Originally published on Australian Doctor.
Written by Colin Mendelsohn, UNSW Associate Professor and Tobacco Treatment Specialist.
Vaping with nicotine has the potential to save the lives of thousands of Australian smokers each year, but they are currently banned in all states and territories. However, many health experts across the world now support their use.
Public perception and warnings from public health agencies — including the AMA’s new position statement — are against their use in smoking cessation. I believe this does not reflect the growing evidence that vaping is effective and safe aids to quitting smoking or reducing tobacco use. While there is still much to learn about e-cigarettes, many health experts and organisations across the world now support their use.
Last year, the UK saw a shift in thinking on their use in healthcare settings, with smoking cessation and public health organisations moving to recommend them. In line with this, vaping has now been licensed in the country that will be subsidised by the National Health Service, allowing it to be prescribed by doctors for free.
The change in thinking came with the release of an independent review of the evidence on vaping by an expert panel commissioned by Public Health England. The panel concluded vaping was at least 95% less harmful than smoking. Meanwhile, another UK study found vaping combined with counselling and other pharmacotherapies, such as varenicline and nicotine replacement therapy, improved smoking cessation outcomes.
However, here in Australia, there are still concerns about their safety and the public health threats that may evolve with their widespread use. For example, it is claimed that they could act as a gateway to smoking for children, although there is no evidence to support this. Many of the surveys that have found an association between vaping and smoking have been misinterpreted as showing a causal link. Whereas, in truth, all they really demonstrate is that young people and adults who smoke are
more likely to experiment with e-cigarettes.
In the UK and US, regular use by children is rare and is almost entirely confined to current or past smokers. Among adults who had not smoked previously, only 0.2% currently vape. There is also no evidence they normalise smoking. Further, as the use of e-cigarettes has grown in both countries, smoking prevalence has continued to fall and is now at an all-time low.
In light of all this, I think that there is sufficient evidence to support the use of vaping for selected smokers in general practice. The Australian Association of Smoking Cessation Professionals already endorses their use for those who are unable, or unwilling, to quit with approved first-line therapies. I believe it is time for GPs to
I believe it is time for GPs to familiarise themselves with the available devices and solutions so they can properly advise their patients. Despite not being available on the PBS, GPs can write prescriptions that allow patients to legally import and use nicotine solutions for smoking cessation under the TGA Personal Importation Scheme.
In conclusion, I believe e-cigarettes are safe and effective, and present another valuable tool to help smokers who are otherwise unable to quit.
Dr Mendelsohn is a tobacco treatment specialist in Sydney and immediate past Vice President of the Australian Association of Smoking Cessation Professionals.