Doctor applauds task force’s stance against using e-cigarettes for quitting smoking

In this April 16, 2019 photo, a woman exhales while vaping from a Juul pen e-cigarette in Vancouver, Wash.

A recent guideline by the Canadian Task Force on Preventative Health Care published Monday in the Canadian Medical Association Journal recommends against using e-cigarettes as a first option for quitting smoking.

Instead of using e-cigarettes as a first-line approach to quitting smoking, the task force recommends using other approved behavioural, pharmacotherapy, or combined interventions that have proven benefits.

Some of the recommended interventions include individual and group counselling or medications like bupropion, cytisine, nicotine replacement therapy (NRT) or varenicline, according to the task force.

“We have so many better options at our disposal that have been well studied in comparison to vaping,” Dr. Eddy Lang, a member of the Canadian Task Force on Preventive Health Care and a professor and senior researcher for emergency medicine at the University of Calgary told CTV News Channel on Monday.

“We lack the long-term data on the safety of e-cigarettes.”

Although the task force recommends against using e-cigarettes as a first-option to quitting smoking, the recommendation states that individuals can discuss using e-cigarettes with a health-care provider as an option if they were unsuccessful with, or unwilling to try, other interventions.

Though, the task force recommends that individuals who decide to use e-cigarettes to quit smoking be aware of the lack of approved treatments that are safe and consistent, the lack of long-term safety data, and the risks of continued exposure to e-cigarettes containing nicotine.

While Dr. Peter Selby, senior scientist and senior medical consultant at the Centre for Addiction and Mental Health (CAMH) in Toronto agrees that other approved interventions should be explored first before using e-cigarettes to quit smoking, he acknowledges the task force’s recommendation that in some cases it could be appropriate for an individual to try e-cigarettes to quit smoking.

“If you’re a young person never exposed to nicotine, your risk from vaping is high,” Selby told CTV News Channel on Monday. “On the other hand, you’re a 40- or 50-year-old individual who’s been smoking for a long time, you’ve tried every means to quit, and nothing else is working, then actually the harm compared to smoking cigarettes is a lot less.

“So it’s a nuanced recommendation.”

However, while the task force acknowledges using e-cigarettes to quit smoking may be a reasonable choice for some depending on their circumstance, using e-cigarettes with nicotine does not address the nicotine addiction in the same way as other interventions, like NRTs, do.

According to the task force’s recommendation, some NRTs, like gum or patches, slowly reduce nicotine use over time in a controlled way, whereas uncontrolled variables like nicotine formulation, concentration and number of puffs make it challenging to do so with e-cigarettes.

Additionally, there has been a large increase observed in youth vaping in recent years.

As a result, the task force notes that there are uncertain public health and societal impacts of normalizing e-cigarettes as an approach to quitting smoking, highlighting nicotine addiction.

“(E-Cigarettes) are not specifically designed for smoking cessation,” Lang said, noting that there are other interventions developed for quitting smoking that have been studied and proven effective.

“We also don’t want to get into a situation where we’re switching one dependency or one addiction for another.”

Selby, in line with the task force’s recommendation, encourages individuals to try approved interventions first because of their proven benefits and regulations.

“Really it’s a problem with the product not being regulated like a medicine and not being tested like a medicine in Canada,” Selby said. “Other jurisdictions have done it and have ways in which vaping devices or e-cigarettes can be used, but in Canada we haven’t.

“It’s really in the recreational market, so pretty much it’s a buyer beware of what device you’re going to get.”

With tobacco smoking being the leading cause of preventable disease and death in Canada, increasing the risk of many types of cancer, respiratory and cardiovascular diseases, Selby applauds the task force’s recommendation that encourages individuals to quit smoking.

“The task force has done a good job of helping people understand the hierarchy of evidence in the way it’s come out; very balanced (...) not one way or the other,” Selby said.

“But the overall message is: quit,” he added.