A new systemic review indicates that e-cigarettes may be a “gateway” to more tobacco use, but researchers say many unknowns remain.
The authors of a major review of available studies on vaping have concluded that e-cigarettes are harmful to non-smokers – but believe much remains to be established about their health effects.
189 studies were used in a synthesis of the available evidence carried out by researchers from the National Center for Epidemiology and Population Health at the Australian National University.
“E-cigarettes are harmful to non-smokers, especially young people, and when used for purposes other than quitting smoking,” the authors conclude.
“There is strong evidence that non-smokers who use e-cigarettes are three times more likely to continue smoking combustible tobacco cigarettes than non-smokers who do not use e-cigarettes, supporting a ” bridge “.”
The researchers also say that much remains to be understood about the longer-term impacts of vaping.
“A central finding of this systematic review is the lack of evidence regarding e-cigarettes and clinical health outcomes,” they write.
Most of the details available focus on more immediate health outcomes such as addiction and acute impacts, the study says, with the impact on other health conditions still largely uncertain.
“No evidence or insufficient evidence was available on the health effects of e-cigarettes with respect to cardiovascular disease, cancer, respiratory conditions other than lung injury, mental health, child and adolescent development , reproduction, sleep, wound healing, neurological conditions other than seizures, and endocrine, olfactory, optical, allergic, and hematological conditions,” reads an abstract of the study.
“This means that their safety for these results has not been established.”
Professor Nicholas Zwar, who chaired the expert advisory group that compiled the RACGP smoking cessation guidelines, said the ANU study supported the view that vaping could be bad news, in particularly for young users – while acknowledging that the debate is likely to continue.
“There is growing evidence that if non-smokers use e-cigarettes, it predisposes [them] start smoking tobacco,” Professor Zwar said. newsGP.
“Given the increasing use of nicotine e-cigarettes, and most of them contain nicotine, among young people, I think this is a major concern.”
The different approaches to prescribing
For Dr. Hester Wilson, president of the RACGP Special Interests Addiction Medicine, general medicine is divided into three distinct camps on the use of e-cigarettes.
According to Dr Wilson’s assessment, some GPs view vaping as a type of tobacco industry “Trojan horse” and will not prescribe e-cigarettes under any circumstances. They are opposed to those who believe that the federal government should allow consumers to use them freely.
Dr Wilson places the majority of GPs, including herself, somewhere in between, believing that prescribing vaping products for clinical use in certain circumstances can minimize harm.
The ANU report says “limited evidence that freebase nicotine-based e-cigarettes are an effective smoking cessation aid when used in clinical settings” – although it does mention some important caveats .
These include the fact that the use of e-cigarettes by smokers trying to quit “is likely to lead to greater long-term exposure to nicotine than the use of other measures of smoking cessation”.
It also highlights evidence, again ‘limited’, that ex-smokers who use e-cigarettes are twice as likely to relapse as those who don’t.
“How do you put in place a system that allows access to these people, but doesn’t allow open access that leads to another generation of young people starting to vape, and the unknown risks of that?” she said newsGP.
A recent RACGP submission to the Ministry of Health’s consultation on a national tobacco control strategy to 2030 also highlighted the concerns of young people who vape and adopt a lifelong smoking habit.
“We know that e-cigarettes are a particularly attractive option for young people, including school-aged children,” said Professor Karen Price, President of the RACGP.
“That is why we need targeted early intervention and education for school children, including the development and implementation of additional measures to further restrict the marketing and availability of all e-cigarettes, regardless of regardless of their nicotine content.
According to Dr Hester Wilson, many GPs find the current regulatory situation to be a delicate balancing act.
According to the ANU study, about 53% of those who use vaping products also smoke tobacco.
While the ANU report states that “the health effects of double smoking and e-cigarette use are not known”, Dr Wilson says that for those who are heavily addicted, there may be an advantage.
“I would say, in this group of highly dependent people, dual use is actually harm minimization,” she said.
“You maintain your nicotine intake, but your intake of other harmful chemicals in tobacco is going to be lower.
‘[However]this dual use means that people do not quit and continue to be at increased risk due to their tobacco use.
Dr Wilson also says that many GPs find the current regulatory situation a tricky balancing act.
She points to the difficulties created by new laws introduced last year that limited nicotine vaping products to prescription only – although no approved products are listed by the Therapeutic Goods Administration (TGA).
“It’s a lot of work for the GP and for the patient to put this in place. And it’s a little easier for smokers to buy under the counter, and cheaper,” she said.
‘How do we support our members to be able to provide this?
“There are so many unknowns, but there is an opportunity here to reduce the risk of harm for those who are highly addicted and to engage them in smoking cessation treatment, which is really where we want to get to.”
Dr Wilson thinks more work needs to be done to make the prescription process easier for general medicine.
Professor Zwar also says it would help GPs if there was a fully tested and approved nicotine vaping product that had gone through the review process through the TGA.
“Nowhere in the world is there such a product,” he said. “You could do that in addition to having it as a consumable.” They are not mutually exclusive.
“But no sponsor to date has wanted to go down that road. And you could make your own assessments of the motives for that.
While the TGA cited some success in cracking down on illegal advertising, Professor Zwar does not believe the availability of vaping products has been reduced.
“One of the points of the change in the legislation was to allow the law to be consistent across the country and to allow the Australian Border Force to seize nicotine vaping products imported without a prescription,” said he declared.
“It should have made it easier to apply [but] for whatever reason, the application is not done adequately. Enforcement of controls does not appear to be effective.
He is also keen to add context to a statement from the ANU study which suggests that “the vast majority of people who successfully quit smoking do so without help”.
“It’s true,” said Professor Zwar. “But the fact that 20,000 Australians die each year from tobacco-related disease suggests that many people aren’t doing it soon enough.”
“There is a need to offer support to help people quit smoking. Not everyone wants this support.
“But we know that if people are using assistance, in terms of advice from medical professionals, a quit smoking helpline or both, and if they’re addicted to nicotine are using drug therapy to treat their addiction, they are much more likely to succeed.
“I wouldn’t want to discourage people from asking for help.”
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