached for where my cigarette pack would be. Damn, I would love a cigarette right now, but the feeling went away. What I’ve realized is how much of a physical habit it is to pick up a cigarette.”

    “I was freaked out when I heard that I wouldn’t be able to get my vapes shipped to me.”

    The war on nicotine has hit home for Patt Denning as it has for millions of people who vape. As a result of the increasing restrictions on mailing e-cigarettes through the United States Postal Service and other carriers, her supplier informed her that they could no longer ship to California.

    “I was freaked out when I heard that I wouldn’t be able to get my vapes shipped to me,” she said. “I don’t think of my vape as medicine but that was kind of the feeling. All of a sudden I thought, ‘I found the right medicine and you’re going to take it away from me.’ I felt that desperation I imagine people on methadone feel when there is a hurricane or something. I was mad and I thought it was stupid. I had a fear reaction: ‘Oh no, I don’t want to go back to smoking cigarettes.’”

    For a couple of months Denning had her vapes shipped to a friend in Illinois who then mailed them to her. It was yet another hassle and source of potential delay—on top of high excise taxes that were charged on every online order. She cancelled her regular online order, and is now trying to buy products directly from a store in the Bay Area.

    No one who wants to vape should have to encounter these kinds of obstacles. It is infuriating that it’s getting harder and more expensive to purchase vapes—one of the safest ways to use nicotine and the best intervention we know of when faced with the world’s biggest cause of preventable death—while it’s still fast and easy to buy cigarettes, which are for sale virtually everywhere.

    It still amazes Denning that she quit smoking. “Even as a lifelong, 4,000-year-old smoker, that I could accidentally replace cigarettes… That is a minor miracle to me. It makes me realize if I could have had something like this 10, 15, 20 years ago, I probably wouldn’t have smoked cigarettes for as long as I did. It would have saved me a lot of money and lung.” 

     


     

    Photograph of Patt Denning by Helen Redmond

    Juul Labs, Inc has provided unrestricted grants to The Influence Foundation, which operates Filter. Filter‘s Editorial Independence Policy applies.

    • Helen is the senior editor of Filter. She has written about nicotine, mental health and drug policy for publications including Al Jazeera, AlterNet, Harper’s and The Influence. As an LCSW, she works with drug users in medical and community mental health settings. An expert on tobacco harm reduction, she provides training and consultation on mental health, nicotine use and THR, and in 2016 organized the first Tobacco Harm Reduction Conference in the US. Helen is also a documentary filmmaker.

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