Posted on November 26, 2021 By Colin
As a junior doctor in the UK, Kevin Murphy said he was “hideously addicted” to nicotine and would creep off the hospital campus to have a smoke, wearing disposable gloves and, on his way back, chewing as many mints as possible.
Via by Jill Margo, 27 Nov 2021 [link]
Before doing medicine, he’d worked as a radiographer and had seen “loads of lung cancer”. Then he was at his mother’s side when her 40-a-day habit for 40 years ended in lung cancer too.
“I detested myself for smoking and was acutely embarrassed about it ... I was so hideously addicted to it,” says Dr Murphy, 44, now a GP in Adelaide who used nicotine vaping to quit smoking, and eventually quit vaping too.
He did this by disciplining himself to a fixed number of vaping sessions a day and incrementally reduced the percentage of nicotine in his vaping liquid. Eight weeks later, he threw his e-cigarette equipment in the bin and a short while later, gave up the nicotine lozenges that had helped him across the line.
The use of vaping as a cessation tool for smoking is highly controversial in Australia. From last month, a new standard was introduced which criminalised the importing of nicotine fluid for vaping and made it available only on prescription, by specially accredited doctors.
Dr Murphy, who prescribes it to his patients, believes this is entirely the wrong approach and rather than being treated as a medicine, the fluid should be sold alongside cigarettes, with the same restrictions.
“Vaping is not a perfect solution, but it minimises harm. If you have a choice between fresh air and vaping, for God’s sake, choose the fresh air.
“But if you have a choice between vaping and cigarettes, choose vaping. Cigarette smoke has over 7000 chemicals and 70 carcinogens that ruin your internal pipes and accelerate cardiovascular disease. Vaping has 95 per cent less of them.”
While he’s had many successes, including among previously intractable smokers, he has had failures too. Some patients have reverted to smoking and some have become stuck on vaping nicotine although, he says, they still benefit from harm reduction.
“My story is not squeaky clean. I’m at constant risk of relapse. While I mostly find smoke disgusting, very occasionally, if I get a faint waft on the wind, it will catch me unaware and reawaken that old keenness for nicotine.
“Doesn’t happen with vaping, presumably because there is no tobacco smell, so my primitive brain isn’t associating it with nicotine,” he says.
Just before the introduction of the new standard, the Royal Australian College of General Practitioners wrote to its members urging them to prepare for the new vaping laws. As there was no evidence base for how to prescribe these products, it explained it was providing practice points to minimise risk to doctors and their patients.
These included dose and duration limits on prescriptions and avoiding the use of flavours since the chemicals are not standardised, and it’s not known if they are safe when inhaled into the lungs.
“Prescriptions for nicotine vaping products are not a first-line treatment for smoking cessation and should only be tried when other measures, such as nicotine replacement therapy with behavioural support, have failed,” said college president, Dr Karen Price.
The College noted the long-term health effects of vaping are unknown and that the evidence base for their efficacy as a smoking cessation tool remains uncertain.
It describes these products as addictive, harmful and possibly fatal if ingested in certain amounts and encouraged GPs to use other cessation therapies, such as gum, patches, sprays, lozenges and approved drugs, ahead of vaping. It also alerted GPs to be wary of being pressured into prescribing vaping products.
There have also been wider concerns about big tobacco companies being behind vaping and the risks of children taking up the practise.
While many GPs now shy away from prescribing vaping, Dr Murphy says his personal history has unexpectedly given him an advantage.
“They don’t understand the overwhelming power of nicotine addiction because they’ve never had to grapple with it. That’s one reason we’re struggling to get more prescribers on board.”
Dr Murphy appears, with others, in a new book Stop Smoking, Start Vaping, the healthy truth about vaping, slated for release on Monday. Written by vaping expert Dr Colin Mendelsohn, it outlines the controversy and the scientific evidence for vaping and provides practical steps to help adult smokers switch.
Dr Mendelsohn says tobacco harm reduction with safer nicotine products is an additional, evidence-based tool for helping smokers quit, but many doctors remain misinformed about it and about the safety of nicotine.
As the new Australian standard was coming into effect last month, he says a comprehensive analysis funded by the UK National Institute for Health Research, showed that, as a “single therapy”, vaping nicotine was more effective than all the available stop-smoking medicines.
The study, which analysed 171 randomised controlled trials, ranked e-cigarettes first, followed by varenicline (Champix), nicotine replacement therapy and bupropion (Zyban).
It found the most effective treatment was “a combination” of varenicline and nicotine replacement therapy, which is rarely used in Australia.
The analysis also found professional support increases success with all treatments, suggesting that getting advice and support from a health professional will increase quit rates further when vaping.
Dr Mendelsohn says there is an ethical issue here, and it is time for doctors to get on board. As smoking remains the leading, preventable cause of death and illness in Australia, helping patients quit is a core responsibility of medical practice.
“Medical practitioners have a duty of care to provide the best possible management at each patient encounter. Withholding a legitimate treatment option that could prevent a life-threatening illness is a breach of that obligation.”
With traditional treatments having low long-term success rates, he says the duty is to provide the best possible management at each patient encounter.
Dr Mendelsohn, founding chairman of the Australian Tobacco Harm Reduction Association charity, says with vaping declared the last quitting option by the college, many smokers will go through repeated failed attempts over many years using traditional therapies, during which further harm and suffering will occur.
“The Lancet showed combining vaping nicotine with a nicotine patch tripled the success rate of quitting after six months compared to using the patch alone.
“Organisations such as the Heart Foundation, QuitVic and WHO, that claim that there is a lack of evidence for vaping as a quitting aid, need to review their position statements ,” he says.