Smoking cessation: which place for steaming?

In 2020, the Directorate-General for Health (DGS) and the inter-ministerial mission to combat drugs and addictive behavior (Mildeca) are asking the High Council for Public Health (HCSP) to update its 2016 recommendations on the electronic cigarette. The reason ? Two “major events” have put “on alert”: 2,561 cases of severe pneumonia associated with vaping in 2019 in the US (no cases listed in France), the majority have received e-liquid containing THC from informal sources, and the World Health Organization (WHO) Seventh Report on the Global Tobacco Epidemic, which states that vaping products are not safe and their effectiveness in cessation has not been clearly demonstrated.

“There is not enough evidence-based knowledge to suggest [la cigarette électronique] as a smoking cessation aid in the health care system of smokers “, states the High Council for Public Health in its opinion published in early 2022(1). An attitude much less favorable to “weapons” than that expressed in 2016, when HCSP presented the electronic cigarette as “a tool to quit smoking” and “a way to reduce risk”. HCSP nevertheless considers it useful to reach vulnerable audiences, preferring electronic cigarettes following the failure of validated nicotine substitutes.

What’s the problem ?

“HCSP’s opinion is completely separate from reality, estimate Dr Frédéric Le Guillou, pulmonologist and chairman of the French Respiratory Health Association. Not being able to recommend vaping to a healthcare professional goes against their practice. We need to be able to do that with those who choose this tool to help themselves. » David Saint Vincent, psychologist, coordinator and “vaping” training spokesman at the Addiction Federation, believes that depriving oneself comes down to “to deprive yourself of a healing discourse around an interesting product to work with uses, the search for pleasure and other aspects that do not exist with the patch, for example”. And to remember it “the approach to smoking cessation has evolved towards work with uses and risk reduction”.

Why this position?

HCSP believes that the data on the benefit / risk balance of electronic cigarettes are too weak. Deontologically, a health professional can therefore not advise her with a view to quitting smoking. A scientific rigor that goes badly with those who hoped for a positive signal for a product adopted by the people. “HCSP is in its role, but its position on the subject is cautious, consider David Saint Vincent. It did not take into account the interest in vaping in reducing the serious risks associated with tobacco consumption. »

Shall we talk about vaping at the pharmacy?

HCSP is content to mention, in 2022, a “benefit / risk ratio for ” vape ”, which may represent an aid to certain consumers”. What makes the statement “contradictory and complicated” for the Addiction Association(2). “HCSP’s opinion would have been more helpful in advising professionals facing an electronic cigarette issue”emphasizes David Saint Vincent.

What about the patient?

It is true that “Clarify that the electronic cigarette is not a substance. That it is sold for an economic and non-sanitary purpose, and that it must be used in an adapted and individualized way ”, suggests David Saint Vincent. Emphasize that support from a smoking cessation professional is a plus. Keep in mind that there is no hindsight on the long-term side effects, but that in the absence of combustion, the “vapor” does not produce carbon monoxide or the resulting tar, which is a broad cause of tobacco-related mortality. And remember that the association patch and “vape” give the best result.

Is steaming dangerous?

“Lack of studies proving the long-term safety of electronic cigarettes” does not prevent “a pretty positive a priori”, says David Saint Vincent. Especially compared to the 7,000 chemicals in tobacco smoke(3), of which at least 70 are carcinogenic. Some e-liquid compounds are already known. Liquid propylene glycol, low in volatility and slightly viscous(4), is used in the pharmaceutical and food industry, cosmetics, as well as for nightclub smoke machines. Glycerol, or glycerin, vegetable and natural, is also widely used in medicine and cosmetics.

Thierry Pennable, with Porphyry

1. Opinion on the benefits / risks of electronic cigarettes, HCSP, 26 November 2021.
2. “Vaping: Experts from the High Council for Public Health lag behind patients and society”, Addiction Federation, 14 January 2022.
3. National Food Safety Agency, “Tobacco and Vaping Products”.
4. National Institute for Research and Safety (INRS), “Propylene Glycol”, Toxicological Journal No. 226.

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