How to support vapers who are ready to quit nicotine for good
Dr Roger Henderson
This article was funded by the manufacturers of NICORETTE®. They had input into the content and reviewed material. The healthcare professional involved in writing this article does not endorse any specific medicinal brand or product.
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Dr Roger Henderson qualified as a doctor from St Bartholomew's Hospital, London in 1985, and as a general practitioner in 1990. He is a senior GP, recently retired from his long-standing position as the head of a 15,000-patient general practice where he was also a GP trainer, running his large main surgery and two branch surgeries including a University campus. He now works as a sessional GP. He has a special interest in smoking cessation and has been advising healthcare professionals on this topic for over 20 years. |
The changing face of smoking in the UK
The number of people smoking in Britain has decreased dramatically from after the war – when 82% of men smoked1– to 1974 when 46% of the adult population were smokers, to its current level of around 13%2.This was helped in part by the 2007 tobacco smoking ban3, along with the input of specialist smoking cessation services in the last few decades4, increased tobacco taxes and health warnings on tobacco product packages. However, there is still some way to go to achieve the Government ambition of England becoming ‘smoke-free’ by 2030 (the definition of which is that adult smoking prevalence falls to 5% or less)5 even though the health benefits of quitting smoking are well known.
Vaping is increasing with 57% of vapers being ex-smokers6
Compared to 2012 when 1.7%6 of British population used e-cigarettes, over 8% now do so7. This means there are currently some 4.3 million e-cigarette users in the UK of which 2.4 million are ex-smokers, 1.5 million continue to smoke and 350,000 users have never smoked6. The usual reasons given why tobacco smokers change to using electronic cigarette devices are to quit cigarettes completely or to help them stay off smoking tobacco7. However, this does not mean that ex-smokers who are now vaping are content to continue their new habit, since three quarters of vape users in a UK survey say they want to either reduce their intake or quit e-cigarettes completely8.
How to support vapers who are ready to quit nicotine completely
This is where health care professionals (HCPs) play a crucial role in helping vapers when they are ready to quit including advising them on the best ways of achieving this. NICE guidance advises vapers to use their e-cigarettes for long enough to help prevent them smoking but also for HCPs to discuss how to stop them while ensuring they don’t return to smoking9.
HCPs should also be aware of how difficult it can be to abstain from nicotine dependence, and some of the similarities and differences between vapers and smokers who wish to quit (including the flavouring available to vapers, awareness of nicotine consumption and habitual vaping). Similarities include a sense of social inclusion (the ‘smokers’ club’), nicotine withdrawal symptoms and hand to mouth cue triggers such as eating or drinking alcohol. When talking to vapers who wish to quit completely, I always consider these and make sure there are robust strategies in place to give the greatest chance of success.
As HCPs, we should be advising vapers in a similar way to how we discuss quitting with those who smoke tobacco, where supporting them is crucial to successful intervention. What I have found to be very effective is to use the ‘3 A’s approach’: Ask if the patient is a vaper and thinking of quitting. Assess if they are ready to quit vaping completely without returning to smoking. Advise them as to ways of quitting, including cutting down gradually or stopping abruptly. I also make sure a vaper understands what can trigger a craving - including alcohol, eating, stress, boredom and seeing someone else smoke or vape – and how to distract from these.
Nicorette QuickMist Mouthspray (nicotine) is now licensed for vaping cessation
Nicotine replacement therapy (NRT) has helped tobacco smokers quit their habit for a long time but vapers can now also quit with the help of Nicorette QuickMist Mouthspray, which has been shown in a study to halve cravings in 80% of vape users (82.6% Nicorette QuickMist group vs 55.1% placebo group, p<0.001)10. It has been granted a licence from the UK Medicines and Healthcare products Regulatory Agency (MHRA) as the first licensed therapy in the UK with a new indication to relieve and/or prevent cravings and nicotine withdrawal symptoms in nicotine dependence, including those arising from nicotine vaping, and up to 4 sprays per hour may be used with a maximum dose of 4 sprays per hour for 16 hours in any 24 hour period. This really is an exciting development in helping to support people who are ready to take the next step in their quit journey to reduce or quit nicotine vaping, which so many e-cigarette users may wish to do.
Click here for NICORETTE® QuickMist Mouthspray product information
References
1 Action on Smoking and Health (ASH). Smoking Statistics. May 2021. Available at: https://www.ash.org.uk/resources/view/smoking-statistics (Accessed March 2023)
2 Office for National Statistics. Adult smoking habits in the UK: 2021. December 2022. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2021 (Accessed March 2023)
3 Smokefree England. A quick guide to the smokefree law. Available at: http://www.smokefreeengland.co.uk/what-do-i-do/quick-guide/ (Accessed March 2023)
4 National Centre for Smoking Cessation and Training (NCSCT). Stop Smoking Services and Health Inequalities. 2013. Available at: https://www.ncsct.co.uk/usr/pub/NCSCT_briefing_effect_of_SSS_on_health_inequalities.pdf (Accessed March 2023)
5 UK Parliament. House of Commons Library. The Smokefree 2030 ambition for England. November 2022. Available at: https://www.commonslibrary.parliament.uk/research-briefings/cbp-9655/ (Accessed March 2023)
6 Action on Smoking and Health (ASH). Use of e-cigarettes (vapes) among adults in Great Britain. August 2022. Available at: https://www.ash.org.uk/uploads/Use-of-e-cigarettes-vapes-among-adults-in-Great-Britain-2022.pdf?v=1661865959 (Accessed March 2023)
7 GOV.UK. Nicotine vaping in England: 2022 evidence update summary. September 2022. Available at: https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update/nicotine-vaping-in-england-2022-evidence-update-summary (Accessed March 2023)
8 Data on file; vapers behaviour and attitudes, 2022
9 National Institute for Health and Care Excellence (NICE). Tobacco: preventing uptake, promoting quitting and treating dependence. November 2021. Available at: https://www.nice.org.uk/guidance/ng209 (Accessed March 2023)
10 Data on file; QuickMist vaping study, 2022.