April 28, 2023 – Every day, Sonia Sharma meets people like Natalie H. who are attempting to quit vaping.
Natalie, a member of the nicotine addiction support group on the Fontana Tobacco Treatment Center on the University of California, San Francisco, switched from traditional cigarettes to e-cigarettes, but found the electronic version just as addictive and eventually decided to quit nicotine use altogether.
“I went from being an occasional cigarette smoker (a few a month) to a daily vaper,” Natalie said. who preferred not to disclose her last name to guard her privacy. “Vaping made my nicotine addiction worse, not better.”
“People tell us they're vaping before they hit the ground in the morning,” says Sharma, a physician assistant who co-leads Natalie's support group on the university. She's met individuals who smoked 4 to 5 cigarettes a day, then switched to e-cigarettes to quit smoking, after which vaped the equivalent of a pack a day. Others switched to e-cigarettes to quit smoking, but then went back to vaping and smoking. And others began vaping without ever having smoked. They need to quit, she says, but don't understand how.
Researchers on the National Institutes of Health in 2020 reported that 5.66 million adults within the United States vape. Just over 57% of respondents said they began using e-cigarettes to quit smoking traditional cigarettes. Another study in 2021 based on survey data found that about 60% of e-cigarette users desired to quit vaping.
Vaping has been sold as a option to quit smoking. The research is inconclusive on this conclusion. But unlike cessation aids like nicotine gum or lozenges, using vaping to quit is recent territory. Vapers lack guidance on the way to use the devices to quit, and so they have even less guidance on what to do in the event that they turn out to be hooked on the vaping themselves.
A brand new addiction?
Monica HannaDeputy Director of Nicotine and tobacco withdrawal program at RWJBarnabas Health's Institute for Prevention and Recovery in New Jersey, said she has observed higher levels of nicotine addiction among the many vapers she has worked with.
“When someone takes a drag on a vaping device, it doesn't burn as much as traditional tobacco,” she said. “That causes people to take deeper drags, and when they take deeper drags, they develop a stronger nicotine addiction over time.”
A 2019 study of nearly 900 people published in The New England Journal of Medicine found that smokers who used e-cigarettes to quit smoking were almost twice as prone to quit smoking as those that used other nicotine alternative therapies. But 80% of people that switched to e-cigarettes were still using e-cigarettes one yr after their quit attempt.
Given this addictive potential, Nancy Rigotti, MD, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital in Boston, said patients need to make use of vapes “correctly” to quit smoking. That means quitting smoking completely and stopping vaping once patients are sure they are going to not start smoking tobacco again.
“We need to help these people quit vaping,” said Rigotti, who works with pharmaceutical company Achieve Life Sciences. Development of a prescription drug to treat nicotine addiction caused by e-cigarettes and cigarettes.
And Mall nicotine users who’ve tried to quit smoking by vaping ultimately turn out to be dual users.
“It is important to emphasize that health benefits [of switching to vaping] only occur when the switch to vapes is complete and permanent. So far, that seems difficult for most smokers, and in my experience, it hasn't worked,” said J. Taylor Hays, MD, former medical director of the Mayo Clinic Center for Nicotine Dependence in Rochester, MN.
In addition to the challenges of communicating the current findings, there is no established method to help vapers quit, so Nigar Nargis, PhD, senior scientific director of tobacco control research at the American Cancer Society.
“There are some experimental methods such as the use of social interventions, counseling and some awareness campaigns,” she said.[Little] Progress has been made in clinical interventions.”
In contrast to smoking cessation products resembling chewing gum or patches, which clear recommendations There are no comparable guidelines for the duration of use for e-cigarettes, partly because the FDA has not yet approved e-cigarettes as a smoking cessation aid.
Alex Clark, CEO of the Consumer Advocates for Smoke-free Alternatives Association, a nonprofit that supports vaping, said people can vape longer and still benefit from switching from traditional cigarettes.
“The most significant thing is that individuals start replacing cigarettes with a smoke-free product and proceed doing so until they’ve completely switched,” said Clark, whose group accepts donations from the e-cigarette industry. “After switching, persons are encouraged to proceed using the product for so long as they feel they should.”
But FDA guidelines from 2013 advised nicotine replacement therapy manufacturers – including gum, patches and lozenges – carry a label recommending that users complete the treatment. According to the agency, if a person feels they need to “ [the nicotine replacement therapy product] If you want to quit smoking for a longer period of time, talk to your doctor.”
Hays, now a professor emeritus at the Mayo Clinic, said he would not recommend that patients try vaping as a method of quitting because there are more proven methods such as patches and gum. If a patient insists, vaping can be considered under medical guidance from a cessation expert.
He also said people should only buy products from large companies that are likely to have “adequate quality control.” Hundreds of vaping devices are on the market and they are not all created equal, he said.
However, if an e-cigarette user wants to quit vaping, counseling may involve using traditional smoking cessation methods such as gum and lozenges, as there are few resources available to help people with a specific vaping addiction.
The long-term health consequences of vaping are also unclear, and it will be decades before scientists can draw conclusions, says Dr. Thomas Eissenberg, co-director of the Center for the Study of Tobacco Products at Virginia Commonwealth University in Richmond, VA.
“I don't think anyone knows the long-term effects of heated propylene glycol, vegetable glycerin and flavorings intended as food ingredients, especially when these compounds are inhaled a whole bunch of times a day, week after week, yr after yr,” he said.