A multinational review by a team of scientists, including a University of Massachusetts Amherst public health and health policy researcher, reconfirmed that vapes are the most effective smoking cessation tools available to date.
Titled, “Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta‐analyses,” the study concluded that the most effective smoking cessation tools were nicotine vapes, varenicline and cytisine in that order. “We found high‐certainty evidence that nicotine e‐cigarettes (OR 2.37, 95% CrI 1.73 to 3.24; 16 RCTs, 3828 participants), varenicline (OR 2.33, 95% CrI 2.02 to 2.68; 67 RCTs, 16,430 participants) and cytisine (OR 2.21, 95% CrI 1.66 to 2.97; 7 RCTs, 3848 participants) were associated with higher quit rates than control.”
The researchers added that a combination of NRTs, namely nicotine patches, fast‐acting NRTs and bupropion, were the next most effective aids. While the least effective appeared to be nortriptyline, non‐nicotine vapes and the method of gradually lowering the nicotine dosage of an NRT.
Why lowering nicotine does not work
The latter finding is in line with what many tobacco harm reduction (THR) experts have been highlighting, in relation to the ineffectivity of low nicotine products for smoking cessation. In fact, when in 2022 New Zealand’s Vaping Regulatory Authority (VRA) wanted to reduce the maximum ‘nicotine salt’ limit in vapes, Aotearoa Vapers Community Advocacy (AVCA) co-founder Nancy Loucas had highlighted that this would jeopardise the smoking cessation efforts of many.
Similarly, on discussing reducing the nicotine limit on regular cigarettes, ACT Social Development and Children spokesperson Karen Chhou, said that having only low nicotine cigarettes available on the market, only pushes smokers to consume more. She added that this would also increase their financial burden, as those smokers who are reluctant to quit, will do anything possible to consume the same amount of nicotine, hence they would just purchase more cigarettes. She had added that that low income nationals would be hit the hardest, and that the measure could lead to more poverty.
Meanwhile a research team at the University of Waterloo, found that the public remains largely misinformed about low nicotine products. In fact, 64% of the 3,500 smokers who participated in this study supported the reduction of nicotine in cigarettes/tobacco products in order to make them less addictive.
She added that those smokers who are reluctant to quit will do anything possible to consume the same amount of nicotine. “A few smokers may behave just as the backers of this never-before-tried policy are supposed to and wean themselves off cigarettes and on to less harmful alternatives, but without doubt some will do everything they can to smoke more for the same hit. Some of those people will have responsibilities to little children, and they will suffer in the long run, creating a greater burden for the already stretched child welfare system.”
There is no scientific evidence indicating that reducing nicotine decreases addiction
She added that there is no scientific evidence indicating that reducing nicotine levels is a viable solution. “Where’s the research that says this is a sensible policy that won’t cost us all more in social impacts than it saves in healthcare? There’s a strong argument too that this will drive up the trade of black market tobacco with high nicotine, driving those addicted to cigarettes to turn to crime to feed their habit. The gangs will be rubbing their hands with glee. This reeks of a poorly thought out feel-good policy with numerous potential negative downsides – classic Labour.”
Sadly, data from Europe where such a cap has already been set, support Chhou’s arguments. After a 20mg nicotine cap was set by the EU TPD, researchers found that smokers who were trying to quit and were forced to consume lower levels of nicotine than they were used to, resorted to using the products more often than they normally would, which means that ultimately they were consuming more toxins. Others simply reverted to using more harmful tobacco products which had no restrictions imposed on them.