[*Note from HIFA moderator (NPW): Thanks to Jenna Butner, who has drafted this introduction to Q5: What are the pros and cons of electronic nicotine delivery systems (ENDS; vaping) (eg as an aid to stop smoking; as an addictive alternative to smoking among young people)? We look forward to explore the issues raised over the coming days. Please send your contributions to: hifa@hifaforums.org ]
HIFA Tobacco Working Group
Hello, I’m Jenna Butner, a member of the HIFA working group that is facilitating this discussion. I’d like to introduce question #5: “What are the pros and cons of electronic nicotine delivery systems (ENDS, vaping) as an aid to stop smoking or alternative to smoking among adolescents and young adults?”
Electronic nicotine delivery systems (ENDS) also referred to as vaping has increased exponentially during the last several years. The rise in E-cigarette or vaping product use-associate lung injury (EVALI) and acute respiratory illness related due to ENDS has risen. Among adolescents, ENDS poses a serious health risk, and little is known on the long-term effects. In a recent publication by Delnevo, et al. physicians may recommend usage of E-cigarettes for smoking cessation, particularly to older patients with a history of severe tobacco use disorder (TUD), however there is ambivalence regarding the safety of ENDS as a treatment for TUD, as there remains the belief that ENDS and cigarettes are equally harmful. In Hartmann-Boyce’s systematic review, of 78 completed studies, there was strong evidence that quit rates were higher in people randomized to ENDS than in those randomized to nicotine replacement therapy. Consideration of ENDS as a harm reduction approach in high risk populations with high rates of TUD, such as those with schizophrenia, schizoaffective disorder and bipolar disorder, whose life expectancy is 10-20 years shorter than that of the general population, may be an alternative treatment approach in the right direction.
As a primary care physician and hospitalist, recommendation for use of ENDS is something I have become more accustomed to. It is my opinion that the use of nicotine without the other chemicals found in cigarettes, is “safer” and I approach it from a philosophy of harm reduction. To that end, having limited knowledge on the contents and quantities of newly developed vaping solutions is unsettling. More education and evidence-based studies on the safety and efficacy of it as a cessation option for TUD is urgently needed.
REFERENCES
Smith, M. L., Gotway, M. B., Crotty Alexander, L. E., & Hariri, L. P. (2021). Vaping-related lung injury. Virchows Archiv: an international journal of pathology, 478(1), 81–88.
Kaliamurthy, S., & Camenga, D. R. (2022). Clinical approach to the treatment of e-cigarette use among adolescents. Current problems in pediatric and adolescent health care, 52(6), 101203.
Delnevo, C. D., Jeong, M., Teotia, A., Bover Manderski, M. M., Singh, B., Hrywna, M., Wackowski, O. A., & Steinberg, M. B. (2022). Communication Between US Physicians and Patients Regarding Electronic Cigarette Use. JAMA network open, 5(4), e226692.
Hartmann-Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2022, Issue 11. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub7. Accessed 14 March 2023.
Chesney, E., Robson, D., Patel, R., Shetty, H., Richardson, S., Chang, C. K., McGuire, P., & McNeill, A. (2021). The impact of cigarette smoking on life expectancy in schizophrenia, schizoaffective disorder, and bipolar affective disorder: An electronic case register cohort study. Schizophrenia research, 238, 29–35. https://doi.org/10.1016/j.schres.2021.09.006
HIFA profile: Currently pursuing an MPH at Yale School of Public Health, Jenna Butner is a medical doctor, Researcher and Educationalist at APTP. With a key interest in Substance Use Disorders among forced migrants, she is currently collaborating with the US Embassy in Jordan to fill critical gaps in SUD identification, knowledge, prevention, and treatment that exist in refugee populations in humanitarian settings. Dr. Butner holds an MD from Ross University School of Medicine and completed her Residency in Family Medicine at Bronx Lebanon Hospital Center. She then completed a fellowship at Mount Sinai Beth Israel Hospital in Hospice and Palliative Medicine, followed by an Addiction Medicine Fellowship at Yale. Email:
jenna.butner AT yale.edu
