Treating Nicotine Dependence How Do ENDs Fit Into This Puzzle? Angela Brumley-Shelton, M.A. MPH Certified Tobacco Treatment Specialist Coordinator, Community Health Equity & Education Tobacco Coordinator Lexington-Fayette County Health Dept. Lexington, KY
Project e-Prevent: Understanding e-cigarettes and
their effect on KY’s youth March 24, 2016
London Community Center London, KY
The Debate…Cessation Aide or Just New Product?
End use of traditional cigarettes in U.S. • Cessation aide • No tar & fewer chemicals overall • Nicotine is not harmful
Will undo 25+ years of progress made in cessation research and practice
• DOES NOT STOP NICOTINE ADDICTION • Increase youth initiation • Does not break hand to mouth action • Portray smoking as glamorous again
What’s the rest of the world doing
with their ENDs & cessation puzzle?
APPROVED
• United Kingdom • e-Voke for clinical
use in late 2015
• can be “prescribed” as a cessation treatment
• makers claim made with pharmaceutical-grade e-liquid
NOT APPROVED
• EU • ENDs will be
classified as tobacco-related products; regulated 2016
• Spain
• Philippines
• New Zealand
• Canada
• Australia
CONSIDERING or WEAKLY DISAPPROVED
• World Health Organization
• Recommended use of approved cessation methods instead
• BUT
• conceded ENDs hold promise when previous quit attempts have failed
What does the research say?
Powerful Research Challenges
• Insufficient data to draw widely accepted conclusions about use for cessation Debate
• Only been in the U.S. for ~8 yrs, in existence since 2004 New Product
• Use rates are growing faster than research about long-term health effects and cessation Time gap
• Big Tobacco will always have more of it than Public Health $$$$$$$$$
Why Are ENDs So Difficult to Study?
• Every system is different Variety
• $-$$$$ Price Range
• MUCH more variance than with traditional cigarettes User variability
• cannot dose exactly to compare to placebos & NRT for RCT
Nicotine Dosing Inconsistency
Newest Data Important for Cessation: Still No Consensus & Little Consistency
• ENDS may actually lower cessation likelihood up to 28%
– Step-down logic is not working
– Report being heavily criticized
• Evidence increasing ENDs likely effective for short-term abstinence (~1 month) and reduction in CPD, but not for long-term cessation
• Cochrane review of the first 2 RCT’s that met “gold standard” for medical research so far
– Nicotine-containing ENDS showed some positive effect as cessation aide
– Limitations: small number of trials, high attrition, outdated product used
Dual Use
Traditional Cigarette
Use
Sole use of ENDs Use to
Quit
Dual Use
• No access
• Side effects
Traditional cigarettes
• Nostalgia
• Novelty wears off
Dual use
On the Horizon
• Must deliver nicotine more consistently
• Must use daily
Improved tank systems may be more effective for cessation, must use daily
• Will this lead to a decrease in sales?
STAT & Harvard T.H. Chan School of Public Health (2015) Public poll: 65% respondents believed e-cigs are harmful to users
• Price of e-cigs vs. traditional cigs
Federal regulation critical for ENDs to be cleared as cessation aide
What does all this mean if we work
directly in cessation?
Guidelines for providing cessation
assistance for ENDS users
Ask Advise
Refer
Pharmacotherapy
KY QuitNow
Behavioral interventions Address toxicity of
e-liquids and hazards of mod units/batteries
Harsh criticism for using e-cig =
alienation
Provide information
that ENDS are not regulated
Anecdotal Experiences
Driving down numbers of
people seeking cessation assistance
“KY Smokers” don’t like
them
Complaints when used with
goal of cessation: mouth and
throat irritation
Dual use = impossible to
quit
Middle ground perception—not as “bad” as cigarettes,
better experience than NRT
INCREDIBLY easy to ramp up
nicotine addiction
Rock and a Hard Place… Repercussions for Any of Us Who Provide Cessation
Divided PH Community in its efforts to fight Big Tobacco
Revived financial and marketing power of Big Tobacco
It’s difficult to argue with heavy smokers who turn to ENDs then feel better
When Your Client Asks About ENDs Use
• Do not recommend, prescribe, or approve use of ENDs
• ENDs are not approved by any credible medical organization in the U.S. as a cessation aide
• ENDs are not regulated by FDA
Copies of this slide deck with references is available upon request. Please contact:
Angela Brumley-Shelton
Lexington-Fayette County Health Dept. 650 Newtown Pike
Lexington, KY 40508 (859) 288-2457
*Special thanks to Audrey Darville and Elizabeth Anderson-Hoagland for their assistance with this information
