Quitting cigarettes is one of the hardest things to do, as many former and current smokers know from painful personal experience. Public health and politicians must do better to help smokers quit. 700,000 deaths per year in the EU should be enough of an incentive to make us rethink our current approach.

To effectively help smokers quit for good, three conditions must be met:

Firstly, smokers must be able to choose from as many options as possible to find out what smoking cessation method works best for them. People are different, and therefore different ways to give up smoking must be made available and affordable. For very few people (less than 4%), quitting with no help works. For a few, nicotine replacement therapy (such as nicotine gums or patches) works, and it turns out that for many people, new nicotine alternatives help them with quitting smoking once and for all. Those products range from vaping and heat-not-burn products to snus or nicotine pouches. What all these new forms have in common is that they separate nicotine consumption from the combustion of tobacco (which produces the vast majority of the toxicity of smoking), making them far less harmful than smoking cigarettes. Each one is different, each working best for each different person.

62% of smokers in France and 53% in Germany believe anti-smoking policies ignore how difficult it is to stop smoking. Clearly, smokers are not satisfied with traditional cessation methods and therefore look to vaping as a means of quitting

Secondly, we need a modern, open regulatory framework to fit these new alternatives. These new products are not the same as smoking. Hence, they must not be painted with the same regulatory brush. What we need instead is risk-based regulation. Vaping is 95% less harmful than smoking and, therefore, must not be treated the same way. Harm reduction must become a centrepiece of anti-smoking policies, like in the field of pharmaceutical drugs. Harm reduction follows practical strategies and solutions to reduce harmful consequences associated with using certain substances instead of an unrealistic `just quit´ approach. Encouraging smokers who are not able to or don’t want to quit smoking to switch to vaping is a best-case example of harm reduction.

Thirdly, smokers must have accurate information about the potential risks of different products to make decisions. The same applies to medical professionals who are working with those smokers. They need to know the facts to make a lasting difference for smokers.

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The Consumer Choice Center, together with World Vapers’ Alliance, recently presented a new survey conducted with 30 general practitioners and over 800 smokers in Germany and France – with an initial piece of good news: more than half of respondents want to quit smoking!

Awareness of the health effects of smoking tobacco has grown exponentially over the last decades, prompting policy-makers to make rules to curb usage. However, just like any vice that carries risk, prohibitive and strict measures have not yielded the desired results.

Standard nicotine replacement therapy (NRT) is recognised, observed, and covered by social security systems, despite showing very limited effects in the efforts of helping those who choose to quit, do so. Vaping has presented consumers with the opportunity to satisfy the need for nicotine, all while posing a fraction of the harm. Vaping is 95% less harmful than using conventional cigarettes, and is simultaneously the most successful smoking cessation tool.

Knowing all this, we can say that vaping is to nicotine use what seatbelts are to driving or what condoms are to sexual encounters: while it may be safer to not use nicotine at all, not drive a car, or not have sex, it is crucial to apply harm reduction. Since the invention of the first e-cigarette in 2003, vaping has come a long way in offering a choice to smokers who wish to quit, and has done so with far less risks involved than cigarettes.

Unfortunately, accurate reporting on vaping is sometimes hard to find. A lot of readers might recall the spike in EVALI (E-cigarette, or Vaping Product, Use Associated Lung Injury) cases in the United States in 2019, which was blamed on vaping. To this day, these cases have disincentivised smokers from switching, even though it has been shownthat affected users had been consuming THC-containing e-liquids from the illicit market. Unbeknownst to buyers at the time, vitamin E acetate had been added to those liquids, with fatal consequences for those who consumed them. All the story really did was underline the importance of a regulated and legal market for vaping products, which prevents leaving the market to bootleggers.

When advocating for harm reduction, organisations such as ours don’t just run into media scare stories, but also into widespread misconceptions. The CCC/WVA survey showed that 33% of smokers in France and 43% in Germany believe vaping is as harmful or more harmful than cigarettes. The erroneous beliefs on nicotine stretch even further: 69% of smokers in France and 74% of smokers in Germany believe nicotine causes cancer, which is far removed from the scientific evidence. Experts on nicotine have long known this, yet the information has not permeated to the public, to politicians, or to general practitioners.

Doctors are essential change-makers when it comes to the unhealthy habits of their patients. However, our survey has shown that too many doctors share ill-informed views on nicotine, or aren’t even aware of the concept of harm reduction. As a result, most doctors do not recommend vaping as a smoking cessation tool. Their views on nicotine (they often believe it causes lung damage) is also fundamentally incoherent: if nicotine were to cause lung damage, why would doctors recommend NRTs, all of which contain nicotine?

Tobacco harm reduction has a long way to go before reaching the ambitious targets of large-scale smoking cessation. Information is therefore crucial: the demonisation of the most successful harm reduction tool needs to stop, and so do punitive rules and regulations. Vaping ought to be at the core of any upcoming policy changes designed to curb tobacco consumption, instead of being the target of overtaxation.

Originally published here

Public health officials and those with significant sway in setting health policy were joyous last month when the Food and Drug Administration denied the ability of Juul Labs to continue selling its vaping device.

Handed down as a Marketing Denial Order, the decision forces gas stations, retailers and vape shops to pull Juul devices off the shelves, depriving consumers of their ability to buy these products through legal means.

Though the company has won a temporary stay by the D.C. District Court of Appeals, the FDA’s recent “nicotine zero” mandate — including limits on nicotine in cigarettes and bans on menthol tobacco products — shows the administration won’t back down on its plans to reduce nicotine consumption.

But that would be a real missed opportunity for public health.

Rather than banning consumer products or setting rigorous — if not impossible — standards for getting vaping products to market, the FDA could follow the president’s rhetoric and endorse tobacco harm reduction as an alternative.

As a matter of public health, harm reduction is one of the key pillars of President Biden’s National Drug Control Strategy, as he revealed in this year’s State of the Union address. This includes education, support, clean needle exchanges and safe injection sites for those addicted to drugs like heroin and other prescriptions. If this path is virtuous for those addicted to opioids, why shouldn’t it be the same for those addicted to nicotine, as practiced elsewhere?

The United Kingdom not only recognizes the benefits of vaping devices but actively recommends them in their own materials and the National Health Service, their state health system, championing the 1.2 million British vapers who have now quit smoking. Health wards in New Zealand routinely offer vaping products to patients.

If the United Kingdom and New Zealand can cite various studies and health surveys demonstrating that vaping devices are 95 percent less harmful than smoking, why does this evidence fail in crossing the ocean to American regulators?

If the latest Gallup polls are believed, 6 percent of Americans are vapers, most of whom make less than $40,000 yearly. That is the equivalent of 20 million vapers who have chosen a less harmful product to quell their nicotine cravings.

Twice that number —nearly 40 million — are still smokers, according to the CDC. Pivoting to a harm reduction strategy could easily save millions of lives.

That includes recognizing the vape shop owners, passionate vaper community groups, and tobacco control professionals who have come to rely on an entire industry of vaping products as a more effective strategy in eliminating the harms of tobacco.

Those who applaud the administration’s actions on Juul point to the company’s past advertising to youth and the higher uptake of young people to vaping devices. These are troubling situations that deserve careful consideration, public scorn and action, especially considering the effects of nicotine on adolescent brains.

That said, rather than mitigating these harms to young people and addressing them properly, why are we so quick to abandon 40 million smokers from the opportunity to switch to a less harmful product to satisfy their addiction?

Most vapers enjoy products from a competitive marketplace of open tank systems, disposables and pod tanks far from the grip of any tobacco executive. This point is often overlooked in the public debate on vaping.

If the pandemic taught us anything about public perceptions of risk, it is that we must empower individuals to make decisions to improve their own situation rather than making it for them.

Thwarting adult consumers’ ability to choose a healthier option is denying the genuine health benefits that come with embracing harm reduction.

We have laws for a reason, and they should be enforced to keep vape devices away from the hands of youth. Education and strong parental supervision would do wonders in keeping a generation from addiction.

But completely abandoning the prospect of a smoke-free society would be a folly, and it’s time our public health officials admit it.

Originally published here

Heavy-handed vaping regulations and taxation do nothing but create more smokers

Health Canada announced last week that warning labels will now be required on each and every cigarette in a pack. That global first is part of Canada’s goal to have fewer than five per cent of Canadians smoke by 2035. It’s hard to tell what effect similar measures have had in the past but for whatever reasons tobacco use in Canada has been on a significant decline over the last 15 years. In 2007, 31 per cent of Canadians identified as regular smokers. By 2020, that number was down to just 11 per cent. That’s certainly good news. We all know the devastating impact smoking can have. Approximately 48,000 Canadians die each year from tobacco-related illnesses.

But while the decline in smoking is cause for celebration, new vaping regulations from Ottawa could actually run counter to Health Canada’s smoke-free 2035 goal by pushing some former smokers back to smoking.

Vaping, which is nicotine consumption without the combustion of cigarettes, is dramatically less harmful than smoking, and is therefore widely considered a useful harm reduction tool for smokers trying to quit. A 2017 study from researchers at the University of California found that U.S. census data showed vaping had contributed to a significant increase in smoking cessation. It therefore recommended positive public health communications supporting vaping. That’s the approach being taken in England, with positive results. After Public Health England deemed vaping 95 per cent less harmful than smoking, the U.K. Office of Health decided to promote vaping to adult smokers as part of the country’s own plan to be smoke-free by 2035. It has even created a “swap to stop” program in which smokers can trade in their cigarettes for free vaping devices.

Unfortunately, Canada’s approach to vaping does not embrace harm reduction in the same way the U.K.’s does. Where narcotics and other drugs are concerned, harm reduction is the order of the day in Ottawa. But when it comes to tobacco products, for some reason eradication is still the goal. Thus Ottawa has already sought to ban all vape flavours except tobacco and mint/menthol — even though nearly half of Canadian vapers use flavours as their preferred method to leaving smoking behind, and for good reason. A nationally representative longitudinal study of over 17,000 Americans showed that adults who used flavoured vaping products were 2.3 times more likely to quit smoking when compared to vapers who consumed tobacco-flavoured vaping products. Why is not hard to understand. If you are trying to quit tobacco, being limited to vaping products that taste like tobacco isn’t very helpful.

But Ottawa isn’t just targeting vape flavours. Now it’s also scaling up taxation. The new tax it proposed in April’s budget would add $7 to the price of a 30mL bottle of vape liquid, $10 for a 60 mL bottle, and $14 for a 100 mL bottle. For those who vape with cartridge devices, a four-pack of one-millilitre cartridges, which usually retails for between $24-$26, would have an extra $4 tacked on.

What will be the effect of these tax hikes?

Vape prices are very likely to rise. A 2020 working paper published by the National Bureau of Economic Research that analyzed data from 35,000 U.S. retailers found that for every dollar increase in taxation vape prices rose between $0.91 and $1.16, meaning that the tax is almost entirely passed on to consumers. For a four-pack of one-millilitre cartridges, prices can be expected to increase between $3.64-$4.64.

And how will vapers respond to these price hikes? Many will go back to smoking. That same NBER study showed that a $1 increase in vape taxes increased cigarette sales by fully 10 per cent.

From a public health perspective this is exactly the wrong approach. We know that vaping is a very useful harm reduction tool. Targeting vaping with flavour bans and high taxation will certainly discourage people from vaping but it will also encourage some former smokers to go back to cigarettes and keep some current smokers from switching to vaping. If Canada wants to have any shot at achieving its smoke-free 2035 goal, we should follow the U.K.’s lead and incorporate vaping as a means to that end. Heavy-handed vaping regulations and taxation do nothing but create more smokers, and no one wins if that happens.

Originally published here