Five deaths and an outbreak of serious lung illnesses have been associated with vaping in the US recently. Tobacco treatment specialist, Dr Colin Mendelsohn, asks ‘Should Australia’s 250,000 vapers be concerned?’
Let’s set the record straight on the alarming headlines out of the US these past two weeks.
Nearly all the deaths and lung illnesses reportedly ‘linked to vaping’ involved people vaping contaminated black-market cannabis (THC) oil purchased from street vendors. No cases have been linked to nicotine vaping.
Vaping nicotine is the most popular aid for quitting smoking in western countries and is a far safer alternative to smoking.
The alarm surrounding the recent deaths in the US could prove to be devastatingly ironic.
If Australians who currently vape go back to smoking tobacco because they’re scared by what they’ve read – far more people could die from tobacco-related illness.
Media reports have been quick to imply that all ‘vaping’ is risky, creating a ‘textbook drug panic’. Anti-vaping activists have exploited the opportunity to justify their opposition to vaping nicotine.
Their mistake, either inadvertent or deliberate, is failing to distinguish the vaping of toxic, tainted cannabis oils from life-saving nicotine liquid. This is vital, as any risk from vaping depends on what drug or chemical is being used.
Vaping nicotine is not risk-free but it is far less harmful than smoking. Millions of former smokers have been vaping nicotine for over a decade without any evidence of serious lung harm, confirmed in a recent comprehensive review.
According to the UK Royal College of Physicians, the risk of long-term vaping is unlikely to be more than 5% of the risk of smoking. Most of the harm from smoking is due to the tar, carbon monoxide and thousands of other chemicals from burning tobacco. Vaping involves heating a liquid solution. There is no combustion, tobacco or smoke and only a small fraction of the risk to health of smoking.
In the US, some illicit manufacturers of cannabis liquid have recently been using Vitamin E acetate in the production process. This oil causes severe inflammation in the lungs when inhaled. Sufferers experience shortness of breath, cough, chest pain and damaged lung tissue which can be fatal.
Testing of most of the cannabis liquid samples by the Centers for Disease Control (CDC) has confirmed the presence of this toxic chemical. Legal cannabis liquid purchased from licensed shops is routinely tested and has not been affected. Some users were also vaping nicotine, but no samples of nicotine e-liquid have tested positive.
By labeling all vaping as harmful, anti-vaping advocates are throwing out the baby with the bathwater. Vaping black-market cannabis products is foolish. However:
Vaping nicotine can be a life-saving alternative for smokers who are unable to quit.
In fact, vaping nicotine is arguably the most effective quitting aid available. A large randomised controlled trial earlier this year found that those who vaped were nearly twice as likely to have quit smoking compared to those using nicotine patches and gums, 12 months later.
Another large trial published in the Lancet this week also demonstrated that adding vaping to a nicotine patch increases the quit rate even further.
Australia is the only western democracy to ban the sale and use of nicotine for vaping. In New Zealand the Ministry of Health is actively encouraging smokers to switch to vaping. In the UK, vaping is promoted as a far safer alternative. Vape shops are now opening in NHS hospitals, to help smokers quit.
Instead of a blanket warning to avoid vaping, we need a more nuanced, evidence-based approach.
- The healthiest option is not to smoke or vape
- Don’t vape if you don’t smoke
- Adult smokers who are unable to quit smoking with conventional treatments can consider vaping nicotine as a short-term quitting aid or as a long-term safer substitute for smoking.
- Street drugs should be avoided at all costs. Illicit products are often contaminated, have unknown ingredients and no quality control. The tragic outbreak from tainted cannabis oil in the US is a reminder of that enduring message.
The wider uptake of vaping could help many thousands of Australian smokers quit their lethal addiction. However, smokers need accurate information to make informed choices.
Colin Mendelsohn is a tobacco treatment specialist. He is a Conjoint Associate Professor and Foundation Chairman of the Australian Tobacco Harm Reduction Association.