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Pr Daniel Thomas – The electronic cigarette is constantly evolving. The third generation of these products aims to deliver nicotine more efficiently to the body and brain, with a mechanism that increasingly resembles the absorption of nicotine by a conventional smoker. For example, this is the operation of the JUUL brand, an extremely small format electronic cigarette, promoted among young people, who can thus fall into a real addiction to nicotine. It is less severe than tobacco addiction, but it is not without health consequences.
I take this opportunity to clarify that heated tobacco, a new product sold by Philip Morris for example through its IQOS brand, has absolutely nothing to do with e-cigarettes, contrary to what the tobacco industry wants to believe.
– What is the impact of e-cigarettes on health?
First of all, you should know that this is a product we have little perspective on, because it has only been on the market for a decade, and new types of e-cigarettes are coming out regularly (for tobacco, it took more than fifty ‘ years to demonstrate its deleterious effects on health). There is not much data on these products in the medium term and not at all in the long term.
As for the effects of electronic cigarettes on health, we do not see for the moment any manifestation at a clinical level, that is in terms of the expression of a heart attack or cancer for example. . At the moment they are impossible to prove, given the limited time exposure of the vapers.
What we currently have are many studies that focus on the biological effects of e-cigarettes, i.e. their intermediate effects. Vaping therefore has proven effects on vessels and inflammation, as well as toxicity on cells. For a non-smoker, vaping is therefore definitely toxic.
But for smokers, exposed to thousands of toxic products every day, switching to e-cigarettes reduces their health risks. In vaping, in particular, there is no combustion, so no carbon monoxide.
– Does the e-cigarette make you addicted?
It depends on the products and how they deliver nicotine to the body. If they do it almost as effectively as the classic cigarette, the vaper risks being hooked to the vape as it can be hooked to the cigarette.
A non-blind study recently showed that there are twice as many smokers who quit vaping than nicotine substitutes. However, after quitting smoking, only 13% of drug substitute users still used it, while 80% of vapers still used e-cigarettes. Here, we see that addiction has moved from smoked tobacco to vaping, particularly as smokers find in vaping the nicotine spike they enjoy when they smoke a cigarette.
– Is it better to avoid lighting electronic cigarettes?
If you are a non-smoker, you should definitely avoid lighting the e-cigarette, at any age, because it is a product whose long-term health effects are unknown. Not only do we not have a sufficient perspective on the toxicity of e-cigarettes, but the biological observations described above indicate a negative impact on health.
– Is there a risk of switching from e-cigarettes to tobacco, especially among young people?
The data on the subject are very contradictory, there is no longitudinal research. However, studies suggest it does, especially since when you’ve become addicted to nicotine, consuming e-cigarettes is more complicated than buying your pack at the local tobacconist.
In the United States, there has been such an increase in vaping among young people that there is now a new generation of nicotine addicted vapers who have never smoked tobacco. For them it is a real public health problem. In France it is a rather marginal phenomenon, but it exists.
– Is it a good idea to use e-cigarettes to quit smoking?
Yes, but under certain conditions. We can summarize my addict recommendations as follows:
– If you are a non-smoker, you should definitely not start vaping.
– If you are a smoker, the e-cigarette is a possible option to quit smoking, provided that you subsequently aim to quit vaping altogether. Because staying solely vaping is no guarantee of long-term good health, as we don’t know what this gives yet.
I would like to point out that sticking to mixed drinks, which alternate between electronic cigarettes and classic cigarettes, is not a good option. Studies show that, even when consumed occasionally or in small daily quantities, the impact of tobacco is harmful to health. There is no light smoke, it is for this reason that smoking in closed public places has been banned, in order to prevent secondhand smoke.
– To quit smoking, is the electronic cigarette more effective than cognitive and behavioral therapies (CBT) or patches?
It is not black or white. We must not demonize the electronic cigarette, nor idealize it. In France, the HAS does not recommend the e-cigarette as the first line to quit smoking, because there is no perspective on the toxicity of the product. However, if the products recommended for first-line and reimbursed treatment – such as patches or tablets (champix, zivan) – do not work, the e-cigarette should be considered. Although this product can generate a new addiction, it is an effective way to quit smoking, which remains much less dangerous to health than the cigarettes produced. As for the therapies, it can also be effective, but it is a more complex treatment to implement.
In summary, if a person wants to quit smoking, I will not offer them the e-cigarette first. But if ultimately it’s the way to quit smoking that suits her best and she accepts it more than the pharmaceutical nicotine substitution, well, I encourage her.
– Do you want to add something in conclusion?
The medical world is still too little interested in the problem of tobacco in the population, much less, for example, than in cholesterol, hypertension or diabetes. It is not enough to tell your patients to stop smoking, it is also necessary to help them, because tobacco is a hard drug. There is a terrible flaw in prescriptions for smokers, who feel guilty about smoking when they are just victims.
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