New Canadian Guidelines Urge Against Vaping as Smoking Cessation Aid

Individuals attempting to quit smoking should not consider e-cigarettes or vaping as their primary option, according to new guidelines from the Canadian Task Force on Preventive Health Care. Published in the Canadian Medical Association Journal on March 1, 2024, the guidelines emphasize the importance of proven methods for cessation, such as medications, nicotine replacement therapies, and counseling. These approaches significantly increase the likelihood of successful long-term quitting.

The task force conditionally recommends against e-cigarette use, highlighting the persistent threat posed by tobacco, which remains the leading cause of preventable cancer-related deaths in Canada, despite a decline in smoking rates over the past few decades.

Rising Concerns Over Vaping Among Youth

Vaping has surged in popularity, particularly among youth. Data from Statistics Canada indicates that 30% of 15 to 19-year-olds reported having tried vaping in 2022, compared to only 10% who experimented with cigarettes. Health experts are increasingly concerned that vaping has become a significant public health issue.

Dr. Eddy Lang, a key contributor to the guidelines, stated, “Our guideline really helps the reader hone in on what works, what they probably shouldn’t be using and what they definitely shouldn’t be wasting their time on.” The update aims to counteract misleading advertisements promoting vaping as a safer alternative to smoking.

Although some smokers view e-cigarettes as a potential tool to overcome nicotine addiction, the guidelines point out that no e-cigarette products have received approval for smoking cessation in Canada. Concerns about the long-term effects of vaping on lung and heart health led the task force to advise against their use for most individuals.

Effective Alternatives for Quitting Smoking

Dr. Matthew Stanbrook, a respirologist based in Toronto, endorsed the task force’s conditional recommendation against vaping. He noted, “Nicotine replacement therapy, the patch, the gum, things people know about — they’re widely available and importantly, they’re standardized and they’re safe and they don’t put toxins in the lung.” E-cigarettes can introduce many of the same harmful toxins and carcinogens found in traditional tobacco smoke, albeit at lower concentrations.

The authors of the guidelines acknowledged that e-cigarettes may be considered as a last resort for individuals who have not succeeded with other cessation methods or who have a strong preference for them. However, the task force expressed a desire to avoid normalizing the use of vaping products. “We didn’t want to substitute one addiction for another,” Lang explained.

The guidelines do not currently address flavored nicotine pouches, which have gained traction among younger populations. These pouches, such as Zyns, deliver nicotine in a manner akin to smoking multiple cigarettes. Future updates may consider their impact.

Behavioural therapies, pharmacotherapies, or a combination of both are strongly recommended as effective strategies for quitting. Behavioral therapy can include self-help resources and group counseling, while pharmacotherapy encompasses nicotine replacement products, such as patches or sprays, along with medications like cytisine and varenicline. Cytisine, a plant-based product, mimics nicotine’s effects in the brain and is viewed as a cost-effective cessation aid.

Dr. Peter Selby, an addictions specialist at the Centre for Mental Health and Addiction in Toronto, emphasized the benefits of cytisine, noting its historical use in Eastern Europe when smoking was not feasible during the Second World War. “A Canadian company made a Canadian product and got it authorized as a natural product, and the evidence is pretty good,” he said.

Selby explained that when nicotine binds to receptors in the brain, it causes withdrawal symptoms if left unfilled. Both cytisine and varenicline work by blocking nicotine’s effects, which helps individuals reduce their desire to smoke.

The guidelines strongly advise against alternative medications, such as acupuncture, hypnotherapy, and laser therapy, deeming them generally safe but ineffective.

Looking ahead, the task force recognizes the need for further research, particularly regarding the long-term safety and effectiveness of e-cigarettes. They also advocate for studies focused on specific populations that may face unique challenges in quitting smoking, including Indigenous communities.

In exploring future avenues, the potential role of AI-based therapy in assisting individuals to quit smoking could be a focus of upcoming research. Dr. Lang reassured those seeking to quit, stating, “It is absolutely possible to quit smoking. It is just very difficult because nicotine is such an addictive substance.”