Australia’s 300,000 vapers were shocked, angry and frightened last week when the Health Minister announced a ban on importing nicotine liquid into Australia with two weeks’ notice and a penalty of AUD$220,000 per offence.
Vapers who had struggled to quit smoking for years and finally found a safer alternative faced the repulsive choice of going back to smoking or purchasing nicotine on the blackmarket. Chat groups were flooded with distressed vapers and panic buying was unprecedented. Retail shops were expected to close.
This was a potential disaster for public health. I saw 15 vapers the next day. Thirteen said they would revert to smoking if they could not get nicotine. Some would try to quit and the rest would seek nicotine on the blackmarket.
Australia has long been the only western democracy to ban the sale and use of nicotine for vaping. Importation for personal use has been allowed if the user has a doctor’s prescription. However, prescriptions are very hard to get and vapers have been illegally, but safely, importing personal supplies for years.
Covid-19 has surely been challenging for all, and though we have now hopefully crossed the peak, we will be seeing its implications for many months or even years to come. We are already seeing the negative impact of the lockdown and economic uncertainty on society’s mental health. Stress and boredom are known triggers for increased smoking and this is likely to predispose people to more addictive behaviours such as smoking and drinking alcohol. In these unprecedented times, we need to pre-emptively support smokers stay away from smoking more, and ex-smokers from relapsing back to smoking.
Despite the UK being at the forefront of global tobacco harm reduction policies, the gap between policy and practice remains massive, from even before the Covid-19 pandemic. Though UK’s national guidelines support long term use of safer nicotine to help people stay away from smoking, clinicians hesitate to recommend the use of stop smoking aids like dual NRT therapy or e-cigarettes for tobacco harm reduction. In times when media stories often don’t give the real picture of safety of these stop smoking aids, people usually rely on influencers like their doctors to give a final verdict on the safety of a product. Multiple surveys have shown that significant number of health care professionals are still confused about the role of nicotine and tobacco harm reduction in smoking cessation. If healthcare professionals are confused then that translates into creating a doubt in smokers’ minds. This in turn can result in smokers not trying a quitting tool like e-cigarette, and vapers constantly being at a risk of relapsing back to smoking, especially in stressful times like the Covid-19 pandemic.
As a practising GP and a firm believer in preventive medicine, I have been involved in upskilling GPs and other clinicians on smoking cessation around the world. I have seen that when accurate information reaches them in a practice-friendly way from another clinician, they are very receptive and supportive of helping their patients quit smoking and manage cravings using the harm reduction principle.
In these times of global emergency, I know how busy the healthcare professionals are. Hence, I and my team at the Centre for Health Research and Education (CHRE, www.chre-uk.com) have been working overtime to empower clinicians by creating easy-to-use infographics and starting telephonic smokefree advice lines for mental health staff. The infographics were recently published by the Royal Society for Public Health on their website for wider dissemination and are already very well received by clinicians across the UK.
We continue our work in this, mindful that whether a harm reduction tool is a prescription medication or not, if health care professionals are not empowered with the scientific evidence, there will always be a risk of a country’s policy not translating into practice. Smoking will continue to take its toll globally unless this is addressed. As healthcare systems and professionals continue to buckle under the pressure of Covid-19, lets ensure that going smokefree does not get forgotten!
Dr Pooja Patwardhan
GP, and Clinical director
Centre for Health Research and Education
Over half a billion smokers live in Asia, and Asian countries have some of the highest per capita smoking rates – and some of the highest numbers of smoking-related deaths – in the world.
Given the staggering damage to its citizens’ health that smoking is responsible for you’d think that regional governments would be eagerly embracing any less harmful alternatives such as vapes and heat-not-burn (HNB) devices to encourage people to wean themselves off conventional tobacco products.
Last week was hot in Seoul. Not just with the outdoor temperatures exceeding 30oC, but also with clear voices of over 100 experts from 18 countries gathered at the 3rd Asia Harm Reduction Forum (AHRF), calling to use the opportunity we have to save 20,000 people dying each day from smoking.
Put yourselves in the shoes of a parent (if you're not already one). You read in the papers about a teenage vaping epidemic. There's a good chance you're one of the many people in the UK who think vaping is just as bad as smoking, and you've already been told that electronic cigarettes are a gateway to smoking cigarettes.
As I see it, currently the Tobacco Harm Reduction (THR) and e-cigarette policy scene continues to evolve in a direction that will result in substantially more tobacco-related addiction, illness and death, than what would likely occur with the skilled addition of a THR component to tobacco control programming. A THR component could highlight e-cigarettes and related vapor devices as harm reduction modalities, recognizing the evidence to date as to their efficacy for smoking cessation and for diversion of teens away from a lifetime of nicotine addiction.
Keeping up to date with the proceedings of the World Conference on Tobacco or Health, in Cape Town recently, I was reminded of the wonderful film, directed by Richard Attenborough - ‘Oh what a Lovely War!’ - which summarises and comments on the events of the First World War using popular songs of the time, many of which were parodies of older popular songs, and using allegorical settings such as Brighton's West Pier to criticise the manner in which the eventual victory was won.
In the Orwell classic Animal Farm there was a binary notion that the animals lived by – “four legs good, two legs bad”. This eventually morphed into “four legs good, two legs better” as the pigs who became the lead animals began walking on two legs like the evil farmer they had replaced.
Binary thinking has a role in areas like engineering where unless a bridge or building is a certain strength it may fall down. However human biology is not quite as amenable to this approach. Notwithstanding that we are all similar, no two people (even identical twins) are exactly the same.
Significant progress has been made in reducing smoking prevalence within the United Kingdom but the benefits have not fallen fairly across all groups. Smoking rates amongst those with personal incomes under £10,000 per annum is more than double of those with incomes over £40,000. However, there are other groups with rates higher still, for example people experiencing mental ill health have a smoking prevalence rate double the population average. Amongst those who are homeless or rough sleeping we see even higher rates, in many instances services report that all their clients smoke.
We already know the benefits to a smoker when they leave smoking behind; vapers are keen to tell us the benefits they accrue. Empowering smokers to transition to these safer products is a huge source of pride for those of us who work in the independent vape industry.
A myriad of studies, evidence reviews and now, replications of previous flawed research, all reinforce that vaping is far safer compared to smoking. The research by institutions such as the Royal College of Physicians, London, Public Health England, St Andrews University in Scotland, Cancer Research UK and many others continue to inform just how much safer. Long term studies by Professor Riccardo Polosa’s team at the University of Catania in Italy even found that smokers with asthma and COPD can reverse the harms caused by their smoking once they switch to vaping. This is all very good news.