Harm Reduction and Vaping

Tobacco harm reduction is a key public health strategy.  In areas where “abstinence-only” approaches are ineffective, harm reduction is widely practised in public health.  An example is the reduction of the harms of illicit drugs by providing syringe exchange of methadone.

Tobacco harm reduction aims to provide less harmful alternatives to smoked cigarettes to reduce the harms associated with smoked tobacco.

In practice, this primarily means encouraging smokers or would-be smokers to adopt non-combustible nicotine products such as e-cigarettes (vapes) rather than combustible, smoking products such as cigarettes.  The rationale is that these products are a lot less harmful than the alternative. 

E-cigarettes (or vaping) can help New Zealand reach Smokefree 2025

Vaping continues to be highly disruptive to tobacco smoking and presents a fraction of the harm. Creating an environment where smokers can use this much less harmful alternative to manage nicotine addiction is likely to have a significant impact on chronic disease prevention in New Zealand, especially for Maori, Pacific and low-income populations.

What the NZ Government and the Ministry of Health says

New Zealand has a harm reduction approach to vaping.

The Ministry of Health says that "vaping is much less harmful than smoking" and "...can help some people to quit smoking."  It also says, "Vaping has the potential to help people quit smoking and contribute to New Zealand’s Smokefree 2025 goal."

The Government has produced information to help those who are smoking cigarettes transition to vaping.  Look here for its Vaping Facts

Nicotine is addictive, smoke is harmful

Tobacco smoking is highly addictive because of the nicotine content of cigarettes, and the mechanism by which nicotine is administered to the brain through combustion and inhalation of smoke.

Very few, if any substances are as addictive as nicotine when delivered via a cigarette. This delivery mechanism is extremely efficient, modifies brain receptors and creates a very high level of dependency.

The nicotine itself is not harmful when delivered in this way. It is the by-product of combustion that causes harm because the smoke contains multiple carcinogens, and leave deposits on the respiratory systems that severely impact on cardiovascular and respiratory function.

Addiction and quitting

The addictiveness of smoked tobacco is evidence in the very low rates of successful quitting, and high rates of relapse to smoking. For example, the average sustained abstinence rates for quitting smoking ‘cold turkey’ at one year is approximately 0.4% of quitters.

Whilst clinical forms of nicotine such as patches, gum and lozenges have been available for many years as quit aids they have a fraction of the efficiency that smoking has in delivering nicotine. Combined with behavioural support, success rates remain low with sustained abstinence at around 1.6% of quitters[i].

E-cigarettes are more efficient at managing addiction

There is increasing evidence that vaping is significantly accelerating the decline in smoking in countries where e-cigarettes are permitted. 

E-cigarettes (vaping) deliver a vapour composed mostly of propylene glycol (also used in asthma inhalers) and flavouring agents. Some, but not all, contain nicotine. The current generation of vaping devices normally work using a tank of vaping liquid that is heated into a vapour and inhaled. The nicotine delivery is much more efficient than clinical products, and mimics the inhalation delivery mechanism of smoking.

In the UK 45% of vapers are current smokers, and 52% are ex-smokers. The UK smoking monitors estimates that over 2.9 million people in the UK vape, and over 1.3 million have quit smoking altogether. Long term ex-smokers are 3 times more likely to report having used an e-cigarette than NRT[iv].

E-cigarettes and harm

The Cochrane Tobacco Addiction Group concludes that switching to electronic cigarettes is likely to lead to significant improvements in health[ii].

Vaping lacks the most harmful components of conventional cigarettes – tar and nicotine. Public Health England concluded that they are 95% less harmful than cigarettes, but substantially more effective in delivering nicotine than medicinal nicotine products[iii]. This helps manage nicotine withdrawal with a fraction of the harm from tobacco, and delivered in a way that is far more acceptable to many smokers who want to quit.

Vaping and Youth

The only reason ASH supports vaping is as a harm reduction measure for those who smoke cigarettes.  We have been asking the Government to regulate vaping for a decade.  It finally did so in late 2021.

Youth smoking rates continue to decline, whilst vaping rates are increasing.   This is largely because it took the Government so long to regulate vaping and it thus allowed youth to experiment with vaping.  Whilst vaping is clearly less harmful than smoking, this does not mean it is harm-free.   

Whilst there are concerns about e-cigarettes being a possible gateway into smoking, there is currently no evidence of this, particularly for youth.  

 To find out about youth vaping, see the ASH Year 10 Survey that annually surveys youth and their vaping habits.  Click HERE

To see the answers to commonly asked questions about vaping policy, click HERE

[i]Moore D, Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: Systematic review and meta-analysis. BMJ 2009:338:b1024

[ii]Hartman-Noyce J, McRobbie H, et al. Electronic Cigarettes for Smoking Cessation. The Cochrane Library 2016

[iii]McNeill A, Brose LS et al. Evidence Review of E-cigarettes and heated tobacco products. Public Health England. (2018)

[iv]West R.  Electronic cigarettes in England – Latest Trends (2018 Q2) Smoking Toolkit Study. www.smokinginengland.info.