Canadian Guidelines Advise Against Vaping for Smoking Cessation

A new guideline from the Canadian Task Force on Preventive Health Care advises against using e-cigarettes or vaping as a primary method for quitting smoking. Instead, the task force emphasizes established interventions, including medications, nicotine replacement therapies, and counselling, which significantly improve the chances of long-term cessation. This guidance was published in the Canadian Medical Association Journal on March 15, 2024.

Despite a steady decline in smoking rates over the past several decades, tobacco continues to be the leading cause of preventable cancer-related deaths in Canada. The task force’s guidelines aim to offer clarity amid a landscape where vaping has become increasingly popular, particularly among youth. A report from Statistics Canada revealed that in 2022, approximately 30% of individuals aged 15 to 19 had tried vaping, compared to only 10% who had experimented with traditional cigarettes.

Dr. Eddy Lang, a member of the task force, highlighted the importance of the new recommendations, stating, “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.” This initiative seeks to counteract misleading advertisements that promote vaping as a safer alternative to smoking.

Vaping remains a contentious subject, particularly among young people. While some smokers turn to e-cigarettes in hopes of alleviating nicotine addiction, the guideline notes that no vaping product has been approved for smoking cessation in Canada. The task force expressed concern over the lack of long-term data on the health effects of e-cigarettes, particularly regarding lung and heart health.

Dr. Matthew Stanbrook, a Toronto-based respirologist, endorsed the task force’s conditional recommendation against vaping. He pointed out that nicotine replacement therapies, such as patches and gums, are not only widely available but also safe, avoiding the harmful toxins found in e-cigarette vapor. “E-cigarettes deliver many of the same toxins and carcinogens found in tobacco smoke directly into patients’ lungs,” he explained.

While the task force acknowledged that e-cigarettes may serve as a last resort for those who have exhausted other quitting methods, they emphasized a critical message: “We didn’t want to substitute one addiction for another,” Dr. Lang remarked.

The guideline does not specifically address flavoured nicotine pouches, which have gained traction among younger users. These pouches, such as Zyns, contain nicotine levels comparable to smoking multiple cigarettes. The task force indicated that these products might be reviewed in future updates.

To effectively support individuals looking to quit smoking, the guideline strongly endorses behavioural therapy, pharmacotherapy, or a combination of both. Behavioural therapy includes self-help materials and group counselling, while pharmacotherapy comprises nicotine replacements and medications like cytisine and varenicline. Cytisine, a plant-based product, has shown promise in mimicking nicotine’s effects and is considered a cost-effective option.

Dr. Peter Selby, an addictions specialist, praised cytisine’s effectiveness, noting its historical use in Eastern Europe during World War II when smoking resources were scarce. He emphasized the need for greater awareness and accessibility of such treatments in Canada, remarking, “The evidence is pretty good.”

The task force explicitly discourages the use of alternative therapies such as acupuncture, hypnotherapy, and laser therapy, labeling these methods as ineffective despite their general safety.

As research into smoking cessation continues, the task force acknowledges the necessity for further studies, particularly regarding the long-term safety and effectiveness of e-cigarettes. They also plan to explore whether specific demographics, such as Indigenous populations, face unique challenges in quitting smoking.

In the future, the potential for AI-based therapy to assist individuals in quitting smoking may be considered, opening new avenues for support. Dr. Lang concluded with an encouraging message: “It is absolutely possible to quit smoking. It is just very difficult because nicotine is such an addictive substance.”

The Canadian health community’s commitment to providing effective smoking cessation resources remains a priority, aiming to reduce the burden of tobacco-related health issues.