Want to quit cigarettes? Vaping is far from a go-to, Canadian guideline says | CBC News

People trying to quit smoking should not reach for e-cigarettes or vapes as their first choice to butt out, a new Canadian guideline says.

Instead, clinicians should stay updated on whether their patients smoke or not, and offer them options to quit that have been proven effective, including medications, nicotine replacements and counselling.

Those interventions boost a person’s odds of quitting for good in the long term, the Canadian Task Force on Preventive Health Care said in Monday’s issue of the Canadian Medical Association Journal. The guideline conditionally recommends against e-cigarettes.

Even though smoking has declined for decades in Canada, tobacco remains the top cause of preventable death from cancer.

“Our guideline really helps the reader hone in on what works, what they probably shouldn’t be using and what they definitely shouldn’t be wasting their time on,” said Dr. Eddy Lang. 

“Part of the motivation for putting out the guideline now is to counter the other kinds of advertisements and promotions that are out there.”

Why not vaping?

The guideline comes as vaping remains popular among youth. Thirty per cent of the 15- to 19-year-olds surveyed said they’d tried vaping in 2022, the latest year for which data is available, according to Statistics Canada. In comparison, just 10 per cent of youth said they’d tried smoking cigarettes.

People who smoke will sometimes turn to vaping, believing it will help them get over a nicotine addiction. But no e-cigarette has been approved for smoking cessation in Canada, the guideline notes. 

Given limited information on the long-term effects of using e-cigarettes on lung and heart health, the task force suggested against their use for most people.

Dr. Matthew Stanbrook, a Toronto-based respirologist, lauded the task force’s conditional recommendation against vapes. 

“Nicotine replacement therapy, the patch, the gum, things people know about — they’re widely available and importantly, they’re standardized and they’re safe and they don’t put toxins in the lung,” said Stanbrook, who wrote an editorial for CMAJ about the guideline. 

E-cigarettes deliver many of the same toxins and carcinogens found in tobacco smoke directly into patients’ lungs, albeit usually at lower concentrations than cigarettes, he said.  

The task force authors acknowledged e-cigarettes remain a last resort for people who have unsuccessfully tried other interventions or strongly prefer them. But after their overview, they said they didn’t want to normalize their use.

“We didn’t want to substitute one addiction for another,” said Lang.

The CMAJ guideline doesn’t address flavoured nicotine pouches, like Zyns — small, white packets containing what doctors say is the nicotine equivalent of smoking multiple cigarettes. These have also recently become popular among younger people. The pouches may be considered in future updates of the guideline, the task force wrote. 

So what does work?

The guideline strongly recommends behavioural therapy, pharmacotherapy or both. The former category includes self-help materials or group counselling, while the latter is made up of nicotine replacements, like patches or spray, and medicines.

That includes cytisine, a plant-based product that mimics nicotine’s effects in the brain, and varenicline, a synthetic version. 

WATCH | No more new smokers?:

Should Canada ban future generations from smoking?

Ottawa Public Health is recommending the federal government consider a New Zealand-style generational smoking ban, which sought to prevent anyone born after 2008 from ever buying tobacco products in their lifetime.

Dr. Peter Selby, an addictions specialist at Toronto’s Centre for Mental Health and Addiction, has experience treating patients with cytisine, and calls it a cost-effective way to quit smoking. 

He says Eastern Europeans used cytisine as a replacement during the Second World War when they couldn’t smoke.

“It got lost to the Western world because there’s no money to be made. A Canadian company made a Canadian product and got it authorized as a natural product, and the evidence is pretty good.”

Our brains are full of nicotine receptors, Selby said. When somebody is addicted to nicotine, those receptors multiply. Left unfilled, the patient will experience withdrawal, creating a craving and making them addicted.

“When nicotine shows up, [cytisine and varenicline] block nicotine from acting,” said Selby. “This person smoking will say, ‘I can’t finish my cigarettes. I don’t like my cigarettes,’ and it boosts their willpower to stop.”

What’s discouraged — and what’s next

The guideline strongly recommends against alternative medicines, like acupuncture, hypnotherapy and laser therapy. Though generally safe, these treatments are ineffective, Stanbrook said. 

There’s still a lot of opportunity for future research, the guideline says, such as whether e-cigarettes are effective and safe in the long term. They also say it would help to conduct studies on whether certain groups face particular challenges in quitting smoking, like Indigenous people. 

One area that could be studied in the future: whether AI-based therapy could help people quit.

In any case, Lang says people looking to stop smoking have options.

“It is absolutely possible to quit smoking,” said Lang. “It is just very difficult because nicotine is such an addictive substance.”