It's time to stop vilifying vaping. The scientific evidence is mounting that:
- E-cigarettes are not a gateway drug that entice young people to take up smoking;
- Vapour devices are at least as effective as other nicotine replacements products such as patches and gum in helping smokers quit;
- Vapour from e-cigarettes contains significantly fewer toxins than smoke from tobacco cigarettes;
- Second-hand exposure to vapour is far less harmful than exposure to second-hand smoke.
"The public has been misled about the risks of e-cigarettes," says Tim Stockwell, director of the Centre for Addiction Research of B.C. at the University of Victoria.
"Many people think they are as dangerous as smoking tobacco, but the evidence shows this is completely false."
Dr. Stockwell is not just blowing smoke. He and fellow CARBC researchers have just produced one of the most comprehensive reviews of the research to date and it shows unequivocally that vaping is replacing, not promoting, smoking.
The most encouraging aspect of the report, entitled Clearing The Air, is that it seems to debunk the notion that e-cigarettes will entice young people, get them hooked on nicotine and then see them embrace smoking.
In fact, the evidence points to precisely the opposite trend. Between 2003 and 2013, teen e-cigarette use rose from 1.5 per cent to 16 per cent; during that same period, teen smoking rates fell to 9.3 per cent from 15.8 per cent.
Further, a comparison of smoking rates between U.S. states that restrict e-cigarette sales to youth and those that do not showed that smoking rates rose in the former and fell in the latter. This suggests that banning e-cigarette sales to teens actually might increase teen smoking.
In Canada, teen smoking rates fell a full percentage point from 2013-15, from 10.7 per cent to 9.7 per cent. During that period, there were no significant new anti-smoking interventions, but the popularity of vaping grew markedly. Is that a coincidence?
It is notable, too, that, in Canada, 72 per cent of teens who vape say they use products that don't contain nicotine. (Technically, nicotine-based products are banned in Canada, though they are easy to get.)
"Fears of a gateway effect are unjustified and overblown," says Marjorie MacDonald, a CARBC scientist and the study's principal investigator. "From a public-health perspective, it's positive to see youth moving toward a less harmful substitute to tobacco smoking."
The new review by CARBC researchers also addresses the claims that vaping is a health hazard. E-cigarettes do not deliver tar or carbon monoxide, and contain only 18 of the 79 toxins in cigarettes. There are concerns that vaping may expose users to metals and particulate matter, but the researchers note that this could be addressed with regulation.
Another much-debated issue is second-hand exposure but, again, the evidence seems clear. Vapour contains "exponentially lower levels of cancer-causing agents" than cigarettes, and vapour dissipates in about 30 seconds, compared to 18-20 minutes for tobacco smoke.
So while vaping should not be encouraged for non-smokers, it is clearly a good alternative for smokers, especially heavy smokers.
Finally, is vaping an effective smoking-cessation method? While there are many heartfelt testimonials, the evidence is unclear. Studies report quit rates ranging from 7.3 per cent to 36 per cent with e-cigarettes. But "quitting" can range from a few days to a year or more, and there are no good data on relapse.
What is indisputable is that quitting smoking is hard, and for those who try, vaping is no less effective than other methods; also, when people vape, they smoke less, even if they don't manage to quit altogether.
In other words, harm is reduced. Yet public-health officials are quite divided on vaping. Far too many have embraced an abstinence-only approach rather than a harm-reduction philosophy. This is curious because no one knows better than public-health experts that prohibition doesn't work.
Smoking is deadly. Vaping is almost certainly not.
We should be encouraging those with a lethal addiction to choose the lesser of two evils.