Drs should prescribe e-cigarettes
Friday, 13 April, 2018
Growing evidence of the effectiveness of e-cigarettes as a quitting aid means doctors should consider recommending them as a less harmful alternative for patients who have repeatedly failed to stop smoking tobacco with approved treatments, a new study has concluded.
E-cigarettes are battery-powered devices that heat and vaporise a liquid to deliver nicotine to reduce the urge to smoke. Their use, called vaping, replicates the habits and rituals of smoking without the harmful tar, carbon monoxide and other toxic chemicals from burning tobacco.
Doctors can currently prescribe nicotine e-liquids for therapeutic purposes such as quitting smoking, with the patients importing three months鈥 supply of nicotine at a time from overseas, allowing the patient to use the product legally.
Vaping is currently being legalised in Canada and New Zealand, but a federal parliamentary majority (five out of eight) report last week recommended that a ban on the sale of nicotine-containing e-cigarettes in Australia be retained.
However, a minority report concluded their use by smokers who have tried and failed other ways of quitting 鈥渃ould save many thousands of lives鈥 and that they should be available 鈥渁s a consumer good to Australians鈥.
鈥淚n Australia between 2013 and 2016, the smoking rate has not declined significantly for the first time in decades, despite very high cigarette prices, plain packaging and strict tobacco control laws,鈥 said study author UNSW Conjoint Associate Professor Mendelsohn.
鈥淗owever, in countries which support vaping, smoking rates are continuing to fall, faster than ever in some cases.鈥
Recent studies in populations in the US and UK, where e-cigarettes are legal and widely available, have found that their use, called vaping, is associated with higher success rates of quitting smoking than among non-users. The highest success rates occur with newer e-cigarette models and daily use of nicotine e-liquid, rather than intermittent use.
A 2016 report by the Royal College of Physicians in the UK concluded the health risk from long-term vaping was unlikely to exceed 5% of the harm from smoking tobacco.
Another study found that vaping results in a dramatic reduction in carcinogens and other toxicants measured in the blood and saliva of e-cigarette users, compared to tobacco smokers.
Other research cited in Mendelsohn鈥檚 review found that smokers who switch to vaping have significant health improvements, including improvements in asthma, chronic obstructive pulmonary disease, blood pressure, cardiovascular health, lung function and pneumonia risk.
鈥淢edical practitioners have a duty of care to provide the best possible management at each encounter,鈥 said Associate Professor Mendelsohn.
鈥淲ithholding a legitimate treatment option that could prevent a life-threatening illness is a breach of that obligation.
鈥淔or patients who have repeatedly failed to quit smoking with conventional strategies an e-cigarette is a legitimate, evidence-based option for reducing harm. Their use could lead to substantial improvements in public health in Australia,鈥 he said.
After quitting smoking, it is preferable for people to aim to cease vaping, within three to six months if possible, but long-term use of e-cigarettes is safer than relapsing to smoking, he said.
The聽review of the latest scientific evidence on e-cigarettes聽has been published in the 聽of the Royal Australian College of Physicians.
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