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Vapes, gums or lozenges for smoking cessation?
A clinical trial found vapes almost three times more effective than nicotine lozenges or gum, but one expert says GPs must take a ‘nuanced approach’ with supporting patients to quit.
Vapes were found to be almost three times more effective than nicotine replacement therapy in a clinical trial as a tool to quit smoking.
Almost are daily smokers, but for those from socially disadvantaged backgrounds, smoking rates are up to three times higher.
For this priority group, vapes are no ‘magic cure’ to smoking, but a promising treatment for those wanting to quit, say researchers from the University of New South Wales (UNSW).
Published this week in the Annals of Internal Medicine, the study by researchers from the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney explored whether vapes are more effective than nicotine replacement therapies (NRT) such as lozenges and gum.
Researchers recruited 1045 adults from Sydney or outer Sydney for the trial, who were all receiving a government pension or allowance, who all smoked daily and were willing to quit smoking.
Participants were randomly assigned to either a free eight-week supply of vapes or NRT.
Of the 82.9% of participants who completed the final seven-month follow-up, continuous six-month smoking abstinence was verified with a carbon monoxide breath test.
Among those assigned NRT, the continuous abstinence rate was 9.6%, while in the vaping group, the abstinence rate was almost triple, at 28.4%.
However, for those who had successfully quit smoking cigarettes, 58% of those who quit smoking continued to vape.
‘Vapes are not a magic cure, but they are a promising treatment option that leads to higher quit rates than nicotine gum or lozenges for those experiencing social disadvantage,’ said lead researcher Associate Professor Ryan Courtney.
‘Research findings illustrate that for some who have managed to quit, they may need support to stay vape-free in the longer term.’
Chair of the RACGP Smoking Cessation Expert Advisory Group, and one of the paper’s co-authors, Professor Nick Zwar, said the study is further evidence that vaping can be an effective smoking cessation aid.
‘This study is also important as it used nicotine pod devices, which are the most widely prescribed in Australia due to their low risk of accidental or intentional poisoning,’ he said.
However, Chair of RACGP Specific Interests Addiction Medicine Dr Hester Wilson told newsGP that while the long-term effects of vaping are still largely unknown, they are still ‘probably much less harmful’ than smoking.
‘They don’t have the other 4500 polyhydrocarbons that tobacco has, that have clearly been related to cancer and health damage,’ she said.
‘In the illicit vapes, God knows what they’ve got in them, but with the regulated vapes, [the Therapeutic Goods Administration] has really limited what they can have in them.’
The study’s findings come just one day after the Australian Federal Police (AFP) revealed it had restrained two bank accounts with a combined balance of more than $1 million suspected to be the proceeds of crime from illicit vaping goods sales in Sydney and online.
The AFP says it believes the vapes were sold online to Australian retail consumers and supplied to Sydney-based tobacco outlets.
Looking at the research, Dr Wilson questioned why the study did not include combined nicotine replacement in the study, which she said is ‘the most effective way to use NRT’.
‘We know the best outcomes with nicotine replacement occur when you’ve got your long-term patches, and then you add in the short acting [aids],’ she said.
Dr Wilson is concerned that some doctors may not be giving patients ‘a good enough go’ with nicotine patches, having found in her own practice that patients will delay their first cigarette of the day ‘without even trying’ when using them.
‘When I’m talking to someone who’s wanting to give up smoking, I might say to them, “let’s just put a patch on you. You keep smoking”,’ she said.
‘And instead of having a cigarette as soon as they wake up, they’ll find that their first cigarette is half an hour after they wake.’
Dr Heston said for GPs, helping patients to stop smoking is ‘one of those incredibly positive things we can do for the people that we see’, but many doctors will also need to support their patients to stop vaping.
‘So vaping is a step down – and they do say this in the paper, that it is one of the challenges,’ she said.
‘We apply the same kind of process for smoking cessation to vaping cessation, taking a nuanced approach that engages with where they’re at and supports them to make the shifts that they can make and continue to make those shifts.’
‘It’s working with the person towards being free of nicotine.’
Last year, the RACGP updated its Supporting smoking and vaping cessation: A guide for health professionals, designed to offer expert guidance in the wake of rising vaping uptake and regulation changes.
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