By Sairah Salim-Sartoni
Smoking remains the leading cause of preventable morbidity and mortality with its prevalence disproportionately affecting vulnerable populations.
Even though 60 per cent of tobacco users want to stop smoking, a proportion of them may not be able or do not want to stop using nicotine, and therein lies the challenge, because no one should have to die for their nicotine.
I have never liked using the term “smoker,” so in this article, I am going to refer to the smoking population as “Johnny” the name of my dear uncle who also battled with his tobacco addiction.
So, with that said, let me introduce you to Johnny, who smokes 20-30 cigarettes a day.
Every time Johnny smokes a cigarette, he inhales a dangerous cocktail of over 7,000 different chemicals, many of which cause cancer.
But the truth of the matter is that Johnny is not smoking for those 7000 chemicals… he is smoking for the nicotine, and hence why it is vital to ensure that less harmful nicotine alternatives are available for Johnny because one size does not fit all.
The facts on nicotine
According to the NHS and Royal College of Physicians, nicotine itself does NOT cause cancer, lung disease, heart disease or stroke, and has been used for many years in NRTs to help people stop smoking.
The main culprit has always been smoke, and if nicotine can be delivered effectively and acceptably to smokers without smoke, most if not all the harm of smoking can probably be avoided.
With that in mind, does it make sense to consider alternative nicotine products to support Johnny’s quit attempt?
Vaping is the most common nicotine alternative product and has become the most popular method of quitting in the last five years, so it is worth looking at data.
Are vapes less harmful than smoking?
Now, if you only get your news about vaping from the media, you could be excused of believing that vapes are just as bad as smoking, and unfortunately, the media have probably succeeded because data shows that over 50 percent of adults in the UK now believe this is the case.
However, vaping research on regulated vapes tells a different story as we now have high confidence evidence from systematic reviews (on safety) conducted by the Cochrane group and King’s College London concluding vapes to be “substantially less harmful than smoking.”
But it is important to understand that they are not risk-free, so the message from DHSC is “If you don’t smoke, don’t vape.”
Fortunately, this area of research is plentiful so updates on safety will be produced quite regularly.
So, can vapes help Johnny to stop smoking? Data from systematic reviews on effectiveness report that there is high certainty evidence that nicotine vapes are effective smoking cessation tools and this data coupled with the safety review data provided NICE with enough evidence to class vapes as a smoking cessation intervention within their guidelines for treating tobacco dependence.
This then paved the way for DHSC’s infamous “swap to stop” scheme that is providing free vape starter kits via stop smoking services in England.
In fact, it was vaping that ended Uncle Johnny’s 40-year battle with tobacco!
Oral nicotine products (ONPs) are relatively new to the market (2021), the most common being nicotine pouches and more recently nicotine strips.
It is still early days, and data is limited, but there are indications according to Professor Neil Benowitz that pouches may be beneficial for both smoking and vaping cessation, and their harms are likely to be less than any vaping product and of course smoking.
As I have said before, one size does not fit all. Some patients may want a heated vape like Neafs that provides more of a familiar experience, others may prefer the flavour of traditional vapes, while some may want to avoid inhalation altogether and go for ONPs and that is why a menu of alternatives is needed to cater for individual preference, dependence and situational need.
But with so many products on the market to choose from, selecting vapes or ONPs can be a daunting process to navigate in terms of safety and quality.
That is why my current focus is to try to address this task by collating a selection of trusted novel nicotine products.
The main selection criteria are that they need to be toxicologically tested, have child-resistant features whilst not appealing to youth, have full product traceability, and be independent from tobacco companies.
My aim is to build trust in less harmful smoking alternatives, whilst making the process easier for people who are recommending these products to help people quit tobacco usage for good.
Support is on hand
As a health psychologist who has worked in tobacco addiction for over twenty years, I have made it my life’s mission to ensure that less harmful nicotine products can be accessible for those wanting freedom from tobacco addiction.
For those who can stop or reduce their smoking significantly, it can be both a life-changing and a lifesaving achievement.
Indeed, “Every Contact Counts” as an opportunity to ask someone about their smoking and a variety of high-quality consumer nicotine products “count” as well to ensure they have trusted alternative products to choose from as one size does not fit all.
Supporting you to navigate this area is the first step that we take together in providing additional tools that will empower your patients to achieve their smoke-free goals.
Sairah is a chartered health psychologist with over 20 years of experience within the smoking cessation, public health and tobacco harm reduction sector. She is currently the managing director of Salim-Sartoni Associates (SSA) which provides scientific/clinical and regulatory engagement services and training support for healthcare professionals on tobacco harm reduction and smoking cessation.
