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Vaping Is About Reducing Harm, Not Being Harmless

A new report published by the Royal College of Physicians says vaping could be an important harm reduction tool for quitting smoking.

A major public health group has come out strongly in favor of vaping as a way to quit smoking. The UK's Royal College of Physicians—the same group that, in the 60s, first blew the whistle on cigarettes causing cancer—has released a report heralding vaping as an important public health tool that, the group argues, ought to be promoted far and wide as an alternative to smoking.

"In the UK, the use of electronic cigarettes has exploded and they've attracted a huge amount of controversy," John Britton, the chair of the RCP's tobacco advisory committee and a professor of epidemiology at the University of Nottingham, told me over the phone. "We were looking to provide reassurance to my colleagues in medicine and public health, but also to smokers and the general public, that these products are actually probably a good thing and we should be learning to manage the opportunity instead of considering prohibiting them."

This endorsement is a pretty big deal because the safety and effectiveness of vaping as a way to quit smoking is still a point of contention for a lot of public health and anti-tobacco groups. These groups share information with lawmakers and the public, which can have a serious influence on policies and smokers' choices. But, as the report points out, we've spent decades looking for ways to get smokers to switch to products other than cigarettes to get their nicotine fix (like the patch, gum, or pharmaceuticals). It's still too early to know what kind of long-term effects vaping might have, but there's no evidence to suggest it's anywhere near as harmful as smoking, so why not add it to the toolbox?

"Yes, we have to be cautious in saying we don't know what the long-term hazards are, but the key question is 'are those long-term hazards likely to be as severe or remotely as common as the adverse effects of smoking?'" Britton said. "Electronic cigarettes, however harmful they are, will be nothing like as bad as smoking. So if you're a smoker, you should make the switch."

It's all based on a theory of harm reduction rather than taking an abstinence-only approach to addiction. Obviously it would be great if every smoker just quit and never used any nicotine product again, but we've long understood that this isn't a realistic expectation. So the next best thing would be to find a way to reduce the harm that nicotine addiction causes to both the smoker and the people around him or her.

Vaping, this report says, is potentially a great way to do that. It's kind of like methadone for cigarette addicts.

There are some concerns about teens and youth taking up vaping not as a way to quit smoking but, y'know, just for fun. This does happen, and the report emphasized the importance of working to prevent youth access to any nicotine products, but noted the vast majority of youth who have tried vaping already had a history of smoking, and there's not really any evidence right now that vaping is a 'gateway' to smoking.

According to the report, studies show that taking up vaping increases both the likelihood that a smoker will try to quit and that the attempt will be successful. Vaping has also rocketed in popularity as a stop-smoking aid, the report said, outpacing the patch, gum, prescription drugs, and therapy as the most popular tool used by smokers to help a quit attempt—only going cold turkey is more popular:

Britton said this is partly influenced by the fact that vaping maintains so much of the behavioural elements of nicotine addiction. Smokers don't just need a shot of nicotine, they also often crave the feeling of drawing smoke into their mouths, the throat hit, the weight between their fingers, the habit of popping outside for a drag with friends or pairing a ciggy with their morning coffee or nightcap. All of these elements are removed when a smoker tries to go cold turkey or uses something like the patch, but with vaping, they still get it, just with fewer chemicals and no combustion.

One report isn't going to change the minds of every public health agency and lawmaker, especially here in the US, and there's still lots to learn about how vaping fits into a public health strategy. But this report provides new fodder for the growing number of tobacco addiction experts who believe vaping may just be the solution we've long been waiting for.