By Kemal Atlay, Australian Doctor
Nicotine-containing e-cigarettes are almost twice as effective as nicotine patches and gum in helping smokers quit, a study suggests.
A year after quitting tobacco, however, most vapers were still using e-cigarettes, while fewer than one in 10 smokers who quit with the help of nicotine replacement therapy (NRT) were still using it.
Data from almost 900 UK patients enrolled in national smoking cessation services were assigned to either refillable e-cigarettes or nicotine-replacement products.
They were also given face-to-face support for at least four weeks.
Participants were smoking 15 cigarettes per day on average at baseline and had a median age of 41.
At 52-weeks follow-up, 18% of e-cigarette users had abstained from smoking compared with 10% of those in the NRT group.
However, among participants with one-year abstinence, 80% of those who quit using e-cigarettes were still vaping, while only 9% of NRT users stayed on these products.
The findings were significant because the NRT users tended to cease treatment prematurely and had higher rates of relapse, according to Dr Ryan Courtney (PhD) from the National Drug and Alcohol Research Centre in Sydney, NSW.
“Vaporised nicotine products seem to have quite high user acceptability in terms of the act of using your hands, the sensory-motor aspects. And [users] do actually get enjoyment out of using vaporised nicotine products,” said Dr Courtney, who is also a senior lecturer in health behaviour science at UNSW.
But he said the long-term health risks of vaping were unknown, and that GPs and patients should continue to exercise caution.
“From a harm-reduction approach, vaporised nicotine products frequently do present as a potentially safer option, but there haven’t been the long-term studies that have looked at outcomes,” he said.
In terms of adverse reactions, nausea was more frequently reported in the NRT group (38% vs 31%) and throat or mouth irritation was more prevalent among e-cigarette users (65% vs 51%).
Vaping was also associated with greater declines in cough and phlegm production at the one-year mark.
A limitation of the study was that the findings might not be generalised for smokers who were either less dependent on cigarettes or had taken up vaping for reasons other than quitting.
Lab results reveal what’s really in your e-cigarettes
Vapers who use nicotine-free e-cigarettes are potentially inhaling not only nicotine but also trace amounts of pesticides and a biological chemical found in urine and faeces, an Australian study has found.
WA researchers purchased 10 different e-liquid products labelled ‘nicotine-free’ from Australian suppliers and had their chemical composition analysed by an independent commercial laboratory.
Nicotine was detected in six of the e-liquids, including three that had levels comparable to those found in low-dose nicotine e-cigarettes.
Lead researcher Associate Professor Alexander Larcombe, from the Telethon Kids Institute and Curtin University in Perth, said nicotine contamination was the inevitable result of zero regulation in the manufacture of vaping products.
“The real take-home message here is that people are buying these liquids unaware of what’s in them, and there’s no way they can tell based on what the label says,” Professor Larcombe said.
He said that 2-Chlorophenol, a chemical used in pesticides and disinfectants, was detected in all 10 samples, and eight e-liquids contained 2-amino-octanoic acid, a metabolite found in mammalian blood, urine and faeces.
“[It] indicates the process of making the e-liquids might not be as clean as you might hope,” Professor Larcombe said.
According to Dr Colin Mendelsohn, co-founder and chairman of the Australian Tobacco Harm Reduction Association, an organisation that has accepted donations from the vaping industry, said the findings point to poor quality control and production standards.
“These e-liquid solutions could have been mixed in someone’s kitchen sink without any care or expertise, with the same utensils used to make nicotine e-liquid,” said Dr Mendelsohn, who is also Conjoint Associate Professor at the UNSW School of Public Health and Community Medicine.
However, he said the researchers had overstated the significance of the nicotine contamination in the samples.
“The levels found are trivial and would have no biological effect or any significant adverse effects,” Dr Mendelsohn said.
“The 0.29% nicotine level found in one sample may have a minor effect, for example a raised heart rate, but that would not be of any health importance.”
Dr Mendelsohn said GPs who have patients struggling to quit smoking from conventional therapies should only consider recommending vaping products from reputable suppliers, avoiding black markets or under-the-counter sales.