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Tobacco harm reduction in the UK: e-cigarettes (EC) are making a difference

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Tobacco harm reduction in the UK: e-cigarettes (EC) are making a difference

  1. 1. Tobacco harm reduction in the UK: e-cigarettes (EC) are making a difference Louise Ross • Freelance consultant at the National Centre for Smoking Cessation and Training • Former Stop Smoking Service Manager Leicester City Council • Vice-Chair, New Nicotine Alliance UK October 2019
  2. 2. Since No Smoking Day 2014, the Leicester City Stop Smoking Service has welcomed people who want to use EC/vaporisers to stop smoking. Many of these use NRT too The team have tackled the fact that they are not experts in vaping. They have worked hard to extend their knowledge. , and
  3. 3. Results? Results? With EC, success rates were up to 20% higher than with NRT alone. Many found a combination of EC and NRT (and even Champix) suited them well The service now supplies free EC starter kits and other services around the country having started to do the same.
  4. 4. Consistent success, year on year  2014-15 total  2,005 quits from 4,098  2015-16 total  1,920 quits from 3,718  2016-17 total  1,631 quits from 3,184  2017-18 total  1,479 quits from 2,753  2018-19 total  1331 quits from 2414  180 EC quits from 293: 61% success  487 EC quits from 752: 65% success  512 EC quits from 851: 60% success  573 EC quits from 917: 62% success  556 EC quits from 844: 66% success
  5. 5. Who says it’s safer or more effective?  Public Health England  Royal College of Physicians  Action on Smoking and Health  House of Commons Select Committee  National Centre for Smoking Cessation and Training  Cancer Research UK  Challenge Group on Smoking in Pregnancy ‘Vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits’ Public Health England 2018
  6. 6. The big myths: Health harms Fear of nicotine Smokers don’t know what’s best for them Gateway concerns Lack of evidence
  7. 7. Myth 1 - we don’t know about possible health harms • The people who we want to switch to vaping are already smoking • There are no products of combustion in EC vapour • It’s the tar and carbon monoxide in a smoked cigarette that cause the damage • The Popcorn Lung stories are made-up nonsense (but how they persist!)
  8. 8. Myth 2 – nicotine is highly addictive and toxic • Experience shows that once nicotine is used through vaping, levels needed to maintain comfort can be reduced • It’s the same nicotine that is used in patches and gum – it doesn’t get sanctified just because it’s medicinal • Many health workers, and the general public, still think nicotine is the most harmful chemical in a cigarette This Photo by Unknown Author is licensed under CC BY-SA
  9. 9. Myth 3 - smokers don’t know what’s best for them • Listen to people when they say vaping made a difference after they had tried everything else • Don’t tell them they have to either quit or, basically, die • Recreational nicotine is pleasurable as well as a relief from urges to smoke • Flavours are important to adults • Don’t tell them they’ve got to stop using their vaporiser as soon as possible This Photo by Unknown Author is licensed under CC BY-ND
  10. 10. Myth 4 - it’s a gateway to smoking There is NO evidence of this, and it’s being observed very closely by ASH, PHE, CRUK. With strict regulation, young people who have never smoked are NOT starting to vape in anything more than negligible numbers The gate would appear to swing the other way - out of smoking This Photo by Unknown Author is licensed under CC BY-SA
  11. 11. Myth 5 – There’s no evidence • It’s frequently claimed that ‘we don’t know enough about them’ • There’s more research about EC than probably any other health intervention, but some of it is poor quality and misleading • In the fast-moving world of harm-reduced products, listen to the consumers who say ‘This changed my life’
  12. 12. When you see someone vaping, celebrate the fact that they’re NOT smoking Without the smoke, getting nicotine from vaping is a good harm reduction strategy. Smoke kills, clean nicotine does not
  13. 13. EC: take-home messages  They’re not cigarettes and shouldn’t be treated as such in law  You don’t smoke them  Patients who have switched completely to vaping are ex-smokers  Don’t push them to come off vaping