Can Vaping Help People Quit Smoking? It’s a Fact

 

Simon Chapman, emeritus professor in public health at the University of Sydney in Australia, is a long-time anti-tobacco activist and frequent contributor to The Conversation, which bills itself as “the world's leading publisher of research-based news and analysis.”  Undercutting that claim is a May 3 article Chapman authored, titled, “Can vaping help people quit smoking?” Chapman predictably answered that “It’s unlikely.”

His vaping analysis in support of that finding is grossly flawed.

Chapman starts with the “Myth of ‘hardened smokers’” -- “die-hard addicts: frequently relapsing smokers who just can’t quit.”  He asserts that their existence is a myth because the “average number of cigarettes smoked per day would be rising.”  That number has, in fact, fallen, but for entirely unrelated reasons, such as the imposition of a range of barriers to smoking, both social and economic, over a period of 20 years.

Chapman follows with a sweeping statement: “In other words, there is no evidence long-term smokers are impervious to the suite of tobacco control policies and campaigns that have driven hundreds of millions of smokers around the world to quit.”

No evidence?  There is definitive evidence: 480,000 dead smokers every year in the U.S.

Next, Chapman says that “Vapes don’t help smokers cut back.”  He’s talking about smokers who also vape, and there may be some truth in that, but the larger reality is that Chapman and his anti-tobacco allies in government and academia have been waging for years a very successful misinformation campaign, convincing smokers that vaping is as, or more dangerous than smoking.

Chapman asks how effective vapes are for smoking cessation, and answers with this: “The most recent Cochrane review of randomised controlled trials compared vaping with nicotine replacement therapy (such as drugs, gums and patches). It found about 82% of people who vape are still smoking when followed up six or more months later.  This was better than those using nicotine replacement therapy: 90% were still smoking.”  That answer is both humorous and revealing.

It’s amusing because I have made the same claim about medicinal nicotine for decades, and I agree that “trials also poorly reflect the ways vapes and nicotine replacement therapy are used in the real world and aren’t representative of all smokers wanting to quit.” (here)  In fact, population success with medicinal nicotine is only 7%.  But his answer is also revealing, since his point that 82% of those vaping are still smoking means that 18% quit with vapes, compared with only 10% relying on nicotine medicines.  Why would anyone deny smokers, who could be facing life-threatening illness, the option to quit by vaping?

Chapman posted his article in support of Australia’s crackdown on access to vaping products. Clearly, that government initiative and his pseudo-scientific analysis are woefully flawed.

 

Facts About Safer Smoke-Free Products Are “Somewhere,” But Not at the FDA

 

I recently came upon the FDA website “Nicotine is Why Tobacco Products Are Addictive.”  The section “What Makes Tobacco Use Harmful” starts with partially truthful information: “Nicotine is what keeps people using tobacco products. However, it’s the thousands of chemicals contained in tobacco and tobacco smoke that make tobacco use so deadly.” [emphasis in original].

That’s not too bad, although agency officials know that the thousands of deadly chemicals are present only in smoke, not tobacco.  Then they get more specific. 

“Combustible products, or products that burn tobacco, are the most harmful. An example of a combustible product is cigarettes, which deliver more than 7,000 chemicals along with nicotine that makes it hard to quit.

“FDA-approved nicotine replacement therapies (NRTs), such as gums and lozenges, are the least harmful.”

Then it gets awful, as the guidance turns to noncombustible, or smoke-free tobacco products.

“Noncombustible products, such as heat-not-burn tobacco products, smokeless tobacco, and e-cigarettes, fall somewhere in between combustible products and NRTs.”

Somewhere?

The FDA has hundreds of scientists on staff and has funded research by thousands more at universities across America.  This federal agency is responsible for regulating the entire tobacco industry, and it sets precedents for tobacco regulation worldwide.  It claims to act only on the basis of hard science, yet it feigns ignorance about where the risks fall for smoke-free products.

This farcical position is undermined elsewhere on the webpage where the agency acknowledges that “many studies suggest e-cigarettes and noncombustible tobacco products may be less harmful than combustible cigarettes.” 

Those studies do more than suggest.  Britain’s Royal College of Physicians has stated for years that smoke-free products are at least 95% less hazardous than cigarettes – a fact that anti-tobacco zealots consistently ignore.  The FDA’s response is always “more research is needed,” though for this agency, there will never be enough.  Regulators know the facts, but they refuse to share them with smokers and their loved ones as smoker deaths continue to mount.

 

 

For Smokers With Schizophrenia: The JUUL in the Crown

 

The vast majority of people with mental illness also smoke – a lot.  In fact smoking, which delivers to tortured brains the soothing drug nicotine, is considered by many sufferers, and their doctors, as not optional.

More than 60 percent of schizophrenia patients are current smokers (here), but hope may be found in a small open-label Italian clinical trial, reported by Pasquale Caponnetto at the University of Catania and his colleagues.

Caponnetto et al. recruited 40 people with schizophrenia who did not intend to reduce or quit smoking; they were given JUUL e-cigarettes and pods for 12 weeks.  Caponnetto found that 16 subjects had quit smoking over that period, and 21 others had reduced their cigarette consumption from a median of 25 before the trial, to 10.  At the final six-month follow-up visit, when all participants had been purchasing their own tobacco products for three months, 14 had quit smoking.

This study demonstrates that e-cigarettes can be an aid to cessation or reduced consumption for people with schizophrenia who don’t intend to give cigarettes up.  There is one caveat.

Caponnetto used full-strength JUUL pods – also sold in the U.S. – which contain 59 milligrams of nicotine per milliliter of e-liquid.  The researchers probably obtained special permission from regulatory authorities as the European Union limits e-liquids to only 20 mg of nicotine per ml.  It is likely that smokers with mental illness require higher doses of nicotine in cigarette substitutes.

I am reminded of a short article published in the American Journal of Psychiatry in 2005 (reference here):

“Ms. A, a 52-year-old woman with schizoaffective disorder, bipolar type, started smoking shortly after her first psychotic episode at age 19 and, on average, smoked about 1½ packs per day for 33 years. She had attempted to quit using pharmacotherapy, nicotine gum, or patches in combination with cessation classes. Both gum and patch treatments were ineffective since they did not control her craving for cigarettes.

“Her motivation to quit was strong because of the sequelae of smoking: bronchitis, isolation from others, and destabilization of her psychiatric illness from frequently awakening to smoke. Her brother with a bipolar disorder had experienced severe burns over most of his body and died secondary to a fire caused by his smoking. For her, smoking had become a constant reminder of his suffering, which led to nightmares and further isolation. She was afraid to jeopardize the health and safety of others.

“One year ago, she was cross-titrated over a 1-week period to oral pouches. Since that time, she has not resumed smoking, and her psychiatric and medical symptoms have stabilized. Before her cessation of smoking, she lived an isolated existence. Now she resides with and cares for her parents. For Ms. A, ceasing to smoke was a life-changing event.”

Doctors in 2005 successfully switched a patient with severe mental problems from cigarettes to smokeless tobacco, citing two of my studies (here and here) as the scientific basis for their humane and “life-changing” guidance.   

Now, doctors in Italy have produced life changing evidence that patients with schizophrenia can successfully switch to JUUL.