Royal College of Physicians continue to endorse vaping

In a recent opinion article the Royal College of Physicians (RCP) has once again expressed their support for vaping, highlighting the importance of ensuring that adult smokers are well informed about how switching to an e-cigarette can improve their chances of a successful quit attempt.

Why are e-cigarettes such a crucial tool?
We have known since 1954, when a British Doctors study provided evidence of the link between smoking and early mortality, that smoking is incredibly harmful. It remains to this day the leading cause of preventable illness and death in the UK and in fact, there is no other product that is legally available for human consumption that is as deadly.

Vaping is significantly less harmful than smoking
The evidence that e-cigarettes are a safer alternative to smoking is widely available, with the Office for Health Improvement and Disparities finding that vaping is at least 95% less harmful than smoking.

Evidence like this has allowed many health care authorities, the Royal College of Physicians included, to promote the use of e-cigarettes as a smoking cessation tool for adult smokers looking to quit smoking. It has even allowed for the introduction of a world first ‘swap to stop’ scheme which will see the Government providing one million adult smokers with a starter vape kit.

An e-cigarette can deliver nicotine quickly and replicates the way that nicotine is administered and absorbed when smoking. This allows the user to cut out the many deadly chemicals which are present in tobacco smoke, while still addressing their nicotine addiction and avoiding withdrawal symptoms. Toxicological studies into the use of nicotine containing e-cigarettes have found that people who make the switch to vaping and stop smoking completely demonstrate significantly reduced levels of the carcinogens and toxic chemicals associated with cigarette smoking.

RCP advise that 'in the interests of public health it is important to promote the use of e-cigarettes as widely as possible as a substitute for smoking in the UK', which is something they have continued to endorse since 2016.

Quit rates are 50% higher with vapes than NRT
A plethora of research has identified vaping as being a highly effective alternative to smoking. A Cochrane review has found nicotine containing e-cigarettes to be twice as effective as common nicotine replacement therapies (NRT) like nicotine gum and patches at successful long-term smoking cessation.

A subsequent review has also found that vaping is equally as effective as medicinal options like Champix, while also being much more accessible and cost-effective than stop smoking medicines, which are only available on prescription. The latest Smoking in England statistics show that e-cigarettes are the most popular aid for quitting smoking available in the UK, and the fact that they are affordable and easily accessible to all adult smokers likely plays a big role in this.

The different nicotine strengths that e-liquids are available in allow the user to tailor their vaping experience to best suit their needs, selecting the strength that reflects their previous nicotine intake from smoking cigarettes and will best manage their nicotine cravings. The different flavours also make using an e-cigarette a more pleasurable experience, making vapers more likely to continue to pick up an e-cigarette in favour of returning to smoking traditional cigarettes.

Additionally, e-cigarettes offer a satisfying substitute for smoking because they replicate the act of smoking in a way that NRTs are not able to achieve. By mimicking not only the feel of smoking a cigarette, but also the hand to mouth action of smoking, e-cigarettes can integrate into the daily routine without the user having to try and make substantial behavioural changes.

Addressing vaping misconceptions
Action on Smoking and Health’s recent ‘Use of e-cigarettes among adults in Great Britain’ survey has identified that 39% of current smokers falsely believe that vaping is equally as harmful, if not more so, than smoking.

Nicotine vs tobacco
As highlighted in the article, one of the reasons for the confusion around the harms of vaping relative to smoking, is misunderstanding the difference between nicotine and tobacco.

It is easy to understand why many people overestimate the harms of nicotine, given how closely we relate it to the deadly habit of smoking. However, nicotine itself is a relatively low harm substance which affects the body in a similar way caffeine. Nicotine is not known to cause cancer, but is an extremely addictive substance and is responsible for the cravings that smokers will get between cigarettes. We take a closer look at this in our post 'Is nicotine harmful to the body?'

Cigarette smoke on the other hand, is known to contain many different carcinogens and harmful chemicals, including tar, carbon monoxide, and arsenic, which are extremely harmful to the body and known to cause serious health problems like lung cancer and heart disease.

By switching from smoking to vaping, you can eliminate the inhalation of these many harmful substances, which are not found in e-cigarette vapour, while still managing your nicotine cravings.

Fears of swapping one addiction for another
Another reason that many current smokers will give for not using an e-cigarette is that they do not want to swap one addiction for another. It is important to understand that in this situation, the addiction remains the same, and that switching to an e-cigarette is a way to manage your nicotine addiction in a more clean way.

The reason that giving up smoking can be so difficult is because of the addictive nature of nicotine, but the part of quitting smoking that is most important for your health is to no longer be inhaling the harmful toxins in tobacco smoke.

By using an alternative nicotine source like a vape, you can avoid the withdrawal symptoms that hamper many stop smoking attempts, while removing the need for combustion. E-liquids even allow you to lower your nicotine strength over time, so you can become less dependent on nicotine and even remove it completely if you wish.

Combatting the rise in youth vaping
While the rise in underage vaping is something that needs to be taken incredibly seriously, it should not prevent adult smokers from utilising an e-cigarette as a harm reduction tool.

The Government have made it clear in their recent call for evidence that they hoped to establish ways to remove access to vaping products for underage vapers, while still allowing them to be accessible to adult smokers. This is because they have recognised vaping as being a ‘crucial’ harm reduction tool.

The RCP opinion article points out that there is a need to recognise the fact that experimenting with things that are not considered good for their health is common among teenagers. In 1982 smoking rates among 11 – 15 year olds were at 19%, whereas in 2021 this figure has fallen to just 3%. Research has shown that in 2022 11.6% of 11 – 17 year olds had experimented with vaping, but there has been absolutely no increase in tobacco smoking among this group, disproving the myth that vaping can be seen as a gateway to smoking.

It is incredibly important that policies which aim to reduce vaping rates among young people do not encroach on their efficacy for adult smokers. Strict regulation on vaping productions and restrictions on the way they are marketed can make them less appealing and accessible to young people without affecting their use by adult smokers, while more extreme measures like a ban on flavours could substantially reduce their appeal to adult smokers and make them a less popular and less effective alternative to smoking.

Fortunately, organisations like Action on Smoking and Health (ASH) have recognised the importance of making the facts around the safety of vaping relative to smoking clear to current smokers, and are fighting to combat the many myths surrounding vaping. Their brief ‘Addressing common myths about vaping’ provides an essential resource filled with evidence and research on the facts about vaping.

Hazel Cheeseman, Deputy Chief Executive of ASH, recently emphasised the importance of tackling safety fears, saying:

“The Government has backed a vaping strategy as its path to reduce rates of smoking, but this approach will be undermined if smokers don’t try vapes due to safety fears or stop vaping too soon and revert to smoking. The Government must act quickly to improve public understanding that vaping poses a fraction of the risk of smoking.”

How the Royal College of Physicians promotes vaping
The RCP have been showing their support for vaping as an effective stop smoking aid since 2016, when they released a comprehensive report on e-cigarettes, when they stated that e-cigarettes should be promoted as a substitute for smoking.

In 2019, following an outbreak of lung disease in the US which was found to be related to black market THC e-liquids which contained the thickening agent vitamin E acetate, RCP responded by releasing their advice and reassuring UK vapers. They outlined the differences between UK and US vaping regulations, and reiterated that e-cigarettes are a far safer option than combustible tobacco products, urging vapers to not allow the unfortunate incidents in the US to deter them from continuing to use an e-cigarette and remain successfully smokefree.

They were also one of more than 50 organisations who endorsed the 2021 All-Party Parliamentary Group for Smoking and Health’s report of recommendations for England’s Tobacco Control Plan, which included the important role that e-cigarettes should play.

RCP finds not all clinicians are promoting vaping
A recent debate at the Asthma UK Centre for Applied Research prompted the Royal College of Physicians to undertake a rapid survey to get a better understanding of the wider clinical view around vaping.

The survey aimed to better understand how the wider clinical community are utilising e-cigarettes as a harm reduction tool for their patients. The survey found that 55% of participating respiratory consultants and specialist registrars from across Wales have not been promoting vaping as a smoking cessation tool to patients, indicating that there is still some way to go if we are to truly utilise e-cigarettes effectively.

The support of health authorities like the Royal College of Physicians has helped reassure many current vapers that they have made the best decision for their health by making the switch from smoking to a less harmful alternative.

At a glance
·The Royal College of Physicians advises that 'in the interests of public health it is important to promote the use of e-cigarettes as widely as possible as a substitute for smoking in the UK'

·Toxicological studies have found that people who make the switch from smoking to vaping have substantially reduced levels of carcinogens and toxicants

·Smoking in England statistics show that vaping is the most popular smoking cessation tool in the UK