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Smoking Cessation

Nov04

E-cigarettes

Tuesday, 04 November 2014 Categories // Current Affairs, Health, Smoking Cessation , Living with HIV, Opinion Pieces, Megan DePutter

Are they for harm reduction, a tool to help people quit or both? And what about the authorities’ attempts to regulate them? Megan DePutter weighs in on the vaping craze and the issues it raises.

E-cigarettes

Upon moving to Glasgows west end, I noticed a number of things about my neighbourhood: a striking abundance of lovely restaurants, cafes filled with appetizing sweets in the windows, cozy pubs, and more electronic cigarette shops than I could count. 

I dont want to comment on whether e-cigarettes are safe, because I cant pretend to truly know enough about them. However, when I look at some of the arguments against e-cigarettes, I do notice some trends that frequently pop up in harm-reduction/abstinence debates. 

For example, arguments against e-cigarettes often point to the concern that vaping does not act as an effective smoking cessation product. This is consistent with most discussions about other drugs, where there is an assumption that the goal is abstinence. 

The other argument against vaping is that e-cigarettes still contain nicotine - which is precisely why e-cigarettes could be considered a danger, or an effective harm reduction product.

It was recently announced that Nova Scotia is re-writing tobacco legislation to prevent people from using e-cigarettes indoors. Furthermore, they intend to ban stores from selling e-cigarettes to those under 19 and from displaying, advertising or promoting them.They also aim to ban the sale of flavoured tobacco.

What I found most interesting about this is how the Health Minister Leo Glavine justified the new legislation: "The flavour juice, it's still nicotine. It becomes an addiction for our youth and that's where we draw the line. 

Thats an interesting choice of words, I think, as he focuses on the fact that its an addiction, rather than the harmful effects of nicotine itself. 

I look at some of the claims that the e-cigarette shops advertise on their shop windows here in Glasgow and wonder if they are exaggerated. They make vaping sound less harmful than drinking tea.

The thought has crossed my mind that perhaps instead of quitting, smokers may simply switch to vapor. Then I realized this is the same argument that people make against harm reduction: that giving someone a clean needle will only encourage them to continue using. Is this why the government intends to control e-cigarettes? To keep the focus on abstinence instead of harm reduction? 

Now, I am a believer in the regulation of food and drugs (for example, it irks me to no end that the naturopathic community can peddle all sorts of products with lofty claims to fix everything from rheumatoid arthritis to cancer to HIV with no shred of clinical research or scientific evidence). It makes sense that this industry should have to abide by some regulation and make claims backed on scientific evidence. But everything Ive heard about cigarettes is that the tar and other chemicals they are loaded with are what truly generates the most risk. So even if e-cigarettes present a risk of nicotine addiction, arent they already a huge step ahead of traditional cigarettes, which contain 40 known carcinogens among the 10,000 chemicals?  I cant help but wonder whether the rush to control vaping is a reaction that is located somewhere in the harm reduction / abstinence debate. 

Arguments against vaping because of potential nicotine addiction could easily turned on their head, as people who find the smoking addiction tough to beat could at least significantly reduce the harms of smoking.

Usually the argument goes that nicotine is harder to beat than heroin or crack. Perhaps it is true; I know a lot of people who have beaten heroin or crack and continue to smoke cigarettes - it may very well be that smoking helps them manage their addiction throughout rehabilitation. Many probably consider smoking to be almost irrelevant after overcoming addictions to substances that threaten and impact their lives in a much more immediate way. 

Yet smoking is a big threat to health. I cant help to think of author Carolyn Knapp, who overcame alcoholism and a powerful eating disorder only to die of lung cancer. 

PositiveLite.com has reported a number of reasons why smoking is a significant concern for the health of people living with HIV (see related articles below) And so, in the HIV sector, supporting people in their cessation or reduction of smoking is probably one of the most important challenges today. If Im frank, I dont think the sector is doing enough to help smokers. Weve managed to get HIV drugs that can turn HIV into a chronic, manageable condition, and yet smoking threatens to jeopardize the health and longevity of people living with HIV, perhaps as much as anything else the sector is currently addressing. 

But it makes sense that a disproportionate number of people with HIV smoke. After all, smoking can be a coping mechanism to deal with stress, anxiety, or as I mentioned, manage other addictions. Nicotine can also stimulate attention and memory, and for people who are experiencing some of the neuro-cognitive effects of HIV drugs, it may make sense to reason that the stimulation that comes from nicotine is likely helpful. This is all to say that, given the difficulty in quitting smoking, and the reasons why people living with HIV smoke, wouldnt harm reduction be particularly advantageous, rather than pushing the age-old solution: just quit? 

Likely the increased regulations around vaping will be intended to prevent non-smokers from starting smoking, to prevent ex-smokers from starting again, and to encourage people who are on the path of smoking cessation to quit rather than take up vaping. But I fear that this approach will miss the mark of supporting people who are already smokers by offering them a chance to significantly reduce the harms of traditional cigarettes. As I mentioned, some regulations and limits are likely a good thing, but limiting the access to, and attractiveness of, vaping may do more damage than good, and only in the name of His Holiness, Abstinence.

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