So you want to give up smoking? E-cigarettes are being touted as the smoother way of kicking a tobacco addiction, but the jury is still out on whether this truly is the case. Part of the problem is medical studies aren’t keeping pace with a booming industry that’s busy developing new products.
“There are only a handful of randomised controlled trials and the earliest involved devices that have now been superseded by new technology,” says Professor Chris Bullen of the University of Auckland’s School of Population Health. “The newer, second-generation products are much better at delivering nicotine; some can deliver as much as the standard cigarette.”
Smoking e-cigarettes, known as vaping, has quickly grown in popularity, especially in the US and Europe, where there are many devices to choose from. They mimic real cigarettes by heating a solution (e-liquid) that usually contains a blend of nicotine, propylene glycol and flavourings, producing a vapour the user inhales.
“There are thousands of flavours to make the experience more attractive,” says Bullen. “Many people go with the tobacco flavour that most resembles their preferred brand of cigarette, but you can also get flavours like coffee and whiskey. In Europe, vape stores are on the main streets and are very slick, with beautiful products displayed in glass cases.”
In New Zealand it’s illegal to sell e-cigarettes as a tool to quit smoking. Although some devices are available in retail stores, any products containing nicotine can be imported only in small amounts for personal use, so there is a thriving online trade.
“What we do know is that most of these products, if they are decently manufactured, contain a lot less junk than cigarettes,” says Bullen. They produce neither carbon monoxide nor many of the other chemicals that are known carcinogens.”
Bullen carried out a trial in 2013 comparing e-cigarettes to nicotine patches, which showed similar rates of success in helping people quit smoking: 7.3% of the vapers and 5.8% of the patch wearers stopped. However, a subsequent population-based study from the University of California, San Diego School of Medicine found that smokers who used e-cigarettes were 59% less likely to quit than smokers who never used e-cigarettes.
“We found at six months that many people had become dual users,” says Bullen. “This raises big questions. Is it good just to cut down on cigarettes? Is it a pathway to quitting or might it actually delay it?”
He believes vaping has the potential to become a substitute for cigarettes – like the opioid medication methadone is for users of the drug heroin. “You may well keep your nicotine addiction ticking over and it may be a socially acceptable addiction like coffee or alcohol. We need to have a discussion as a society – is this a reasonable alternative?”
With e-cigarettes now a multibillion-dollar industry and tobacco companies buying into it, this seems a discussion we urgently need to have. Although proponents may claim that after only a few days of switching to vaping users notice all the benefits of quitting, from easier breathing to a better sense of taste and smell, the long-term effects of this method of filling the lungs with nicotine haven’t been proven.
“What happens if you vape 30 to 40 times a day over 30 years? No one knows what that does to your lungs,” says Bullen.
There is also a concern that flavours like bubble gum and chocolate may attract younger people to vaping, creating a whole new market, as well as questions over whether improving the delivery of nicotine is a good or a bad thing. “People may not have to puff as hard, but will they keep needing more nicotine or will they reach a level where it’s enough? That’s an unknown.”
Bullen is about to do another trial comparing new-generation e-cigarette devices with nicotine-replacement therapy. “We need more information so the Ministry of Health can decide how to regulate these products, and make sure they are as high quality and safe as possible.”
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