UK Health Agency Reaffirms the Power of Vaping to Help Smokers Quit

On June 25, the United Kingdom’s National Institute for Health and Care Excellence (NICE) published new draft guidelines encouraging health care professionals to disseminate clear and up-to-date information for smokers who want to use vapes to quit cigarettes.

Developed with the help of Public Health England (PHE), the UK’s leading health agency, an expert committee advises that nicotine-containing e-cigarettes are “more likely to result in people successfully stopping smoking” when combined with behavioral support; notes that vaping is “similarly effective” to short- and long-acting nicotine replacement therapy (NRT); acknowledges that e-cigarettes are “significantly less harmful than smoking” although long-term health effects remain unknown; and calls for the funding of further research. The guidance consolidates and updates eight previous guidelines on smoking and is out for consultation until early August.

“This should have a considerable impact on the level of confidence among health care professionals, some of whom have until now been uncertain or reluctant to support patients to switch from extremely harmful smoking to something significantly safer,” Louise Ross, the former manager of the Stop Smoking Service in Leicester and the current business development manager for a smoke-free app, told Filter.

Over the past few years, the UK has transformed into a model for tobacco harm reduction (THR), and activists have been hopeful that public health officials there will continue down that path, especially in a post-Brexit regulatory landscape. In one promising development there among many, a collection of UK universities recently launched a trial in which they’re providing free e-cigarettes to hundreds of homeless people, a population with a high smoking rate; the research will judge how effective vaping products are at assisting them in quitting cigarettes.

The NICE recommendations are not necessarily a surprise. Indeed, a study published in the New England Journal of Medicine in 2019 found that vapes were not as effective for quitting as NRT, but much more effective—somewhat disappointingly for some activists, NICE does not go as far to declare vapes superior cessation tools. Still, the guidelines represent a victory for THR advocates. They can now be cited to health organizations and agencies that oppose vaping at all costs in favor of an abstinence-only approach to nicotine.

“We know that vaping is a really popular and effective way to stop smoking.”

Advocates are not particularly optimistic, however, that the guidance will stretch beyond the UK’s borders. As recent as May, ahead of World No Tobacco Day, the World Health Organization (WHO) reasserted its anti-vaping stance, stating that the tobacco industry has “promoted e-cigarettes as cessation aids under the guises of contributing to global tobacco control” and that “switching from conventional tobacco products to e-cigarettes is not quitting.”

“The new draft guidelines recommending that UK physicians should promote safer nicotine vapes (‘e-cigarettes’) for adult smokers should be a wake up call for the World Health Organization,” Dr. Charles Gardner, the executive director of INNCO, a global nonprofit that supports the rights and well-being of adults who use safer nicotine, told Filter. “The WHO continues to believe that reducing harm is an evil Big Tobacco plot. NICE and PHE have no industry influence. They look at evidence. INNCO compliments them on their courageous stance against current tobacco control dogma.”

The UK strategy is a stark contrast to that in the United States—and in many other countries that follow the US example. Misinformation about the benefits of e-cigarettes for adult smokers still plagues much of the public conversation in the US. Many former smokers who switched to vaping have been persuaded that a string of “vaping-related” lung injuries reported in 2019 were related to vaping nicotine—not illicit, adulterated THC cartridges as was in fact the case. Many seem to be returning to cigarettes.

“This should all be part of a consistent message to people who smoke, encouraging them to give vaping a try,” Ross said of the NICE recommendations. “We know that vaping is a really popular and effective way to stop smoking.”

“Now,” she continued, “we have evidence from yet another credible source that we should all put our efforts into getting more people to try it.”


Photograph by harry_nl via Flickr/Creative Commons 2.0

Both INNCO and The Influence Foundation, which operates Filter, have received grants from the Foundation for a Smoke-Free World. More information about The Influence Foundation’s funding is available hereFilter’s Editorial Independence Policy applies. 

Health Canada Keeps Admitting That Its Vape Policies Could Increase Smoking

On June 19, Health Canada, the agency responsible for the country’s health policy, released a proposed regulation that would ban flavored vaping products, with the exception of tobacco, menthol and mint.

It’s yet another blow for tobacco harm reduction (THR) advocates, who now see Canada—once considered a promising model on nicotine policy—to be a disappointment. The country has been open to other harm reduction measures like safe consumption sites and safe supply programs, and has considered decriminalizing drugs in an effort to curb overdose deaths. For a short time at least, advocates had believed the nation would adopt a THR-oriented approach similar to the United Kingdom.

At the moment, however, that could not be further from the case. Because tucked into the analysis statement by the government on the intended flavor ban, Health Canada acknowledges that its legislation could lead to an increase in smoking.

“A startling admission.”

“It is anticipated that some dual users who currently use flavored vaping products would not substitute their purchases with tobacco- and mint/menthol-flavored vaping products,” the statement reads. Instead, “they would choose to purchase more cigarettes.”

“The statement is very direct,” David Sweanor, an industry expert and chair of the Advisory board for the Centre for Health, Law, Policy, and Ethic at the University of Ottawa, told Filter. “It’s basically saying, ‘We’re Health Canada, and we’re going to do something that kills Canadians.’”

No other national government, as far as the THR advocates and tobacco control experts Filter spoke with could remember, has issued such a caveat. And it’s also not the first time in recent months that Health Canada has made what Amelia Howard, a consumer advocate and sociology PhD student at the University of Waterloo, called “a startling admission.”

In December, Health Canada released proposed regulations on a nicotine cap, which would set a limit of 20 milligrams per milliliter (mg/mL) for all vaping products. The agency likewise stated that, with a nicotine cap in place, “it is anticipated that some dual users who currently use vaping products above 20 mg/mL nicotine would not substitute their vaping product purchases with lower concentrations of nicotine.” Rather, “they would choose to purchase more cigarettes.” (It’s expected that the nicotine cap could be enacted any day, too, and the industry will only have 15 days to comply.)

“The fact that a government can brazenly admit their policy will lead to more smoking and death is wild,” Matt Culley, a board member of the US-based CASAA, a consumer advocacy nonprofit that promotes smoke-free alternatives to combustible tobacco, told Filter. “It really goes to show how demonized vaping remains.”

This is despite the fact that Canada has stated it intends to reduce its smoking rate to 5 percent by 2030. If the ultimate aim is to end combustible cigarette use, this is obviously not the way to do it.

“Our policies have not aligned with the country’s goals,” Darryl Tempest, the executive director and chief advocate of the Canadian Vaping Association (CVA), told Filter. “It is not a public policy that relates to adults or harm reduction or small businesses.”

Canada amended its tobacco laws to include vaping products in 2018, and like certain states in the US, some Canadian provinces have already enacted their own flavor bans . And just as major public health organizations in the US, like the American Heart Association and the American Cancer Society, tend to harp on the perceived risks of vaping nicotine rather than the enormous benefits of replacing smoking with vaping, the Heart and Stroke Foundationthe Canadian Lung Association, and the Canadian Cancer Society have followed suit. Consequently, Health Canada’s position remains seemingly caught up in the moral panic around youth vaping that consumed the US in late 2019.

This is the situation even as thousands of vapers, vape shop owners, lawyers, scientists, public health experts and consumer advocates have written comments to the government expressing their concerns. Some of them, like Tempest, have emphasized increasing evidence that neither bans nor nicotine caps will benefit public health: One study, published in The Lancet, perhaps the world’s best regarded peer-reviewed medical journal, suggests that smokers given higher-nicotine vaping products consume fewer dangerous carcinogens; another, in JAMA Pediatricsfound that after San Francisco’s ban on flavored vapes and tobacco products, teens in the city’s high schools were more likely to take up smoking than teens in other US school districts.

THR activists have seen their hopes on Canada largely diminished since 2019, when BMJ, a medical journal published by the trade union of the British Medical Association, put out a controversial paper about youth vaping and smoking rates in the country. The paper concluded that, in Canada as in the US, there was an uptick in youth vaping between 2017 and 2018. Unlike in the US, however, the authors claimed that there had been a noted increase in youth smoking as well—validating the often-debunked and contested idea that there was a “gateway” effect from vapes to combustible cigarettes.

THR proponents like Clive Bates, a public health consultant and the former director of Action on Smoking and Health in the UK, wrote about how those figures were wrong. And almost a year later, the journal published a correction without much publicity. The damage, it appeared, had already been done.

“We have a good history of our courts throwing out bad drug policies on constitutional challenges.”

Tempest isn’t giving up. He said that his organization is currently in conversation “with a little more than 80 members” of the Canadian Parliament, nearing a third of the federal legislature’s 338 members. Data in hand, he remains worried yet hopeful that he can persuade enough lawmakers to look at alternative policies.

“There is absolutely no question that this can be a charter challenge,” Tempest said. Under Section Seven of the Canadian Charter of Rights and Freedoms, he explained, “everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.”

“We have a good history of our courts throwing out bad drug policies on constitutional challenges,” Sweanor echoed. “That’s how we ended up with safe injection sites. That’s how we ended up with medical marijuana. It’s certainly possible.”