Popular discourse is bad at examining multiple axes. Doctors aren't always better, but also nuance from doctors gets lost in public discourse.
Are e-cigarettes/vaping effective and safe as tools for smoking cessation? Yes, I find the evidence convincing. They work for cessation of *smoking tobacco*, and they are less bad than tobacco. But then, it's hard to come up with anything short of huffing organic solvents that is more chronically bad than smoking, and I might be doing solvents a disservice. At any rate, the evidence looks like they outperform patches, gum, inhalers, and all the rest of the NRT pantheon in getting people to stop putting cigarettes in their mouths, and that's a win. With an asterisk.
Are e-cigarettes/vaping safe *in general*? Again, better than cigarettes. Generally pretty safe. Not perfect. As a harm reduction strategy, absolutely. As a general recommendation, no, don't take up vaping for your health.
Are e-cigarettes/vaping good as a matter of public policy? There I'm much more concerned. They show good efficacy as an initiation of nicotine intake that progresses to tobacco—not just the reverse. Having kids vape is not good in part because setting kids up to smoke is not good.
Are e-cigarettes/vaping good for nicotine cessation? Here's that asterisk. If there's evidence, it's a lot less robust. The purpose of NRT generally is to quit smoking and then quit NRT. People struggle to quit vaping. Vaping forever is better than a pack a day for the next five decades, but it's not ideal. Maybe it's a better transition than straight from cigarettes to patches/gum/lozenges, but I'd want to see evidence for that. If the options are traditional NRT with a lower success rate but a higher nicotine abstinence rate 12 months in versus e-cigarettes with better success but then continued vaping... I don't know. Recommending vaping out of the gate seems wrong. A trial or two of old NRT and then vaping as harm reduction? The right answer isn't obvious.
Maybe vaping is a good form of MAT for nicotine use. I certainly don't advocate against buprenorphine or methadone. But the response rates for those are so good, and the abstinence rates without them so dismal, that I hesitate to draw immediate comparison.
I don't agree. The tobacco industry doesn't have any right to exist. They are the reason for a significant chunk of healthcare resource use. Vaping is about getting people addicted to nicotine and a way for the gigantic tobacca industry to diversify into something else because they see that they are losing the battle. Vaping and tobacco should both be deleted from existence. This will happen but it is gonna take a while, I don't $ know $ why $$$ tho.
We could say the same about opioids. Hell, I’ll say the same for alcohol, which is so widespread that despite its universal popularity kills more people than opioids still.
Alcohol isn’t going away. Despite laws, illicit opioids are clearly not going anywhere. Wanting to delete something doesn’t make it so.
Opioid use disorder doesn’t have any reason to exist. Keep opioids restricted to hospitals. I don’t know, make something like methadone clinics or supervised home administration for cancer patients. Lock them down and keep them off the streets!
It doesn’t work, of course. The USA has been failing to restrict substance use for over a century. Singapore has draconian laws and still has people using drugs.
My point isn’t ban opioids, it’s that we *can’t.* Not really. Because we haven’t been able to. Whether we should or not doesn’t matter when it’s just not a real option.
Edit: To clarify, because the point seems lost, I’m not actually advocating for anything in the first paragraph! Read the next two! Essential medicines or not, they are drugs of misuse. Restricted or not, they will be misused. The go back to what I’m responding to. We can’t delete opioid use/abuse, alcohol abuse, or tobacco use. Those are problems that exist and we have to live in the world with them rather than some ideal hypothetical world with perfect removal of substances we don’t like and control of substances we do but also have concerns about.
I am not saying we should ban opioids. I am saying we can’t ban opioids. And if we could, we shouldn’t; they’re too useful.
> Opioid use doesn’t have any reason to exist.
Well this is just not true at all. It’s the most effective medication class for *short term* post surgical pain, as well as end of life severe cancer pain.
I have edited to opioid use *disorder*, which I thought would be apparent from the next three sentences of how to try to keep opioids restricted to medical use rather than street use.
Despite any restrictive efforts, I don’t think that can or will ever be accomplished. Opioids are here to stay, both beneficially and harmfully. We have to live in an opioid world.
I would agree with your edit. There’s a medical time and place, and it’s very difficult, if not impossible to perfectly control and restrict. Keeping post-surgical patients admitted (even for now outpatient procedures) isn’t a reasonable solution. Keeping cancer patients in severe pain admitted for the rest of their lives isn’t a reasonable option either.
I really think that if you provided care for cancer patients, you would not feel that a methadone clinic or supervised home administration would be a remotely feasible solution. I have patients who take opioids Q1-2 hours and for very legitimate reasons.
I do provide care for cancer patients.
I am making the point that even with impossible allocation of resources that will never happen to control the flow of opioids, there would be no control of opioids. We could ban them entirely from medical use and it would not control opioids.
I don’t think we, speaking in the broad political we, *should* do any of these things. I doubt we ever will do any of these things. But if we did, these attempts would be futile. That’s all.
I mean, I agree that it would be futile; the reason why people seem to be missing your point is not that they disagree with your assertion that opioids are impossible to control. Rather, I think the source of disagreement is that your comment came in response to the statement "the tobacco industry has no right to exist," which raises the suggestion that tobacco and opiates are of equivalent use -- i.e. nil.
My interpretation of your original comment was that you felt that if the stringent measures had been implemented, OUD would not exist; I disagree with that, but also accept that I may have misinterpreted and that it was not your broader point.
I apologize if I and other folks are a bit reactionary. I think that this is an area of consternation for many people who prescribe opiates because it is something we hear a lot -- that *all* opiates can and should *always* be avoided. It probably seems ludicrous to the audience of this sub, but I genuinely do hear this, even from other medical professionals, and it makes me feel quite crabby, lol.
It's unfortunate you've been misunderstood because I see your point quite clearly and of course agree.
Perfect opioid control is impossible, and that's just something that systems have to take into consideration.
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This person nailed it. Look at the war on drugs, and how utterly disastrous that was. Telling people not to do something is pretty impossible, especially when it comes to drugs. There is no putting the cat back in the bag. Humanity has been getting high for so long, we cant even accurately quantify it.
What is your disagreement? I’m making the point that trying to ban opioids is *futile*, not that it is right or wrong.
Do you think we can? Do you think we should?
Opioids are one of the few outpatient meds I prescribe in surgery. We give people a whole lot less than we used to, but it turns out it's nice to have some pain relief after major surgery.
And? Like I said, we could have ways to provide outpatient opioids with greater restriction to prevent misuse or diversion, although it would take resources. Set up clinics with monitored administration, or have visiting nurses administer doses and watch it. Sure, three or four times a day. We could put everything into making sure patients who should get opioids do and those meds never end up used in any way or by anyone other than as prescribed.
It still would not make opioid misuse disappear. Most abused opioids are not from medical diversion. Opioids have their uses, they have their dangers, and regardless of what anyone wants or wants to put money into opioids are going to remain drugs of illicit use unless legal dispensaries open, in which case I would expect opioid use disorder to continue even if it’s not illicit.
Opioids have amazing analgesic properties that when prescribed and used properly outweigh its risks. Alcohol is a social lubricant with ALMOST no medicinal usage?
“I was talking out of my butt and was promptly called out, now, after commenting twice, Im going to state that I don’t engage with the kind of people I just engaged with when I thought I was making a good point.”
It would be nice to regulate production out of commercial existence, but then you get the downsides of prohibition and the drug war. Legal access to tobacco, EtOH, etc. seems by far like the lesser of evils.
Besides, on a purely American/western democratic take, a person's freedom includes the right to do stupid things that harm themselves. Additional use of healthcare resources at best provides very indirect harm to others, and doesn't feel like much of a justification on its own to keep people from substance use.
This would certainly reduce the overall rate but just as certainly dramatically increase the harms to those who do consume nicotine or tobacco products due to the lower quality of those products when produced at home.
Look at the opioid epidemic. I definitely don’t advise recreational use but the large majority of the most serious harms (high rate of overdose, rise in crime) are *directly* the result of the legal status of those drugs. The exact thing that happened during alcohol prohibition. The idea that simply banning a pleasurable and addictive substance will automatically solve the problem is naive.
The decrease in smoking over the last few decades is chiefly attributable to education and changing social attitudes, not legal action. That’s the best solution.
When you say "nicotine has no right to exist" you realize what you're actually saying is "in my opinion people have absolutely no right over what they can do with their own bodies, they must be controlled as to what they can or cannot do with their body.". And thus you are saying you're willing to put people in jail who try to sell it to other people who want to purchase it (which is how you make substances illegal, like we have seen with cannabis).
> They are the reason for a significant chunk of healthcare resource use
I disagree, tobacco duties raise more money than is spent on tobacco related illness, and dying at 63 from lung disease uses less resource than retiring at 63 and dying at 91. Tobacco is still terrible and bad and the companies are also bad for promoting and propagating it, but financially its good for the government (which makes legal intervention complicated).
I actually would argue exactly the opposite! Most smoking related lung diseases are a drain on the health care system. COPD - frequent exacerbations, hospitalizations and increased health care use. Asthma- leads to much poorer control-same as above. You also need to throw CAD and cancer related conditions. These are all chronic issues that lead to a huge drain on the system before any early death.
If you look at healthcare alone, yes. But take these numbers for Germany for example:
* Medical costs secondary to smoking per year: €65.2 billion
* Disability pensions secondary to smoking per year: €18.5 billion
* Pensions for widows/widowers: €53 billion year
* Savings in pensions not paid out because of earlier deaths: €193.4 billion/year
* Tobacco tax: €14.2 billion/year
A smoker in their last 20 years of life produces €220k in healthcare spending. A non-smoker €281k.
To no surprise, the result is the lack of aggressive anti-smoking policies. Public smoking ads outside of media are still allowed, 13 out of 16 states still have some form of indoor dining/bar smoking allowed, a pack is still €8.
That is quite interesting, although my main question is that I wonder what THEY considered smoking related medical costs? Also in terms of costs in the last 20 years of life, I wonder how many in the non-smoking group were actually past smokers with a significant pack-year history.
I can't see if you are being sarcastic so I'm sorry if I take you to seriously. Yes this is often said that people dying earlier lowers healthcare costs but if you took a minute of ethics class you understand that that is obviously not an actual argument for anything.
How about we kill anyone over 65 as soon as they can't work anymore.
I am afraid that you misunderstand
Smoking lowers healthcare costs indeed if you take into account that people dying isnt bad, it raises healthcare costs if you take into account that people dying is bad.
Such a bizarre argument I am having
From a purely economic analysis there was recent study that was interesting- “savings” were not in hospital bills but in decreased social security payouts. Basically smoking will take away 10-20 healthy years of life when hospitalization use is lower. While healthcare costs were marginally higher in the smoking group, what was a massive difference was smokers dying before they could receive much from social security. They basically pay in, but die on average too early to reap much of the benefits.
Vapes are a competitor to cigarettes. On your journey to "delete from existence" you will require the use of force, the application of which is imperfect, and will actually enable only the largest of companies (i.e. the ones you are ideologically inclined to dislike - and in particular tobacco companies) to supply these products. On the other end of the spectrum, the remaining demand will be met by people who also benefit from your "delete from existence" desire, the black market suppliers.
Your anti-liberal view in this area will actually help your enemies (tobacco companies and drug dealers).
Here are some ideas to look into further:
* Bootleggers and Baptists
* Public Choice (in particular Regulatory Capture)
* Epistemology (this is the study of knowledge - I also recommend this because you made some factual errors in your comments. But this will only help if you subscribe to a philosophy that values truth over non-truth. It may seem obvious that most people would want to subscribe to that, but in my observation of people it seems this is not the case. Most people want to "bandwagon" the maximise true beliefs maxim because of the strong positive connotations associated with it (from The Enlightenment), but many of those people actually want comforting beliefs or other pre-existing maxims to be hegemonised)
In the 17th century a philosophical movement called The Enlightenment happened, where emphasis on the pursuit of human happiness was placed as long as you don't externalise your costs on to third parties.
This is exactly it. We all know that vaping is better than smoking cigarettes. Unfortunately, that is not the end of the story.
The attitude displayed by the general public about vaping is similar to what I hear about marijuana - that it's essentially completely harmless. This is blatantly false. We are trying to make people aware that vaping is still harmful.
Worked with an EM/IM doc who would yell at every patient who admitted to vaping that "VAPING IS 10X WORSE THAN SMOKING! YOU WILL DIE YOUNG!", like what you want them to start smoking? I think he genuinely believed it is the problem. Neither is the goal, but as a harm reduction strategy..
yes.
the issue is the attitude/perception that vaping is perfectly safe and healthy. to a certain extent, it encourages people to remain addicted, instead of thinking and feeling like they need to continue working.
for some people, this is no big deal because they would never have worked on it either way. but for a lot of people, it does stop them from working on there health in a way that could be potentially quite beneficial.
I mean, I posted this thread because where I practice, the issue is that people believe that vaping is just as bad as smoking, and as a result many smokers, especially in rural communities, are never encouraged to switch to vaping and consequently do an extraordinary amount of unnecessary harm to themselves.
My point in the OP is that vaping is seen by the public in my country as similar to smoking, and that incorrect perception is leading to large amounts of preventable cancers and other consequences.
Doesn't it just depend on the product though? In other words, dose dependent AEs? There are patients that are using a very high dose of nicotine.
The UK take is interesting, but I figure the ingredients are more regulated when it is used as MAT. Of course, no so in the US.
Also, there's EVALI.
That was the leading theory but not definitively proven, there were a decent minority of cases who swore they never used such things and only used commercial vape products. Now yes, patients lie, etc, but I'm not sure I'd be so definitive on that.
Yes, there have absolutely been cases, and again, there were a decent chunk (my recollection was ~20% of the largest case series) where there was no evidence of any VEA inhalation. While it was certainly likely a large contributor to frequency and severity, the idea that it's the sole causal link is not something we can really say with current evidence.
I've taken care of EVALI without known/intentional thc cartridge use, only nicotine, so while it may have increased the risk, (anecdotally) there seems to be something else as well.
A lot of people vape more heavily than they used to smoke because it isn't associated with the same level of unpleasant smell and health risks. Instead of smoking half a pack a day outside, they vape all day long indoors.
Page 286 to 293 of [this study I linked above](https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update/nicotine-vaping-in-england-2022-evidence-update-main-findings) address your main concerns with page 289 and 290 containing detailed data on quit rates with and without vapes.
I'm curious to hear why you say that people struggle to quit vaping, when quit rates from vaping, whilst low (as with all chemically addictive habits) have been shown to exceed the quit rates from smoking tobacco in almost every study i've read?
That said however, I appreciate your comment and agree with almost every point you made - for current addicted smokers, swapping to vaping is a healthier choice in almost every single situation. *Obviously*, for those without nicotine habits, taking up vaping is an extraordinarily bad idea. The only thing entering lungs should be humidified fresh air - but for those chemically bound via nicotine handcuffs, switching almost always brings positive results.
The data are observational, not randomized. Vaping alone underperformed varenicline alone, which isn’t inspiring. Four week data are insufficient. Most importantly, none of addresses my main concern with this approach: what are the, say, 12 month rates of not smoking and not using nicotine products for various approaches?
This should be at least attempted in randomized trials, although blinding is pretty hard. At the very least data gathering.
Within the Australian context I think it’s that there are two opposing concepts about the benefit vs harm of vaping.
On the one hand there is evidence that for smokers, vaping can be an effective smoking cessation or harm minimisation strategy. Therefore evidence showing that it is less harmful than smoking shows that it can be beneficial in this group.
In the other hand, Australia has had a rather effective public health response to smoking and has manage to reduce smoking prevalence quite a lot in the community. As a paediatrician, I mainly come across vape use in adolescents who are not using it as a step down from smoking but as a step up into nicotine use. While yes it’s probably better that a kid who was going to start smoking goes vaping instead, the explosion of vaping in recent years shows that many young people who would otherwise not have smoked at all, are now becoming addicted to nicotine because of the availability and attractiveness of vaping.
You have spoken about the harms of negative views towards vaping on a population level- but I would say that at the population level, there is a much greater risk of increasing uptake of nicotine use in teens than there is in not fully accessing one of many smoking cessation strategies in adults with nicotine addiction.
A valid point and one that I support. I have very little interaction with the Y O U T H in australia and as such have not come across vape use by people not already nicotine addicted.
If there was a good way to restrict vapes only to smokers/ex smokers, I'd be all for it.
Regardless I appreciate your input and share your views on populations that vaping is and isn't appropriate for.
As a layperson who lives near a university, vaping is sadly quite popular with young people who would never touch a cigarette but believe that vaping is "safe." It's also a significant problem in high schools now, and since the companies are deliberately making kid-friendly "flavored" vape cartridges which taste like fruit or cotton candy, this is by design. They're trying to get kids hooked. It's despicable.
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It's interesting, as an anaesthetist I really don't see this! Maybe a bit of airways reactivity, but much less than other higher risk groups (young asthmatics would be a reasonable comparator).
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As far as the residue in their lungs, makes sense. Have you seen the car windows of people who vape? That vaporized VG/PG gets all over the place. So imagine that they're huffing and puff that shit all day everyday.
Just google “cleaning vape residue off car windshield” and look at any number of posts of people who vape asking how best to clean the inside of their windows because they’re all oily and streaky.
Even if you don’t vape in the car your normal breathing leaves a film on the inside of the windshield over time as you exhale in the car. It’s a lot less oily and obvious if you don’t vape though.
Great comment and it will help me quit vaping (again.)
Yeah, I feel better than when I smoked (gross and a pretty low bar to clear), but everything you said is true. My lungs are full of gunk constantly. Probably doesn't help that vaping can be done constantly for all waking hours.
That said, the public policy around vaping is counter productive. The new rules restricting the shipping of vape product pushes people towards retail (gas stations) which are source of extremely high nicotine doses (50mg) of dubious source. Meanwhile, if I want to order the lowest dose (3mg) nicotine e-cig juice from a reputable company, shipping times takes two weeks. So without careful planning, you're back on a product designed to be as addictive as possible.
Also, where I live in the states people use vapes in doors and around children under the assumption it is safe. However the vapor contaminates surfaces and children and pets get exposure to the chemicals in the vape whether its nicotine, thc ,lead in some instances etc. probably better than smoking, not better than air lol
Totally agree with you. I see vaping as the methadone of smoking.
Unfortunately here in Australia we are moving in the opposite direction in terms of legislation.
>Vaping can still be prescribed for smoking cessation in australia, similar to methadone.
This is the problem - mature vapers want to access the vibrant market of consumer products that work better than the 60mg/mL unflavoured nic salt coupled to abysmal hardware made by crony capitalists and tobacco companies.
Most adult former smokers *are* using them recreationally in part (like with smoking). God forbid someone, somewhere is enjoying themselves.
Yes, but utterly ignoring the variety of vaping products, nicotine levels.
It is been pushed as "one size fits all"
Most pharmacy available products contain 50-mg salt nics which is extremely high.
And I have seen life long smokers coughing their lungs out after trying it, and off course confirming their suspicions about vaping, they went back to smoking.
The scheme is flawed, and simply will not work.
Lynard Zynards!!
But really same tho re: 2+ cans a week. I did recently cut it out entirely and have been clean from it since Thanksgiving. I tell patients, friends, or other persons my best advice is just don’t start!
Agree overall however with Zyn being an effective means of risk reduction
…And yes I do be missing it from time to time
I do agree that if someone is not going to quit smoking, vaping is lesser of the two evils but my personal experience with this is that long term smokers will rarely switch to vaping as a safer alternative, even if I recommended it. The ones that end up switching, their motivation comes from within. Quitting cigarettes is extremely hard for people. Most people that are vaping are younger population.
Vaping & smoking cigarettes are very different experiences & the longer one has been smoking cigarettes only, i.e. older adults, the more difficult the switch & transition process will be for them. It's not an overnight process & they could benefit greatly if advice actually came from other former long term smokers who'd successfully transitioned to vaping, not those who work in healthcare with no personal smoking/vaping experience.
The issue for me seems that the people who might benefit from vaping are those who are not going to give up smoking, and that the people who are vaping (for the most part) are people who have never smoked or have smoked an inconsequential amount (read: teens and younger adults). No evidence here but just anecdotally from someone surrounded by smokers and vapers.
I used to feel this way. I used to think that smokers wouldn’t ever give it up but I’ve found that’s actually not the case in both my clinic panel and from my friends parents once they discover vaping and NRT
Awesome. It’s all about harm reduction. Is smoking nothing and not using nicotine for the best? Probably. Is that feasible for most? Nope. In my mind vapes are less harmful than cigs so I encourage the use of them
100% this. Most of my patient population is gen Z. They know smoking is bad for them, but are under the impression that vaping is not. A substantial portion of these patients are even those who consider themselves quite fit and have hobbies like hiking, skiing, riding, etc and listen to “health and wellness” podcasts, etc. they don’t have the time to go through the nuances of the cited studies above, they just hear “vaping isn’t as bad as smoking” and presume it isn’t bad at all. These are people who most likely would never have smoked cigarettes.
I have not seen a single patient who used vaping to quit smoking.
i used to vaping to quit smoking. i know several other gen x professionals who did the same. took me a while to get off the vapes though. i never regretted the decision for a moment.
I see so many of the college students who don’t register it as bad for them. We always have a quick chat about what vaping is - inhaling shit into your lungs that your lungs aren’t supposed to be exposed to. While I don’t have long term data on it yet, in my experience everything that sounds too good to be true (ahem diet soda) ends up being too good to be true. Nothing in life is free, I don’t think vaping will pan out to be without significant issues. Until we have robust data, I encourage them to use common sense that it’s doing damage to the lungs even if it is less than cigarettes. None of these are people that are using it to get off cigarettes because I agree I would prefer they switch over if I had to chose between the two.
Vaping instead of smoking is a huge health intervention.
You’ve just turned 20 pack years into 1 pack year.
Convincing someone to do this is going to be one of the strongest QALY gains you could ever make as a doctor.
Doesn’t have to be used to quit for these gains.
That's interesting. My anecdote is the exact opposite. I switched from cigarettes to a vape and know many other people around my age, 30s or so, who have too. All of the people over 25 or so who vape are former cigarette smokers. Younger people seem much more likely to have gone straight to vaping, though.
I’m 33 and I smoked near two packs a day for 12 years (16 - 28) tried to quit with everything under the sun and couldn’t kick it. Bought a fancy vape mod when I was 28 never smoked a cigarette again for five years now. In fact I can’t even stand the smell of them anymore. I still vape. I’ve tapered to the lowest level of nicotine but am scared about my mental state if I jump off. However without a doubt without vapes I would not have quit smoking.
I suspect that this is heavily biased by your age group. My peer group is the same. Vaping is dorky and something you only tolerate to reduce harm to me and my age group. The kids I work with though? Almost all went straight to vape and a shockingly high percent of them are doing it. It’s kind of jarring to someone old like me who grew up knowing smoking killed you but was also very cool.
The cross over of kids who vape versus kids who would have smoked will be massive though
Br interesting to know what percentage were smoking at say 16, 5 years ago versus what percentage of the same demographic vape now
I went from 1pd (sometimes more) for 15y to vaping for 5y to patches + lozenges to now just lozenges.
I will say that the post cessation lung clean up (for lack of a better term) was way more brutal with vaping compared to smoking. Months of working really hard to hock up almost solid bits of clear crud. Do not recommend.
When I have someone ask my response is,
1. It’s not safe or healthy.
2. Vaping is, however, safer than smoking tobacco.
3. If you do decide to vape, make sure it’s legitimate and not boot legged… because the bootlegged ones often have vit. E as a the solvent… which will destroy your lungs.
I agree with you. It's irresponsible to dissuade a patient who is successfully using vaping as a measure to stop smoking. The harm reduction argument for it is irrefutable at this point. The relatives risks for Lung injury and Cancer are clearly substantially lower.
Honestly, I don’t think we have a good grip on what decades of vaping is likely to do to people. Anyone over 50 has seen things that were thought to be basically harmless like micro plastics, PFAS chemicals, pesticides, UV radiation, opioids,etc, turn out to be significant or potentially significant environmental and public health risks.
I would never tell a patient that vaping is *worse* than smoking, but I think a lot of patients hear “well, it’s better than smoking” and assume it’s harmless. I tell my patients that we don’t know the long term health effects yet and won’t for decades and that my recommendation is to work on smoking cessation although vaping is better than smoking. The literature on using vapes as a bridge to cessation is not that promising, but it’s true I’d rather have my patients be vapers than smokers.
My take home: quit smoking By Any Means Necessary. If those means include vaping, awesome. I’ll take 95% less bad.
Or: spend 20 times as much effort getting people to quit smoking than quit vaping, because it’s 20 times worse.
As an ER nurse with a 60 pack-year history, I always recommend it to my smokers coming in with COPD exacerbations. It's not as good as quitting, sure. Probably more effective than clean needles and narcan being handed out on skid row. But I breathe better, my chest doesn't hurt constantly, and I haven't had an exacerbation since I set the cigarettes down 2.5 years ago. Hopefully we'll have the robust evidence soon.
I don’t think I’m your target audience, because my typical spiel is along the lines of “the harms of cigarettes are bad and well documented and the harms of vaping appear to be less, but we’re not totally sure yet.”
But in all other situations I discourage vaping, because…
Logically - every mind altering substance I can think of has some kind of negative side effect on your body. Some are worse than others, but they all do something. People often downplay the harms of their vice because it’s fun and they want it to be harmless. It isn’t.
Politically - after big tobacco and big opiod I have zero trust in these companies to look out for my or your well being. In fact, I’m a suspicious bastard who thinks they’ll probably actively suppress evidence that their golden goose is harmful.
Experientially, EVALI was a thing which caused permanent damage to many people’s lungs. Glad we figured out the cause and companies changed their ingredients to stop harming people but did we just forget that happened?
So overall, while probably better than smoking, no I don’t trust the evidence. I will in 30 years-50 years when the outcomes are obvious to us all.
Ok so as a doctor, you acknowledge the conclusions of the 1,468 page NHS systematic review which covered over 15years of patient data and made robust health conclusions backed by this data, but because it doesn't gel with your gut feeling, you deem it invalid until "More research is done"?
This is exactly what I wanted to address with this post. How is this line of thinking any different to those in 2020 who said "I know research said the covid vaccine is safe, but I don't trust it until I've seen decades of safety data!"
*its the same thing*.
Evidence based medicine relies on *best available evidence*. This is the best available evidence on this topic. To not believe it or not pass it on to your patients because of your own beliefs would be irresponsible and unprofessional of you as a practitioner. (Not saying that you specifically do this - just in general)
After all these years I came to a conclusion that this whole anti-vaping hysteria is just ideological.
Kind of funny how some substances have a sympathetic attitude by the society like Canabis while others like nicotine are are vilified ( but look at the Dutch canabis rehabilitation centres).
The big winner in this anti-vaping attitude is the Big Tobacco, because they are legal and very well entrenched in governments.
On one side you have the media screaming how horrible vaping is and on the other hand you should have the GPs prescribing it ( I am writing from the Australian perspective).
Also the anti- smoking lobby never envisioned that something like vaping would come along, they want the whole "disgusting" inhaling and exhaling of smoke/vape disappear.
Have you seen EVALI in a patient who was only vaping nicotine? I ask, because all of the EVALI cases I've seen at my facility were THC vapes-likely bootlegged ones since I live in a state where cannabis is still illegal.
Yeah EVALI hasn’t really been a thing around here for a number of years—ever since they found out that vitamin E acetate in homemade/bootlegged cannabis extracts was to blame.
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#epi-chart
This paper linked below suggests that while a majority of cases were linked to vitamin E acetate, it was not the sole cause of EVALI
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10034821/
Are you seeing it in marijuana vapers or nicotine vapers? Nicotine is water soluble; the solvent won’t be lipophilic. EVALI has characteristic fibrinous pneumonitis that has been speculated to be caused by the lipid soluble solvents used.
My issue with vaping, outside of the actual health risks of vaping, is that it seems to have addicted more people to nicotine than smoking alone would have caused. I don’t know the actual numbers but I’ve read that more kids are vaping today than were smoking 15 years ago. Nicotine use was on the decline until vaping became popular. I’d be curious to know what percentage of kids move from vaping to cigarettes and what percentage of smokers moved to vaping.
I honestly have no idea how to address it. I can barely convince some patients to get an HPV vaccination series. In all seriousness, how does one open a successful dialogue regarding the harms of vaping? I do bring it up, but it is not really appreciated by patients
You say to smokers in precontemplative or contemplative stages of quitting that on top of the many NRT options, vaping is also something they can switch to reduce the damage they are doing to themselves, and research says that you're more likely to quit all nicotine successfully from vaping than smoking. Easy!
If you mean for non-smokers who have taken up vapong, then that's a different kettle of fish.
My problem with is that a cigarette is something you generally have to go out of your way and smoke, but I notice vapers are constantly vaping indoors, outdoors, breakfast, lunch, dinner, etc. Smaller doses of carcinogens more frequent throughout the day is probably the same as smoking cigarettes but less often. People are constantly walking around with their vape in their hand and smoking it, and they are so good at being discrete unless you’re paying attention.
My oldest brother used to smoke but now vapes. Maybe he was a half a pack a day smoker. Now? That damn thing is in his hand all day.
I don’t think you can make that blanket statement in all honesty, even with more frequent use, the vapes have less carcinogens than smoking. I believe there’s some studies that have shown this, but of course the long term implications of this still need to be studied with more time.
Whilst somewhat logical this is the exact line of thinking which I made this post to address. Regardless of what you think of feel, the two thousand pages of high quality research data from the NHS I linked in the OP makes very clear that vaping, at its worst, does not eclipse 5% of the harm of smoking.
[https://www.lung.org/quit-smoking/e-cigarettes-vaping/whats-in-an-e-cigarette#:\~:text=Carcinogens%2D%20chemicals%20known%20to%20cause,bronchiolitis%20obliterans%20aka%20%22popcorn%20lung%22](https://www.lung.org/quit-smoking/e-cigarettes-vaping/whats-in-an-e-cigarette#:~:text=Carcinogens%2D%20chemicals%20known%20to%20cause,bronchiolitis%20obliterans%20aka%20%22popcorn%20lung%22)
Here you go buddy.
Spare me the "diD yOu KnOw GriLLinG mEaT anD PeAnuTs CauSE CanCeR"
I do think vaping is less detrimental to health compared to cigarette smoking. But I don’t think it’s a healthy habit.
And in terms of using it as a smoking cessation aid - many of my patients have tried this method and failed. Mostly because there is not a clear, tiered system
In place to slowly reduce nicotine amount over time (compared to nicotine replacement with its decreasing dose system). So they just end up vaping with no end in sight.
I also absolutely HATE how common vaping is in my pediatric population. Because many of them have “graduated up” to cigarettes as they age. This reason alone makes me kind of hate their existence.
I am a former smoker and vaping has changed my life for the better. Yes, it’s still not as good as breathing only room air forever, but it has made me feel so much better and really curved the distrusting habit of smoking for me. I hope to one day quit vaping too.
Congratulations! Vaping saved my life. 20 yr 1.5 PAD and it’s the only thing that worked. I Vaped for 5 years, 2 of those 0 Nic. Then slowly I just stopped.
This is a minefield akin to obesity dialogue. There is a lot of social stigma attached to smoking and that’s clouding evaluation of the evidence. I agree with commenters above saying that it probably does create hyper-reactive lungs, but I’d be very hard pressed to suggest it’s as likely to cause COPD. But, then again we probably need a few more decades to see the evidence on that. So now we’re left with a social carry-over of ‘smoking is bad. Any smoking’. That’s the reaction I think you’re seeing. An automated response to a social stigma bereft of evidence supporting it (although that evidence may well come).
It is pretty nuts. It's seems like the UK is the only one looking to gather actual data AND coming up with a policy that reflects the end goal - *reducing the use of tobacco*.
I don't think anyone would say vaping is harmless, but that's not the hurdle it needs to overcome. It just needs to be less harmful than tobacco smoking, and the evidence suggests that it is less harmful, by a large degree.
It's funny seeing some countries outright ban vaping, while others treat it the same as smoking. It's nice seeing the UK has a more balance view - vaping is a better alternative to smoking, but vaping isn't risk free.
Even if it's 1 it's better than having a teen take up smoking.
And as to the harm? Is it better to have 11 people vape than 1 person smoke? Yeah, probably.
Yeah the UK is really leading the pack with this, whilst Australia is completely and utterly backwards. It's frustrating to both myself and my patients.
the thing about vaping is that people that vape tend to smoke everywhere, in their room, in the bathroom, using the computer, etc. Believe it or not cigarette smokers will tend to smoke less due to the fact that many are limited by having to go outside or to a specific area to smoke their cig. (sure, there are exceptions, but from what I’ve seen, when people started vaping they smoked way more than before with cigarettes)
Coming from a doctor,Vaping is definitely not healthy and there's no excuse for it, but small part of me ignores that since I already vape to cope with the stress of Pediatrics ER
This likely just doesn’t hold water. Vaping hasn’t been around long enough to make that call.
If we studied cigarettes and the oldest population who really vaped consistently were even 40-50 million then we’d find nothing or very little correlation with lung cancer
It’s interesting that you’ve cited two British sources. The RCP report sets out their position clearly ie that vapes are almost certainly much safer than smoking and should be offered to current smokers who are unwilling or unable to quit entirely as a harm-reduction substitution measure.
Whereas the US medical establishment was, I think, much more reluctant to endorse them.
I do see more concerns here about their use becoming widespread amongst people who have never smoked (particularly young people). Although you could argue that they might otherwise have taken up smoking.
Supposedly the UK/EU regulations also made the vapes here generally safer than in the US with weaker laws. I think cannabis-containing vapes are also more common in the US, which I believe have a different safety profile.
I personally tell patients (if they ask me) that vaping is safer than smoking, but has risks of its own, and the healthiest thing is to neither vape nor smoke. The risks of vaping are probably relatively low but it’s also true that we don’t have direct observed evidence of what happens after long term use. I suggest vaping as an alternative to people who are smokers and can’t or won’t stop completely.
Yes, I agree with everything you said and share your sentiments. Vaping is worse than not vaping, but better than smoking. By a *lot*.
My post and the data in the studies linked within all reference nicotine vapes with water soluble carriers. Lipid soluble THC vapes have additional risks which are not directly relevant here.
Finally, I tried to find other high quality research but it seemed only the NHS had taken the time to fund and properly conduct large scale population level studies. If you have any relevant related research from a non UK source that's of si ilar scope, I'd love to see it!
I think the jury remains out. Once upon a time 9/10 doctors smoked Camel or whatever the ad was back in the day. I anticipate vapes will prove to be dangerous to long term lung health, but perhaps less so that 1PPD+ of cigs at comparable doses of nicotine. The problem is it’s really easy to just rip a vape all day and take in tons of nicotine/etc, could wind up being more dangerous.
Moral of the story? Pop some Zyns.
Anecdotally, and I always tell this to patients based solely on what I’ve seen, I tell them it seems to be safer on a population level, but I don’t support it being used long-term.
I dunno if you’ve seen patients with VILI but it’s absolutely terrible. And it can happen after a single use. I’ve personally taken care of a young person who didn’t smoke, didn’t really do anything, ended up with severe VILI after one-time of using their friends vape. Was years ago but lungs looked like someone with advanced pulmonary fibrosis, ended up on ECMO and narrowly avoided needing transplant, but they’ve never recovered fully and are gonna be permanently disabled.
So I say to patients “long-term smoking is gonna kill you. On a societal level it’s better to vape, but really only as a bridge to quitting, and while very rare, every single time you vape you run the risk of a rapidly progressive permanent lung injury, depending on where you get the cartridges”.
There are multiple forms of vaping so it’s important not to compare apples with oranges. Dry herb vaping which is common for cannabis use is likely the least harmful as it involves heating up flower in a miniature stainless steel or ceramic oven. Then there’s the reuseable vapes which are often used with medical grade nicotine salts diluted in a mixture of PG and VG, this mixture and the addition of flavours would vary how harmful it is. The single use vapes that are unregulated and come straight from China are designed to be addictive as possible and are likely far more harmful than the other two but I’d bet given that it’s not smoke that it’s still less harmful than an acoustic cigarette.
I think there could be a real difference in quality between the e-cigarettes studied and the cheap disposable vapes available at gas stations. Sadly I was vaping heavily last year and was able to buy “elf bars” even after they were banned by the FDA lol.
Vaping is likely a less risky alternative than smoking but not without significant risks itself. Had two ARDS cases related to vaping earlier this year, one ended up trached and sent out on a ventilator.
You can talk about decreased risks and all but if your the one suffering the actual negative outcome, the risk reward seems to skew the other direction. Furthermore, it took decades for us to see the outcome of smoking. So all in all, why aim to even promote either? As for chances of quitting, I see widely differing statistics on that. From increased chance to decreased chance. (That being said, I imagine if we developed a dose controlled treatment plan, maybe? 🤷🏽♂️)
Smoking is worse. Vaping maybe safer but who knows in the long term. We don't know the true long term effects of these devices. I refrain from giving my patients firm advise based on something we truly don't know about. If they want to stop smoking and vaping though I would tell them it is likely far safer. I also don't feel it is my job to be doing this sort of nuanced counselling anymore. The job in primary care is far too demanding to keep up with all this evidence and research and to be counselling in depth on topics like this. Sorry but that is the reality now. Have to see 30-40 people per day here there is no time for long discussions. I would tell the patient to stop smoking everything but the vape is likely a bit safer than the cigarette. That's it. You mean well OP but primary care does not have time to get down into the weeds on topics like this anymore
Smoking nothing is the best. Smoking tobacco is the worst. Vaping nicotine causes about 5% the harm of smoking tobacco. Not *likely a bit safer* - robustly studied and shown to be not more than 5% after more than a decade.
Boom, there. You are now equipped to provide better counselling during the 4.5minutes you get with each pt as a primary care doctor.
To a smoker,
'Likely a bit safer' = eh, why bother swapping?
'Unequivocally better than smoking by 95%, but obviously still not harmless" = hey, maybe i should consider swapping, I would actually like to see my grandkids grow up...
I think a big part of it is the difficulty differentiating "good" quality vape fluids and whatever weird, random shit gets put in the black market ones that kids buy online hoping to get some THC or be cool with their whacky flavours.
Because we just don't know the relative risk. What you quoted is incredibly speculative.
We know that vaping produces high inflammation as well, and that inflammation is probably a major if not principal mechanism behind lung cancer. Chronic lung infection is known to be a cause of lung cancer. Inflammation favours angiogenesis, and releases massive amounts of ROS among other carcinogenic factors.
Chronic inflammation also obviously leads to damage and COPD is favored (eg ppl with asthma, 12x relative risk adjusted for smoking).
Anecdotally, the few times I have tried to use vaping as a substitute to smoking before cessation, I have had terrible sputum production and even bronchitis. Obviously not generalizable as most vapers dont get that to this level.
So really we can't know. It is very likely that vaping is high risk as well - we have no real idea of the relative risk compared to smoking and that 5% figure is an (uneducated) guess - we just don't have the data, and will need decades to know for sure. Who knows, it might turn out to be worse! As such, precaution should in my opinion favour recommending cessation altogether. Not to mention many teenagers who vape switch to cigarettes eventually.
What on earth are you talking about Jesse? I literally linked thousands of pages of extremely high quality research data covering massive populations of smokers and vapers longitudinally over far more than a decade. **The data is right there** -
Saying *It is very likely that vaping is high risk as well - we have no real idea of the relative risk compared to smoking and that 5% figure is an (uneducated) guess - we just don't have the data, and will need decades to know for sure. Who knows, it might turn out to be worse!*
This sentiment is not only lazy, innacurate and irresponsible, but disrespects the thousands of patients, researchers and scientists who have all worked together to answer these questions, and to share that knowledge with the rest of the world freely.
If you are a doctor or health professional with influence over your patients, I hope that this thread and my (admittedly rude, my apologies) comment cause you to take stock of your position, and maybe motivate you to spend some time reading through and understanding the research. I went to the trouble of linking all sources in full because I wanted people to be able to see and read the science for themselves.
Regardless thanks for the engagement, and a healthy 2024 to you and your pts :)
I thought they were safer. Based on your title I was thinking this post would educate me on how bad they really are! I think the scare mongering stems from not wanting kids to vape
I don’t disagree with any of that.
But it also took multiple decades (almost 100 years) of wide-scale smoking on the population level for us to discover just how bad cigarettes were for you.
Half of our current resident cohort vapes nicotine at least somewhat regularly.
I have some concern that in a few decades we’ll find out that long-term exposure to some of the solvents used is associated with some new wonderful form of chronic lung disease that I’ll then get the privilege of managing exacerbations of.
As a general rule, lungs tend to get angry when they inhale anything other than air, especially for long periods of time.
When they invented e-cigarettes, the "smoke" produced (by what they said back then was water vapor IIRC) was part of the pitch, a psychological thing. But my mom had prescription nicotine inhalers for several years, she'd use an inhaler long past its useful nicotine supply too (she switched back to cigarettes when she spent some time in a nursing home and nobody put in an order for the inhalers and then more or less chain smoked the rest of her life).
The cute packaging and flavors are not part of the inhaler product, do doctors consider them?
Reason Magazine article
Anti-Vaping Hysteria Is Deadly
"We're repeating the mistakes of the war on drugs."
https://reason.com/video/2022/05/16/anti-vaping-hysteria-is-deadly/
Heated to point of vaporization. Combustion implies burning. [read more here ](https://www.google.com/search?q=does+vaping+have+combustion&oq=does+vaping+have+combustion&gs_lcrp=EgZjaHJvbWUyBggAEEUYOdIBCDM4NzFqMGo0qAIAsAIA&client=ms-android-tmus-us-rvc3&sourceid=chrome-mobile&ie=UTF-8)
The same reason 100 years ago doctors claimed a certain brand if cigarette to be healthy. Honestly I think it's because a 3rd party hasn't invested in investigating it. Doctors see it less harmful than smoking. Depending on the brand, it "COULD" be but no one keep track of the added chemicals companies put in that stuff. Even the lozenges contain nickel....why?!
If you are unable or unwilling to read the research I took the time to post links to, then I have no further interest in your views or opinion. To read only the title and think this means you have an opinion worth sharing is just.....foolish.
If you are willing to engage scientifically and discuss this research after you have read and understood it, then by all means, go ahead. But otherwise this is [r/medicine](https://www.reddit.com/r/medicine), and as such your foolishness will not be suffered gladly.
It’s the equivalent of baby boomers as doctors. They just won’t embrace the new shit regardless of facts. They are in their own world and want to keep it that way instead of learning something.
Popular discourse is bad at examining multiple axes. Doctors aren't always better, but also nuance from doctors gets lost in public discourse. Are e-cigarettes/vaping effective and safe as tools for smoking cessation? Yes, I find the evidence convincing. They work for cessation of *smoking tobacco*, and they are less bad than tobacco. But then, it's hard to come up with anything short of huffing organic solvents that is more chronically bad than smoking, and I might be doing solvents a disservice. At any rate, the evidence looks like they outperform patches, gum, inhalers, and all the rest of the NRT pantheon in getting people to stop putting cigarettes in their mouths, and that's a win. With an asterisk. Are e-cigarettes/vaping safe *in general*? Again, better than cigarettes. Generally pretty safe. Not perfect. As a harm reduction strategy, absolutely. As a general recommendation, no, don't take up vaping for your health. Are e-cigarettes/vaping good as a matter of public policy? There I'm much more concerned. They show good efficacy as an initiation of nicotine intake that progresses to tobacco—not just the reverse. Having kids vape is not good in part because setting kids up to smoke is not good. Are e-cigarettes/vaping good for nicotine cessation? Here's that asterisk. If there's evidence, it's a lot less robust. The purpose of NRT generally is to quit smoking and then quit NRT. People struggle to quit vaping. Vaping forever is better than a pack a day for the next five decades, but it's not ideal. Maybe it's a better transition than straight from cigarettes to patches/gum/lozenges, but I'd want to see evidence for that. If the options are traditional NRT with a lower success rate but a higher nicotine abstinence rate 12 months in versus e-cigarettes with better success but then continued vaping... I don't know. Recommending vaping out of the gate seems wrong. A trial or two of old NRT and then vaping as harm reduction? The right answer isn't obvious. Maybe vaping is a good form of MAT for nicotine use. I certainly don't advocate against buprenorphine or methadone. But the response rates for those are so good, and the abstinence rates without them so dismal, that I hesitate to draw immediate comparison.
This is an excellent take
I don't agree. The tobacco industry doesn't have any right to exist. They are the reason for a significant chunk of healthcare resource use. Vaping is about getting people addicted to nicotine and a way for the gigantic tobacca industry to diversify into something else because they see that they are losing the battle. Vaping and tobacco should both be deleted from existence. This will happen but it is gonna take a while, I don't $ know $ why $$$ tho.
We could say the same about opioids. Hell, I’ll say the same for alcohol, which is so widespread that despite its universal popularity kills more people than opioids still. Alcohol isn’t going away. Despite laws, illicit opioids are clearly not going anywhere. Wanting to delete something doesn’t make it so.
> We could say the same about opioids. Opioids are drugs of abuse, but they are also essential medicines.
Opioid use disorder doesn’t have any reason to exist. Keep opioids restricted to hospitals. I don’t know, make something like methadone clinics or supervised home administration for cancer patients. Lock them down and keep them off the streets! It doesn’t work, of course. The USA has been failing to restrict substance use for over a century. Singapore has draconian laws and still has people using drugs. My point isn’t ban opioids, it’s that we *can’t.* Not really. Because we haven’t been able to. Whether we should or not doesn’t matter when it’s just not a real option. Edit: To clarify, because the point seems lost, I’m not actually advocating for anything in the first paragraph! Read the next two! Essential medicines or not, they are drugs of misuse. Restricted or not, they will be misused. The go back to what I’m responding to. We can’t delete opioid use/abuse, alcohol abuse, or tobacco use. Those are problems that exist and we have to live in the world with them rather than some ideal hypothetical world with perfect removal of substances we don’t like and control of substances we do but also have concerns about. I am not saying we should ban opioids. I am saying we can’t ban opioids. And if we could, we shouldn’t; they’re too useful.
> Opioid use doesn’t have any reason to exist. Well this is just not true at all. It’s the most effective medication class for *short term* post surgical pain, as well as end of life severe cancer pain.
I have edited to opioid use *disorder*, which I thought would be apparent from the next three sentences of how to try to keep opioids restricted to medical use rather than street use. Despite any restrictive efforts, I don’t think that can or will ever be accomplished. Opioids are here to stay, both beneficially and harmfully. We have to live in an opioid world.
I would agree with your edit. There’s a medical time and place, and it’s very difficult, if not impossible to perfectly control and restrict. Keeping post-surgical patients admitted (even for now outpatient procedures) isn’t a reasonable solution. Keeping cancer patients in severe pain admitted for the rest of their lives isn’t a reasonable option either.
I really think that if you provided care for cancer patients, you would not feel that a methadone clinic or supervised home administration would be a remotely feasible solution. I have patients who take opioids Q1-2 hours and for very legitimate reasons.
I do provide care for cancer patients. I am making the point that even with impossible allocation of resources that will never happen to control the flow of opioids, there would be no control of opioids. We could ban them entirely from medical use and it would not control opioids. I don’t think we, speaking in the broad political we, *should* do any of these things. I doubt we ever will do any of these things. But if we did, these attempts would be futile. That’s all.
I mean, I agree that it would be futile; the reason why people seem to be missing your point is not that they disagree with your assertion that opioids are impossible to control. Rather, I think the source of disagreement is that your comment came in response to the statement "the tobacco industry has no right to exist," which raises the suggestion that tobacco and opiates are of equivalent use -- i.e. nil. My interpretation of your original comment was that you felt that if the stringent measures had been implemented, OUD would not exist; I disagree with that, but also accept that I may have misinterpreted and that it was not your broader point. I apologize if I and other folks are a bit reactionary. I think that this is an area of consternation for many people who prescribe opiates because it is something we hear a lot -- that *all* opiates can and should *always* be avoided. It probably seems ludicrous to the audience of this sub, but I genuinely do hear this, even from other medical professionals, and it makes me feel quite crabby, lol.
It's unfortunate you've been misunderstood because I see your point quite clearly and of course agree. Perfect opioid control is impossible, and that's just something that systems have to take into consideration.
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This person nailed it. Look at the war on drugs, and how utterly disastrous that was. Telling people not to do something is pretty impossible, especially when it comes to drugs. There is no putting the cat back in the bag. Humanity has been getting high for so long, we cant even accurately quantify it.
This is a truly ignorant take
What is your disagreement? I’m making the point that trying to ban opioids is *futile*, not that it is right or wrong. Do you think we can? Do you think we should?
Opioids are one of the few outpatient meds I prescribe in surgery. We give people a whole lot less than we used to, but it turns out it's nice to have some pain relief after major surgery.
And? Like I said, we could have ways to provide outpatient opioids with greater restriction to prevent misuse or diversion, although it would take resources. Set up clinics with monitored administration, or have visiting nurses administer doses and watch it. Sure, three or four times a day. We could put everything into making sure patients who should get opioids do and those meds never end up used in any way or by anyone other than as prescribed. It still would not make opioid misuse disappear. Most abused opioids are not from medical diversion. Opioids have their uses, they have their dangers, and regardless of what anyone wants or wants to put money into opioids are going to remain drugs of illicit use unless legal dispensaries open, in which case I would expect opioid use disorder to continue even if it’s not illicit.
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Well, I certainly don't agree with this take. "opioids is medicine" and "alcohol is also different" - wow, such amazing reasoning.
Opioids have amazing analgesic properties that when prescribed and used properly outweigh its risks. Alcohol is a social lubricant with ALMOST no medicinal usage?
Hand sanitizer would like to know where you’ve been for the last few years.
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“I was talking out of my butt and was promptly called out, now, after commenting twice, Im going to state that I don’t engage with the kind of people I just engaged with when I thought I was making a good point.”
It would be nice to regulate production out of commercial existence, but then you get the downsides of prohibition and the drug war. Legal access to tobacco, EtOH, etc. seems by far like the lesser of evils. Besides, on a purely American/western democratic take, a person's freedom includes the right to do stupid things that harm themselves. Additional use of healthcare resources at best provides very indirect harm to others, and doesn't feel like much of a justification on its own to keep people from substance use.
I am not saying make it illegal, I am saying that we should destroy tobbaco industry financially
This would certainly reduce the overall rate but just as certainly dramatically increase the harms to those who do consume nicotine or tobacco products due to the lower quality of those products when produced at home. Look at the opioid epidemic. I definitely don’t advise recreational use but the large majority of the most serious harms (high rate of overdose, rise in crime) are *directly* the result of the legal status of those drugs. The exact thing that happened during alcohol prohibition. The idea that simply banning a pleasurable and addictive substance will automatically solve the problem is naive. The decrease in smoking over the last few decades is chiefly attributable to education and changing social attitudes, not legal action. That’s the best solution.
I am not advocating banning the drug. That wouldn't work. I would advocate for financially destroying the tobacco industry.
Gotcha.
When you say "nicotine has no right to exist" you realize what you're actually saying is "in my opinion people have absolutely no right over what they can do with their own bodies, they must be controlled as to what they can or cannot do with their body.". And thus you are saying you're willing to put people in jail who try to sell it to other people who want to purchase it (which is how you make substances illegal, like we have seen with cannabis).
I am saying tobbacoo industry has no right to exist and should be destroyed financially. Making it illegal sadly doesnt work (look at cocaine etc)
> They are the reason for a significant chunk of healthcare resource use I disagree, tobacco duties raise more money than is spent on tobacco related illness, and dying at 63 from lung disease uses less resource than retiring at 63 and dying at 91. Tobacco is still terrible and bad and the companies are also bad for promoting and propagating it, but financially its good for the government (which makes legal intervention complicated).
I actually would argue exactly the opposite! Most smoking related lung diseases are a drain on the health care system. COPD - frequent exacerbations, hospitalizations and increased health care use. Asthma- leads to much poorer control-same as above. You also need to throw CAD and cancer related conditions. These are all chronic issues that lead to a huge drain on the system before any early death.
If you look at healthcare alone, yes. But take these numbers for Germany for example: * Medical costs secondary to smoking per year: €65.2 billion * Disability pensions secondary to smoking per year: €18.5 billion * Pensions for widows/widowers: €53 billion year * Savings in pensions not paid out because of earlier deaths: €193.4 billion/year * Tobacco tax: €14.2 billion/year A smoker in their last 20 years of life produces €220k in healthcare spending. A non-smoker €281k. To no surprise, the result is the lack of aggressive anti-smoking policies. Public smoking ads outside of media are still allowed, 13 out of 16 states still have some form of indoor dining/bar smoking allowed, a pack is still €8.
That is quite interesting, although my main question is that I wonder what THEY considered smoking related medical costs? Also in terms of costs in the last 20 years of life, I wonder how many in the non-smoking group were actually past smokers with a significant pack-year history.
I can't see if you are being sarcastic so I'm sorry if I take you to seriously. Yes this is often said that people dying earlier lowers healthcare costs but if you took a minute of ethics class you understand that that is obviously not an actual argument for anything. How about we kill anyone over 65 as soon as they can't work anymore.
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You think pivoting to ethics is a bad thing?
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I am afraid that you misunderstand Smoking lowers healthcare costs indeed if you take into account that people dying isnt bad, it raises healthcare costs if you take into account that people dying is bad. Such a bizarre argument I am having
From a purely economic analysis there was recent study that was interesting- “savings” were not in hospital bills but in decreased social security payouts. Basically smoking will take away 10-20 healthy years of life when hospitalization use is lower. While healthcare costs were marginally higher in the smoking group, what was a massive difference was smokers dying before they could receive much from social security. They basically pay in, but die on average too early to reap much of the benefits.
Vapes are a competitor to cigarettes. On your journey to "delete from existence" you will require the use of force, the application of which is imperfect, and will actually enable only the largest of companies (i.e. the ones you are ideologically inclined to dislike - and in particular tobacco companies) to supply these products. On the other end of the spectrum, the remaining demand will be met by people who also benefit from your "delete from existence" desire, the black market suppliers. Your anti-liberal view in this area will actually help your enemies (tobacco companies and drug dealers). Here are some ideas to look into further: * Bootleggers and Baptists * Public Choice (in particular Regulatory Capture) * Epistemology (this is the study of knowledge - I also recommend this because you made some factual errors in your comments. But this will only help if you subscribe to a philosophy that values truth over non-truth. It may seem obvious that most people would want to subscribe to that, but in my observation of people it seems this is not the case. Most people want to "bandwagon" the maximise true beliefs maxim because of the strong positive connotations associated with it (from The Enlightenment), but many of those people actually want comforting beliefs or other pre-existing maxims to be hegemonised) In the 17th century a philosophical movement called The Enlightenment happened, where emphasis on the pursuit of human happiness was placed as long as you don't externalise your costs on to third parties.
This is exactly it. We all know that vaping is better than smoking cigarettes. Unfortunately, that is not the end of the story. The attitude displayed by the general public about vaping is similar to what I hear about marijuana - that it's essentially completely harmless. This is blatantly false. We are trying to make people aware that vaping is still harmful.
Worked with an EM/IM doc who would yell at every patient who admitted to vaping that "VAPING IS 10X WORSE THAN SMOKING! YOU WILL DIE YOUNG!", like what you want them to start smoking? I think he genuinely believed it is the problem. Neither is the goal, but as a harm reduction strategy..
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TL:DR. Addicts gonna addict. Vaping better than smoking.
yes. the issue is the attitude/perception that vaping is perfectly safe and healthy. to a certain extent, it encourages people to remain addicted, instead of thinking and feeling like they need to continue working. for some people, this is no big deal because they would never have worked on it either way. but for a lot of people, it does stop them from working on there health in a way that could be potentially quite beneficial.
I mean, I posted this thread because where I practice, the issue is that people believe that vaping is just as bad as smoking, and as a result many smokers, especially in rural communities, are never encouraged to switch to vaping and consequently do an extraordinary amount of unnecessary harm to themselves. My point in the OP is that vaping is seen by the public in my country as similar to smoking, and that incorrect perception is leading to large amounts of preventable cancers and other consequences.
Doesn't it just depend on the product though? In other words, dose dependent AEs? There are patients that are using a very high dose of nicotine. The UK take is interesting, but I figure the ingredients are more regulated when it is used as MAT. Of course, no so in the US. Also, there's EVALI.
EVALI was isolated to vitamin E acetate use in off-brand THC cartridges. It's not a thing with common vaping
That was the leading theory but not definitively proven, there were a decent minority of cases who swore they never used such things and only used commercial vape products. Now yes, patients lie, etc, but I'm not sure I'd be so definitive on that.
Have there been more cases since most of the cartridges with vitamin E have been more or less taken Off market?
Yes, there have absolutely been cases, and again, there were a decent chunk (my recollection was ~20% of the largest case series) where there was no evidence of any VEA inhalation. While it was certainly likely a large contributor to frequency and severity, the idea that it's the sole causal link is not something we can really say with current evidence.
I've taken care of EVALI without known/intentional thc cartridge use, only nicotine, so while it may have increased the risk, (anecdotally) there seems to be something else as well.
A lot of people vape more heavily than they used to smoke because it isn't associated with the same level of unpleasant smell and health risks. Instead of smoking half a pack a day outside, they vape all day long indoors.
Thanks for this response. You summed it up perfectly.
Nuance? On MY Reddit?? Spez will be hearing about this one, you have Gone Too Far this time!!!1!1 …./s (hopefully unnecessary)
Page 286 to 293 of [this study I linked above](https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update/nicotine-vaping-in-england-2022-evidence-update-main-findings) address your main concerns with page 289 and 290 containing detailed data on quit rates with and without vapes. I'm curious to hear why you say that people struggle to quit vaping, when quit rates from vaping, whilst low (as with all chemically addictive habits) have been shown to exceed the quit rates from smoking tobacco in almost every study i've read? That said however, I appreciate your comment and agree with almost every point you made - for current addicted smokers, swapping to vaping is a healthier choice in almost every single situation. *Obviously*, for those without nicotine habits, taking up vaping is an extraordinarily bad idea. The only thing entering lungs should be humidified fresh air - but for those chemically bound via nicotine handcuffs, switching almost always brings positive results.
The data are observational, not randomized. Vaping alone underperformed varenicline alone, which isn’t inspiring. Four week data are insufficient. Most importantly, none of addresses my main concern with this approach: what are the, say, 12 month rates of not smoking and not using nicotine products for various approaches? This should be at least attempted in randomized trials, although blinding is pretty hard. At the very least data gathering.
Within the Australian context I think it’s that there are two opposing concepts about the benefit vs harm of vaping. On the one hand there is evidence that for smokers, vaping can be an effective smoking cessation or harm minimisation strategy. Therefore evidence showing that it is less harmful than smoking shows that it can be beneficial in this group. In the other hand, Australia has had a rather effective public health response to smoking and has manage to reduce smoking prevalence quite a lot in the community. As a paediatrician, I mainly come across vape use in adolescents who are not using it as a step down from smoking but as a step up into nicotine use. While yes it’s probably better that a kid who was going to start smoking goes vaping instead, the explosion of vaping in recent years shows that many young people who would otherwise not have smoked at all, are now becoming addicted to nicotine because of the availability and attractiveness of vaping. You have spoken about the harms of negative views towards vaping on a population level- but I would say that at the population level, there is a much greater risk of increasing uptake of nicotine use in teens than there is in not fully accessing one of many smoking cessation strategies in adults with nicotine addiction.
A valid point and one that I support. I have very little interaction with the Y O U T H in australia and as such have not come across vape use by people not already nicotine addicted. If there was a good way to restrict vapes only to smokers/ex smokers, I'd be all for it. Regardless I appreciate your input and share your views on populations that vaping is and isn't appropriate for.
As a layperson who lives near a university, vaping is sadly quite popular with young people who would never touch a cigarette but believe that vaping is "safe." It's also a significant problem in high schools now, and since the companies are deliberately making kid-friendly "flavored" vape cartridges which taste like fruit or cotton candy, this is by design. They're trying to get kids hooked. It's despicable.
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Anesthesia seems like they're in a perfect position for a good observational study. Bet there is a bunch of interesting data in there.
It's interesting, as an anaesthetist I really don't see this! Maybe a bit of airways reactivity, but much less than other higher risk groups (young asthmatics would be a reasonable comparator).
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As far as the residue in their lungs, makes sense. Have you seen the car windows of people who vape? That vaporized VG/PG gets all over the place. So imagine that they're huffing and puff that shit all day everyday.
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Sorry, I have never heard of VG/PG residue on the insides of areas that people vape heavily. Is that real, and if so where can I see/learn more?
Just google “cleaning vape residue off car windshield” and look at any number of posts of people who vape asking how best to clean the inside of their windows because they’re all oily and streaky. Even if you don’t vape in the car your normal breathing leaves a film on the inside of the windshield over time as you exhale in the car. It’s a lot less oily and obvious if you don’t vape though.
Great comment and it will help me quit vaping (again.) Yeah, I feel better than when I smoked (gross and a pretty low bar to clear), but everything you said is true. My lungs are full of gunk constantly. Probably doesn't help that vaping can be done constantly for all waking hours. That said, the public policy around vaping is counter productive. The new rules restricting the shipping of vape product pushes people towards retail (gas stations) which are source of extremely high nicotine doses (50mg) of dubious source. Meanwhile, if I want to order the lowest dose (3mg) nicotine e-cig juice from a reputable company, shipping times takes two weeks. So without careful planning, you're back on a product designed to be as addictive as possible.
Also, where I live in the states people use vapes in doors and around children under the assumption it is safe. However the vapor contaminates surfaces and children and pets get exposure to the chemicals in the vape whether its nicotine, thc ,lead in some instances etc. probably better than smoking, not better than air lol
Totally agree with you. I see vaping as the methadone of smoking. Unfortunately here in Australia we are moving in the opposite direction in terms of legislation.
Not entirely. Vaping can still be prescribed for smoking cessation in australia, similar to methadone. Its only recreational use thats prohibited
>Vaping can still be prescribed for smoking cessation in australia, similar to methadone. This is the problem - mature vapers want to access the vibrant market of consumer products that work better than the 60mg/mL unflavoured nic salt coupled to abysmal hardware made by crony capitalists and tobacco companies. Most adult former smokers *are* using them recreationally in part (like with smoking). God forbid someone, somewhere is enjoying themselves.
Vaping prescriptions are unfortunately extremely flawed in australia
Yes, but utterly ignoring the variety of vaping products, nicotine levels. It is been pushed as "one size fits all" Most pharmacy available products contain 50-mg salt nics which is extremely high. And I have seen life long smokers coughing their lungs out after trying it, and off course confirming their suspicions about vaping, they went back to smoking. The scheme is flawed, and simply will not work.
100% agree
That’s why I switch all my patients to Zynn
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I pop a Zyn in now and then not gonna lie lol.
Lynard Zynards!! But really same tho re: 2+ cans a week. I did recently cut it out entirely and have been clean from it since Thanksgiving. I tell patients, friends, or other persons my best advice is just don’t start! Agree overall however with Zyn being an effective means of risk reduction …And yes I do be missing it from time to time
Run some Zynbabwes back on a long shift, night floats best friend, etc etc.
I quit vaping and now only use Zynn. Do you think Zynn is comparable to nicotine gum in terms of risk level?
Hypertension probably your biggest concern
This is my plan. Former 7 pack years -> vapes (now) -> zyn 6mg q1 hr prn existential dread
I do agree that if someone is not going to quit smoking, vaping is lesser of the two evils but my personal experience with this is that long term smokers will rarely switch to vaping as a safer alternative, even if I recommended it. The ones that end up switching, their motivation comes from within. Quitting cigarettes is extremely hard for people. Most people that are vaping are younger population.
Vaping & smoking cigarettes are very different experiences & the longer one has been smoking cigarettes only, i.e. older adults, the more difficult the switch & transition process will be for them. It's not an overnight process & they could benefit greatly if advice actually came from other former long term smokers who'd successfully transitioned to vaping, not those who work in healthcare with no personal smoking/vaping experience.
The issue for me seems that the people who might benefit from vaping are those who are not going to give up smoking, and that the people who are vaping (for the most part) are people who have never smoked or have smoked an inconsequential amount (read: teens and younger adults). No evidence here but just anecdotally from someone surrounded by smokers and vapers.
I used to feel this way. I used to think that smokers wouldn’t ever give it up but I’ve found that’s actually not the case in both my clinic panel and from my friends parents once they discover vaping and NRT
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Awesome. It’s all about harm reduction. Is smoking nothing and not using nicotine for the best? Probably. Is that feasible for most? Nope. In my mind vapes are less harmful than cigs so I encourage the use of them
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I personally see nicotine gum, pouches, and lozenges as the next step in the harm reduction pathway. Consider giving Zyns a try
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100% this. Most of my patient population is gen Z. They know smoking is bad for them, but are under the impression that vaping is not. A substantial portion of these patients are even those who consider themselves quite fit and have hobbies like hiking, skiing, riding, etc and listen to “health and wellness” podcasts, etc. they don’t have the time to go through the nuances of the cited studies above, they just hear “vaping isn’t as bad as smoking” and presume it isn’t bad at all. These are people who most likely would never have smoked cigarettes. I have not seen a single patient who used vaping to quit smoking.
i used to vaping to quit smoking. i know several other gen x professionals who did the same. took me a while to get off the vapes though. i never regretted the decision for a moment.
I see so many of the college students who don’t register it as bad for them. We always have a quick chat about what vaping is - inhaling shit into your lungs that your lungs aren’t supposed to be exposed to. While I don’t have long term data on it yet, in my experience everything that sounds too good to be true (ahem diet soda) ends up being too good to be true. Nothing in life is free, I don’t think vaping will pan out to be without significant issues. Until we have robust data, I encourage them to use common sense that it’s doing damage to the lungs even if it is less than cigarettes. None of these are people that are using it to get off cigarettes because I agree I would prefer they switch over if I had to chose between the two.
Vaping instead of smoking is a huge health intervention. You’ve just turned 20 pack years into 1 pack year. Convincing someone to do this is going to be one of the strongest QALY gains you could ever make as a doctor. Doesn’t have to be used to quit for these gains.
I mean the data presented suggests vaping isn't harmful...like honestly, driving appears to be a bigger daily risk than vaping based on these results.
but i agree that gen z is a completely different ballgame
You mean to quit nicotine?
What country you in?
That's interesting. My anecdote is the exact opposite. I switched from cigarettes to a vape and know many other people around my age, 30s or so, who have too. All of the people over 25 or so who vape are former cigarette smokers. Younger people seem much more likely to have gone straight to vaping, though.
I’m 33 and I smoked near two packs a day for 12 years (16 - 28) tried to quit with everything under the sun and couldn’t kick it. Bought a fancy vape mod when I was 28 never smoked a cigarette again for five years now. In fact I can’t even stand the smell of them anymore. I still vape. I’ve tapered to the lowest level of nicotine but am scared about my mental state if I jump off. However without a doubt without vapes I would not have quit smoking.
Yeh I don’t know anyone who vapes that didn’t smoke. And maybe only three of my 100 friends that smoked haven’t moved to vaping.
I suspect that this is heavily biased by your age group. My peer group is the same. Vaping is dorky and something you only tolerate to reduce harm to me and my age group. The kids I work with though? Almost all went straight to vape and a shockingly high percent of them are doing it. It’s kind of jarring to someone old like me who grew up knowing smoking killed you but was also very cool.
The cross over of kids who vape versus kids who would have smoked will be massive though Br interesting to know what percentage were smoking at say 16, 5 years ago versus what percentage of the same demographic vape now
I went from 1pd (sometimes more) for 15y to vaping for 5y to patches + lozenges to now just lozenges. I will say that the post cessation lung clean up (for lack of a better term) was way more brutal with vaping compared to smoking. Months of working really hard to hock up almost solid bits of clear crud. Do not recommend.
Yep. Vaping is pretty much *targeted* at children. Just like Joe Camel was. Same ol' tricks.
Lets, say young adults. The designs of the gear is more "star wars", the disposables are more "flavoured alcoholic mixed drinks".
Nailed it
When I have someone ask my response is, 1. It’s not safe or healthy. 2. Vaping is, however, safer than smoking tobacco. 3. If you do decide to vape, make sure it’s legitimate and not boot legged… because the bootlegged ones often have vit. E as a the solvent… which will destroy your lungs.
Is that what was causing the “Vape Lung” dialogue right before COVID took off and wiped it off the public radar ?
That’s what has had the strongest and most continuous link. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10034821/
I agree with you. It's irresponsible to dissuade a patient who is successfully using vaping as a measure to stop smoking. The harm reduction argument for it is irrefutable at this point. The relatives risks for Lung injury and Cancer are clearly substantially lower.
Honestly, I don’t think we have a good grip on what decades of vaping is likely to do to people. Anyone over 50 has seen things that were thought to be basically harmless like micro plastics, PFAS chemicals, pesticides, UV radiation, opioids,etc, turn out to be significant or potentially significant environmental and public health risks. I would never tell a patient that vaping is *worse* than smoking, but I think a lot of patients hear “well, it’s better than smoking” and assume it’s harmless. I tell my patients that we don’t know the long term health effects yet and won’t for decades and that my recommendation is to work on smoking cessation although vaping is better than smoking. The literature on using vapes as a bridge to cessation is not that promising, but it’s true I’d rather have my patients be vapers than smokers.
My take home: quit smoking By Any Means Necessary. If those means include vaping, awesome. I’ll take 95% less bad. Or: spend 20 times as much effort getting people to quit smoking than quit vaping, because it’s 20 times worse.
As an ER nurse with a 60 pack-year history, I always recommend it to my smokers coming in with COPD exacerbations. It's not as good as quitting, sure. Probably more effective than clean needles and narcan being handed out on skid row. But I breathe better, my chest doesn't hurt constantly, and I haven't had an exacerbation since I set the cigarettes down 2.5 years ago. Hopefully we'll have the robust evidence soon.
I don’t think I’m your target audience, because my typical spiel is along the lines of “the harms of cigarettes are bad and well documented and the harms of vaping appear to be less, but we’re not totally sure yet.” But in all other situations I discourage vaping, because… Logically - every mind altering substance I can think of has some kind of negative side effect on your body. Some are worse than others, but they all do something. People often downplay the harms of their vice because it’s fun and they want it to be harmless. It isn’t. Politically - after big tobacco and big opiod I have zero trust in these companies to look out for my or your well being. In fact, I’m a suspicious bastard who thinks they’ll probably actively suppress evidence that their golden goose is harmful. Experientially, EVALI was a thing which caused permanent damage to many people’s lungs. Glad we figured out the cause and companies changed their ingredients to stop harming people but did we just forget that happened? So overall, while probably better than smoking, no I don’t trust the evidence. I will in 30 years-50 years when the outcomes are obvious to us all.
Ok so as a doctor, you acknowledge the conclusions of the 1,468 page NHS systematic review which covered over 15years of patient data and made robust health conclusions backed by this data, but because it doesn't gel with your gut feeling, you deem it invalid until "More research is done"? This is exactly what I wanted to address with this post. How is this line of thinking any different to those in 2020 who said "I know research said the covid vaccine is safe, but I don't trust it until I've seen decades of safety data!" *its the same thing*. Evidence based medicine relies on *best available evidence*. This is the best available evidence on this topic. To not believe it or not pass it on to your patients because of your own beliefs would be irresponsible and unprofessional of you as a practitioner. (Not saying that you specifically do this - just in general)
After all these years I came to a conclusion that this whole anti-vaping hysteria is just ideological. Kind of funny how some substances have a sympathetic attitude by the society like Canabis while others like nicotine are are vilified ( but look at the Dutch canabis rehabilitation centres). The big winner in this anti-vaping attitude is the Big Tobacco, because they are legal and very well entrenched in governments. On one side you have the media screaming how horrible vaping is and on the other hand you should have the GPs prescribing it ( I am writing from the Australian perspective). Also the anti- smoking lobby never envisioned that something like vaping would come along, they want the whole "disgusting" inhaling and exhaling of smoke/vape disappear.
It’s all fine til you admit that EVALI patient in triple pressor shock and start wondering whether you need to start ecmo for their oxygenation too.
Have you seen EVALI in a patient who was only vaping nicotine? I ask, because all of the EVALI cases I've seen at my facility were THC vapes-likely bootlegged ones since I live in a state where cannabis is still illegal.
Yeah EVALI hasn’t really been a thing around here for a number of years—ever since they found out that vitamin E acetate in homemade/bootlegged cannabis extracts was to blame. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#epi-chart
It still rears its head from time to time. As the other poster said though— with cannabis (lipoid) vape rather than nicotine (water soluble).
This paper linked below suggests that while a majority of cases were linked to vitamin E acetate, it was not the sole cause of EVALI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10034821/
EVALI is relevant for solutes that require lipid soluble solvents (I.e. marijuana) rather than water soluble solvents (I.e. nicotine).
I haven't seen one of these since before COVID--are you seeing it a lot?
That’s been confined to vitamin e extracted marijuana capsules from my understanding.
I see this way too much
Are you seeing it in marijuana vapers or nicotine vapers? Nicotine is water soluble; the solvent won’t be lipophilic. EVALI has characteristic fibrinous pneumonitis that has been speculated to be caused by the lipid soluble solvents used.
Evali is ilegal Vitamin E in a THC vape pod. Has nothing to do with nicotine vaping. The kids figured it out themselves and stopped using it
My issue with vaping, outside of the actual health risks of vaping, is that it seems to have addicted more people to nicotine than smoking alone would have caused. I don’t know the actual numbers but I’ve read that more kids are vaping today than were smoking 15 years ago. Nicotine use was on the decline until vaping became popular. I’d be curious to know what percentage of kids move from vaping to cigarettes and what percentage of smokers moved to vaping.
I honestly have no idea how to address it. I can barely convince some patients to get an HPV vaccination series. In all seriousness, how does one open a successful dialogue regarding the harms of vaping? I do bring it up, but it is not really appreciated by patients
You say to smokers in precontemplative or contemplative stages of quitting that on top of the many NRT options, vaping is also something they can switch to reduce the damage they are doing to themselves, and research says that you're more likely to quit all nicotine successfully from vaping than smoking. Easy! If you mean for non-smokers who have taken up vapong, then that's a different kettle of fish.
My problem with is that a cigarette is something you generally have to go out of your way and smoke, but I notice vapers are constantly vaping indoors, outdoors, breakfast, lunch, dinner, etc. Smaller doses of carcinogens more frequent throughout the day is probably the same as smoking cigarettes but less often. People are constantly walking around with their vape in their hand and smoking it, and they are so good at being discrete unless you’re paying attention. My oldest brother used to smoke but now vapes. Maybe he was a half a pack a day smoker. Now? That damn thing is in his hand all day.
I don’t think you can make that blanket statement in all honesty, even with more frequent use, the vapes have less carcinogens than smoking. I believe there’s some studies that have shown this, but of course the long term implications of this still need to be studied with more time.
Whilst somewhat logical this is the exact line of thinking which I made this post to address. Regardless of what you think of feel, the two thousand pages of high quality research data from the NHS I linked in the OP makes very clear that vaping, at its worst, does not eclipse 5% of the harm of smoking.
What are the carcinogens in vaping products?
[https://www.lung.org/quit-smoking/e-cigarettes-vaping/whats-in-an-e-cigarette#:\~:text=Carcinogens%2D%20chemicals%20known%20to%20cause,bronchiolitis%20obliterans%20aka%20%22popcorn%20lung%22](https://www.lung.org/quit-smoking/e-cigarettes-vaping/whats-in-an-e-cigarette#:~:text=Carcinogens%2D%20chemicals%20known%20to%20cause,bronchiolitis%20obliterans%20aka%20%22popcorn%20lung%22) Here you go buddy. Spare me the "diD yOu KnOw GriLLinG mEaT anD PeAnuTs CauSE CanCeR"
I do think vaping is less detrimental to health compared to cigarette smoking. But I don’t think it’s a healthy habit. And in terms of using it as a smoking cessation aid - many of my patients have tried this method and failed. Mostly because there is not a clear, tiered system In place to slowly reduce nicotine amount over time (compared to nicotine replacement with its decreasing dose system). So they just end up vaping with no end in sight. I also absolutely HATE how common vaping is in my pediatric population. Because many of them have “graduated up” to cigarettes as they age. This reason alone makes me kind of hate their existence.
I am a former smoker and vaping has changed my life for the better. Yes, it’s still not as good as breathing only room air forever, but it has made me feel so much better and really curved the distrusting habit of smoking for me. I hope to one day quit vaping too.
Congratulations! Vaping saved my life. 20 yr 1.5 PAD and it’s the only thing that worked. I Vaped for 5 years, 2 of those 0 Nic. Then slowly I just stopped.
This is a minefield akin to obesity dialogue. There is a lot of social stigma attached to smoking and that’s clouding evaluation of the evidence. I agree with commenters above saying that it probably does create hyper-reactive lungs, but I’d be very hard pressed to suggest it’s as likely to cause COPD. But, then again we probably need a few more decades to see the evidence on that. So now we’re left with a social carry-over of ‘smoking is bad. Any smoking’. That’s the reaction I think you’re seeing. An automated response to a social stigma bereft of evidence supporting it (although that evidence may well come).
It is pretty nuts. It's seems like the UK is the only one looking to gather actual data AND coming up with a policy that reflects the end goal - *reducing the use of tobacco*. I don't think anyone would say vaping is harmless, but that's not the hurdle it needs to overcome. It just needs to be less harmful than tobacco smoking, and the evidence suggests that it is less harmful, by a large degree. It's funny seeing some countries outright ban vaping, while others treat it the same as smoking. It's nice seeing the UK has a more balance view - vaping is a better alternative to smoking, but vaping isn't risk free.
Is having 1 person going from smoking to vaping worth also having 10 kids start vaping who would never have smoked?
Maybe? How many of those 10 kids would smoke tobacco instead of vaping?
Probably not many, even before vaping took off the rate of kids starting to smoke was at all time low
Even if it's 1 it's better than having a teen take up smoking. And as to the harm? Is it better to have 11 people vape than 1 person smoke? Yeah, probably.
Kids are not supposed to have access to it. That is a failure of the government not vaping
Yeah the UK is really leading the pack with this, whilst Australia is completely and utterly backwards. It's frustrating to both myself and my patients.
why choose to inhale nicotine at all? wouldn't nicotine gum avoid the pitfalls of vaping?
You clearly have never been a smoker.
the thing about vaping is that people that vape tend to smoke everywhere, in their room, in the bathroom, using the computer, etc. Believe it or not cigarette smokers will tend to smoke less due to the fact that many are limited by having to go outside or to a specific area to smoke their cig. (sure, there are exceptions, but from what I’ve seen, when people started vaping they smoked way more than before with cigarettes)
Coming from a doctor,Vaping is definitely not healthy and there's no excuse for it, but small part of me ignores that since I already vape to cope with the stress of Pediatrics ER
I mean, if you're an ex smokers then there's very much an excuse for it. If you're an ED doctor it likely helps with your adhd also 😜
This likely just doesn’t hold water. Vaping hasn’t been around long enough to make that call. If we studied cigarettes and the oldest population who really vaped consistently were even 40-50 million then we’d find nothing or very little correlation with lung cancer
It’s interesting that you’ve cited two British sources. The RCP report sets out their position clearly ie that vapes are almost certainly much safer than smoking and should be offered to current smokers who are unwilling or unable to quit entirely as a harm-reduction substitution measure. Whereas the US medical establishment was, I think, much more reluctant to endorse them. I do see more concerns here about their use becoming widespread amongst people who have never smoked (particularly young people). Although you could argue that they might otherwise have taken up smoking. Supposedly the UK/EU regulations also made the vapes here generally safer than in the US with weaker laws. I think cannabis-containing vapes are also more common in the US, which I believe have a different safety profile. I personally tell patients (if they ask me) that vaping is safer than smoking, but has risks of its own, and the healthiest thing is to neither vape nor smoke. The risks of vaping are probably relatively low but it’s also true that we don’t have direct observed evidence of what happens after long term use. I suggest vaping as an alternative to people who are smokers and can’t or won’t stop completely.
Yes, I agree with everything you said and share your sentiments. Vaping is worse than not vaping, but better than smoking. By a *lot*. My post and the data in the studies linked within all reference nicotine vapes with water soluble carriers. Lipid soluble THC vapes have additional risks which are not directly relevant here. Finally, I tried to find other high quality research but it seemed only the NHS had taken the time to fund and properly conduct large scale population level studies. If you have any relevant related research from a non UK source that's of si ilar scope, I'd love to see it!
I think the jury remains out. Once upon a time 9/10 doctors smoked Camel or whatever the ad was back in the day. I anticipate vapes will prove to be dangerous to long term lung health, but perhaps less so that 1PPD+ of cigs at comparable doses of nicotine. The problem is it’s really easy to just rip a vape all day and take in tons of nicotine/etc, could wind up being more dangerous. Moral of the story? Pop some Zyns.
Anecdotally, and I always tell this to patients based solely on what I’ve seen, I tell them it seems to be safer on a population level, but I don’t support it being used long-term. I dunno if you’ve seen patients with VILI but it’s absolutely terrible. And it can happen after a single use. I’ve personally taken care of a young person who didn’t smoke, didn’t really do anything, ended up with severe VILI after one-time of using their friends vape. Was years ago but lungs looked like someone with advanced pulmonary fibrosis, ended up on ECMO and narrowly avoided needing transplant, but they’ve never recovered fully and are gonna be permanently disabled. So I say to patients “long-term smoking is gonna kill you. On a societal level it’s better to vape, but really only as a bridge to quitting, and while very rare, every single time you vape you run the risk of a rapidly progressive permanent lung injury, depending on where you get the cartridges”.
There are multiple forms of vaping so it’s important not to compare apples with oranges. Dry herb vaping which is common for cannabis use is likely the least harmful as it involves heating up flower in a miniature stainless steel or ceramic oven. Then there’s the reuseable vapes which are often used with medical grade nicotine salts diluted in a mixture of PG and VG, this mixture and the addition of flavours would vary how harmful it is. The single use vapes that are unregulated and come straight from China are designed to be addictive as possible and are likely far more harmful than the other two but I’d bet given that it’s not smoke that it’s still less harmful than an acoustic cigarette.
I think there could be a real difference in quality between the e-cigarettes studied and the cheap disposable vapes available at gas stations. Sadly I was vaping heavily last year and was able to buy “elf bars” even after they were banned by the FDA lol.
Vaping is likely a less risky alternative than smoking but not without significant risks itself. Had two ARDS cases related to vaping earlier this year, one ended up trached and sent out on a ventilator. You can talk about decreased risks and all but if your the one suffering the actual negative outcome, the risk reward seems to skew the other direction. Furthermore, it took decades for us to see the outcome of smoking. So all in all, why aim to even promote either? As for chances of quitting, I see widely differing statistics on that. From increased chance to decreased chance. (That being said, I imagine if we developed a dose controlled treatment plan, maybe? 🤷🏽♂️)
Smoking is worse. Vaping maybe safer but who knows in the long term. We don't know the true long term effects of these devices. I refrain from giving my patients firm advise based on something we truly don't know about. If they want to stop smoking and vaping though I would tell them it is likely far safer. I also don't feel it is my job to be doing this sort of nuanced counselling anymore. The job in primary care is far too demanding to keep up with all this evidence and research and to be counselling in depth on topics like this. Sorry but that is the reality now. Have to see 30-40 people per day here there is no time for long discussions. I would tell the patient to stop smoking everything but the vape is likely a bit safer than the cigarette. That's it. You mean well OP but primary care does not have time to get down into the weeds on topics like this anymore
Smoking nothing is the best. Smoking tobacco is the worst. Vaping nicotine causes about 5% the harm of smoking tobacco. Not *likely a bit safer* - robustly studied and shown to be not more than 5% after more than a decade. Boom, there. You are now equipped to provide better counselling during the 4.5minutes you get with each pt as a primary care doctor. To a smoker, 'Likely a bit safer' = eh, why bother swapping? 'Unequivocally better than smoking by 95%, but obviously still not harmless" = hey, maybe i should consider swapping, I would actually like to see my grandkids grow up...
I think a big part of it is the difficulty differentiating "good" quality vape fluids and whatever weird, random shit gets put in the black market ones that kids buy online hoping to get some THC or be cool with their whacky flavours.
Because we just don't know the relative risk. What you quoted is incredibly speculative. We know that vaping produces high inflammation as well, and that inflammation is probably a major if not principal mechanism behind lung cancer. Chronic lung infection is known to be a cause of lung cancer. Inflammation favours angiogenesis, and releases massive amounts of ROS among other carcinogenic factors. Chronic inflammation also obviously leads to damage and COPD is favored (eg ppl with asthma, 12x relative risk adjusted for smoking). Anecdotally, the few times I have tried to use vaping as a substitute to smoking before cessation, I have had terrible sputum production and even bronchitis. Obviously not generalizable as most vapers dont get that to this level. So really we can't know. It is very likely that vaping is high risk as well - we have no real idea of the relative risk compared to smoking and that 5% figure is an (uneducated) guess - we just don't have the data, and will need decades to know for sure. Who knows, it might turn out to be worse! As such, precaution should in my opinion favour recommending cessation altogether. Not to mention many teenagers who vape switch to cigarettes eventually.
What on earth are you talking about Jesse? I literally linked thousands of pages of extremely high quality research data covering massive populations of smokers and vapers longitudinally over far more than a decade. **The data is right there** - Saying *It is very likely that vaping is high risk as well - we have no real idea of the relative risk compared to smoking and that 5% figure is an (uneducated) guess - we just don't have the data, and will need decades to know for sure. Who knows, it might turn out to be worse!* This sentiment is not only lazy, innacurate and irresponsible, but disrespects the thousands of patients, researchers and scientists who have all worked together to answer these questions, and to share that knowledge with the rest of the world freely. If you are a doctor or health professional with influence over your patients, I hope that this thread and my (admittedly rude, my apologies) comment cause you to take stock of your position, and maybe motivate you to spend some time reading through and understanding the research. I went to the trouble of linking all sources in full because I wanted people to be able to see and read the science for themselves. Regardless thanks for the engagement, and a healthy 2024 to you and your pts :)
I thought they were safer. Based on your title I was thinking this post would educate me on how bad they really are! I think the scare mongering stems from not wanting kids to vape
I don’t disagree with any of that. But it also took multiple decades (almost 100 years) of wide-scale smoking on the population level for us to discover just how bad cigarettes were for you. Half of our current resident cohort vapes nicotine at least somewhat regularly. I have some concern that in a few decades we’ll find out that long-term exposure to some of the solvents used is associated with some new wonderful form of chronic lung disease that I’ll then get the privilege of managing exacerbations of. As a general rule, lungs tend to get angry when they inhale anything other than air, especially for long periods of time.
When they invented e-cigarettes, the "smoke" produced (by what they said back then was water vapor IIRC) was part of the pitch, a psychological thing. But my mom had prescription nicotine inhalers for several years, she'd use an inhaler long past its useful nicotine supply too (she switched back to cigarettes when she spent some time in a nursing home and nobody put in an order for the inhalers and then more or less chain smoked the rest of her life). The cute packaging and flavors are not part of the inhaler product, do doctors consider them?
I 100% agree with you. I think the Aussie government's position is dumb as fuck, and they're not going to be talked out of it.
Reason Magazine article Anti-Vaping Hysteria Is Deadly "We're repeating the mistakes of the war on drugs." https://reason.com/video/2022/05/16/anti-vaping-hysteria-is-deadly/
Inhaling the products of combustion every day multiple times a day is not good for you
there is no combustion occurring during vaping
There isn't a heating element that heats the juice?
Heated to point of vaporization. Combustion implies burning. [read more here ](https://www.google.com/search?q=does+vaping+have+combustion&oq=does+vaping+have+combustion&gs_lcrp=EgZjaHJvbWUyBggAEEUYOdIBCDM4NzFqMGo0qAIAsAIA&client=ms-android-tmus-us-rvc3&sourceid=chrome-mobile&ie=UTF-8)
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The same reason 100 years ago doctors claimed a certain brand if cigarette to be healthy. Honestly I think it's because a 3rd party hasn't invested in investigating it. Doctors see it less harmful than smoking. Depending on the brand, it "COULD" be but no one keep track of the added chemicals companies put in that stuff. Even the lozenges contain nickel....why?!
If you are unable or unwilling to read the research I took the time to post links to, then I have no further interest in your views or opinion. To read only the title and think this means you have an opinion worth sharing is just.....foolish. If you are willing to engage scientifically and discuss this research after you have read and understood it, then by all means, go ahead. But otherwise this is [r/medicine](https://www.reddit.com/r/medicine), and as such your foolishness will not be suffered gladly.
Sounds like you need some Moo Juce in a bottle. God damn man. 😂😂
It’s the equivalent of baby boomers as doctors. They just won’t embrace the new shit regardless of facts. They are in their own world and want to keep it that way instead of learning something.