Irish anti-vaping sentiment needs to be stubbed out

Dr Muiris Houston: It’s good that many former heavy smokers who quit carry on vaping

With Ash Wednesday on the horizon, it brings with it one of the traditional times in the year when ideas about quitting smoking come alive. Will smokers reach out for nicotine replacement devices, prescription medication, sign up for a smoking cessation programme or simply go cold turkey?

In recent years, vaping has emerged as a smoking alternative. Invented in 2003 by Chinese scientist Hon Lik, the electronic cigarette delivers nicotine through an aerosol, rather than via the combustion products of dried tobacco leaves. And while it’s an obvious aid for people quitting, until now there has been a reluctance to give the practice an enthusiastic thumbs-up.

Well, that should be about to change following the publication of a landmark paper in the New England Journal of Medicine. In a trial of e-cigarettes almost 900 smokers seeking to quit were randomly assigned to one of two groups. One group was given nicotine replacement therapy (NRT) – mostly combinations of nicotine patches with a shorter-acting medication, such as nicotine chewing gum, inhaler or mouth spray. The other group was given a refillable e-cigarette, with one or two bottles of e-liquid, and taught how to use the device. Both groups also received weekly face-to-face support over at least the first four weeks of the study.


Researchers from London’s Queen Mary University found that, one year later, almost twice as many people in the e-cigarettes group had stayed away from (real) cigarettes throughout the year compared with the NRT group (18 per cent versus 10 per cent).


When heavy smokers try to quit, they often feel miserable for a while, struggling with urges to smoke, irritability and low mood. Significantly, the group using e-cigarettes experienced fewer of these symptoms than the group using NRT. Another interesting finding was that 40 per cent of smokers in the e-cigarette group were still vaping at one year while only 4 per cent in the NRT group were still using the cessation aid. And among smokers who didn’t manage to quit, there were some in both study groups who reduced their cigarette intake by at least 50 per cent.

Huge finding

Not surprisingly, the first trial to test the efficacy of modern e-cigarettes in helping smokers has been widely welcomed in the U.K. That e-cigarettes were almost twice as effective as the “gold standard” combination of nicotine replacement products is, frankly, a huge finding.

All stop-smoking services should welcome smokers who want to quit with the help of an e-cigarette

Martin Dockrell, tobacco control lead at Public Health England, said: "This landmark research shows that switching to an e-cigarette can be one of the most effective ways to quit smoking... All stop-smoking services should welcome smokers who want to quit with the help of an e-cigarette."

Amazingly on this side of the Irish Sea, at the time of writing, there has been a deafening silence from bodies such as the Irish Cancer Society, the Irish Heart Foundation and the HSE Quit team. It seems that despite a favourable health technology assessment by Hiqa in 2017, a certain "snootiness" persists among advocacy groups here when it comes to vaping.

Seen as socially unsavoury

I suspect that continued vaping among long-term abstainers is seen as a socially unsavoury habit by key advocates. This is despite estimates of the risks of long-term vaping on health at less than 5 per cent of the risks of smoking (no health risks from vaping were found in one gold-standard study looking at over two years of e-cigarette use).

Well, in my opinion, the fact that many former heavy smokers who quit carried on vaping is a good thing. And so by continuing on their high horses, advocacy bodies are actually contributing to the kind of stigma described recently in a feature on lung cancer in The Irish Times’ Health and Family supplement.

It’s time for Ivory Tower residents to climb down and inhale real life in the smoking trenches.