Vaping: Know More

The Basics

What is tobacco harm reduction?

The main purpose of tobacco harm reduction (THR) is to reduce the harm from smoking. Tobacco harm reduction involves encouraging smokers to switch from deadly combustible cigarettes to a lower-risk nicotine alternative such as vaping.

The ultimate goal is complete nicotine and tobacco abstinence. It is well known that a large proportion of smokers are unable or unwilling to quit, therefore remaining at high risk of smoking-related death and illness. THR aims to reduce the health risks in continuing smokers by switching from combustible tobacco to safer nicotine delivery methods. 

Lower-risk products include vaping (e-cigarettes), Swedish snus (small tobacco pouches placed under the upper lip),  and heated tobacco products (which heat tobacco without burning it).
Almost all the harm from smoking is a result of combustion (smoke). It releases over 7,000 chemicals, tars, carbon monoxide, other toxic gases and solid particles.

THR is no different to other harm reduction strategies which are  generally very effective and widely accepted. These include car seat belts; condoms and most recently face masks.

Since 2003, South Africa became a signatory to the World Health Organisation Framework Convention on Tobacco Control.

The FCTC provides an obligation on governments to not only allow reduced-risk products but actively promote them as part of implementing their tobacco control policies. 

What is vaping?

Vaping is a less harmful alternative for adult smokers who are often unable to quit smoking on their own or with other methods. Vaping delivers nicotine and mimics the familiar hand-to-mouth action and sensations of smoking.

Nicotine EVPs (e-cigarettes) heat a liquid nicotine solution into an aerosol which is inhaled and exhaled as a visible mist. This is known as ‘vaping’.

All EVPs consist of a rechargable battery, a tank to hold the e-liquid and a coil or heating element to heat the liquid to create the vapour.

There is no tobacco and no combustion, almost all the toxic chemicals in smoke are absent from vapour. The chemicals that are still present are in far lower doses than in tobacco smoke. (https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update)

Some smokers use vaping for a short time to quit tobacco smoking and then cease vaping. Others continue vaping long-term to prevent relapse to smoking. 

Vaping should not be used by non-smokers including young people who don’t smoke.

Safety and health

Is vaping less harmful than smoking?

There is overwhelming scientific agreement that vaping is far less harmful than smoking. Vaping does not produce smoke. It is the 7,000 toxic chemicals in smoke released from burning tobacco which cause almost all the deaths and disease from smoking.

In contrast, EVPs heat a liquid into an aerosol, without tobacco, combustion and therefore smoke. There are some potentially harmful toxins are present in aerosol but at much lower levels than in cigarette smoke.

According to the UK Royal College of Physicians:

“Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure.”

A comprehensive review by Public Health England concluded:

“While vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals which are present pose limited danger.”

A review by the US National Academies of Sciences, Engineering and Medicine concluded:

“There is substantial evidence that completely switching from regular use of combustible tobacco cigarettes to e-cigarettes results in reduced short-term adverse health outcomes in several organ systems.”

Does vaping cause cancer?

Surprisingly, according to a study from Rutgers University, approximately 80.5% of physicians believe that nicotine causes cancer. The truth is that nicotine does not cause cancer and the cancer risk from vaping is only a tiny fraction of the risk from smoking. The vast majority of harm from smoking comes from tar, carbon monoxide, toxic gases and solid particles released by burning tobacco.

The overall cancer risk from vaping nicotine is estimated to be <0.5% of the risk from smoking (PUBMED). Switching from smoking to vaping dramatically reduces the risk of developing cancer.

Tobacco smoke contains at least 70 known carcinogens (cancer-causing chemicals). These are either absent from vapour or are present at very low levels (UK Public Health).

Isn’t nicotine harmful?

Nicotine is a relatively benign drug. Although it is addictive, it presents very little risk to the user.

Because of its association with smoking, many people (include health professionals) incorrectly believe it is the harmful ingredient in tobacco smoke. However many independent expert bodies disagree:

  • UK  Royal College of Physicians, “Use of nicotine alone, in the doses used by smokers, represents little if any hazard to the user”
  • The Royal Society for Public Health has concluded that nicotine is a mild recreational stimulant and is “no more harmful to health than caffeine”
  • Public Health England “nicotine use per se represents minimal risk of serious harm to physical health and that its addictiveness depends on how it is administered”

Nicotine does not cause cancer or lung disease and only has a minor role in cardiovascular health.

Nicotine has shown mild effects such as temporary increases in pulse rate; blood pressure and narrowing the blood vessels. However, it should be noted that nicotine can impair wound healing and raise blood glucose levels.

Based on decades of use of Swedish snus which releases high levels of nicotine as well as traditional nicotine replacement therapy (nicotine gums; patches; sprays and lozenges), long-term use of nicotine is regarded as low risk.

The addictiveness of nicotine alone is also overstated. There are additional ingredients in tobacco smoke which make nicotine more addictive (monoamine oxidase inhibitors) and coupled with the efficiency in delivery, smoking increases the addictiveness of nicotine.

The behavioural, sensory and social aspects of smoking also enhance its addictiveness.

Second hand vapour, is it harmful?

Unlike second-hand smoke, the risk to bystanders from passive vaping appears to be minimal.

As per Public Health England’s review in 2018, “to date there have been no identified health risks of passive vaping to bystanders”. Royal College of Physicians stated in 2016 “There is, so far, no direct evidence that such passive exposure is likely to cause significant harm.”

This is because the vaper absorbs most of the inhaled aerosol. Less than 10% of the chemicals are exhaled and they are at very low levels in the air. Due the way EVPs operate(on/off functionality), there is no ‘side-stream’ vapour, which accounts for at least 80% of second-hand smoke from a cigarette.

Furthermore, the liquid aerosol droplets from vapour evaporate and disperse in seconds, much more quickly than the solid particles in smoke, reducing risk further.(PUBMED)

 

Passive smoke from combustible tobacco is estimated to be five orders of magnitude (50,000x) greater that than of vapour created by EVP’s.(PUBMED

Long-term effects of vaping

The precise long-term health effects of vaping nicotine have yet to be established (as seen in all new products). Based on the wealth of information collected over 14 years, and an understanding of the ingredients in vapour, the biomarkers (toxins in urine and saliva), The Royal College of Physicians estimates the long-term risk is likely to be no more than 5% of the risk of smoking. There are now an estimated 68 million people vaping in dozens of countries.

Studies so far show no cause for concern in people vaping after stopping smoking for up to 2 years. One study of four years and another of five years duration have not raised health concerns.

Some opponents of EVP’s argue that we should pause until long-term risk (if any) have be established. However, this is a double standard only applied to vaping and not used for any other medicine or treatment.

It is possible that some harms may emerge over time and ongoing monitoring of vaping should continue for any new side-effects. However, it may never be possible to completely separate the effects of smoking from those due to vaping as almost all regular vapers are former smokers.

Over and above this, medical science in the 21st century knows more about chemistry, toxicology, physiology and causes of disease than when cigarettes went into mass production some 120 years ago. There is a greater understanding of the toxic effects of most chemicals and scientists can assess them against occupational and environmental health and safety standards.

The advancements in scientific methods, analytical techniques and equipment are far superior to that available in the past.

What about the 2019 severe lung injuries reported in the US?

In 2019, there was an outbreak of serious lung injury (EVALI) in the US in people who had recently vaped. This condition has now been clearly associated with black-market THC(cannabis) oils contaminated with Vitamin E Acetate, purchased from street dealers.

Not a single case has been linked to commercial nicotine vaping for smoking cessation.

Vaping and popcorn lung.

‘Popcorn lung’ (bronchiolitis obliterans) is a serious, but rare lung disease first detected in popcorn factory workers. It was linked to very high levels of ‘diacetyl’ which is used to create a buttery flavour.

Some earlier e-liquids contained diacetyl, however the levels found in vapour were hundreds of times lower than in cigarette smoke and there has never been a case of bronchiolitis obliterans due to smoking or vaping. Diacetyl is now rarely used. There has not been a single case linking vaping to popcorn lung. 

Additional sources
1. Prof Michael Siegel
2. Cancer Research UK
3. Public Health England

Youth vaping ‘epidemic’ in the US

There has been a decline in vaping rates by high schoolers in the US by 30% from 2018 to 2019 (27.5% to 19.6%). Which has also seen a 58% decline in vaping by middle schoolers (from 10.5% to 4.4%). What is more alarming is that many young people in the US are vaping cannabis instead.

In the US, 85% of current smokers aged 12–15 years had not vaped before they began to smoke cigarettes (PUBMED). Reports indicate that 41.8% of these teens switched to vaping to quit smoking.

A mere 0.4% of never-smokers reported vaping regularly (≥20 days in the last 30 days). Nicotine dependence is rare in never-smoking youth who vape. Less than 4% of never-smokers reported symptoms of nicotine dependence in 2018.

The US has seen a steady decline in youth smoking rates since the introduction of EVP’s in 2008. Since 2014 when vaping became mainstream, the rate has declined a further 200 to 400%. From 2018 to 2019, US youth smoking rates (12th grade) fell by an unprecedented 30% (8.1% to 5.7%). 

After analysing the data in detail, Robert J. West (Professor of Health Psychology, Department of Epidemiology and Public Health, University College London) concluded:

“Data from the NYTS [National Youth Tobacco Survey] do not support claims of a new epidemic of nicotine addiction stemming from use of e-cigarettes, nor concerns that declines in youth tobacco addiction stand to be reversed after years of progress”

Does nicotine damage the developing adolescent brain?

Nicotine has been linked to harmful effects on the adolescent brain in animal studies. However, most animal studies use chronic, high-dose exposure to nicotine which does not accurately reflect the nicotine exposure that would occur from vaping in humans. The same effects found from nicotine in animals are also found in animal tests with caffeine.

Also, there is no long-term evidence of impaired brain function in the hundreds of millions of adults who smoked as adolescents and then stopped.