In this guest blog, Louise Ross – a pioneer of applied tobacco harm reduction – asks what it means to run e-cig friendly support services for smokers. Update 4 September 2015: French language article about Louise and translation of this blog on Vapoliique: Stop-tabac de Leicester (UK): l’expérience ecig friendly
—————— Guest blog – Louise Ross ——————
This month has seen more stop smoking services than ever declaring themselves ‘ecig-friendly’, including all of the services in the north-east of England – see Fresh North East: Stop smoking services go ecig friendly – quit and save.
This makes me really proud; I coined the term back in January 2014, when our team was trying to work out how to embrace this new technology while avoiding censure from critics who may have thought we were stepping way over the line.
Over a year later, I’ve come across quite a few different interpretations of the term, and I thought it might be useful to reflect on what it means to me.
What it definitely isn’t…
In my opinion – let’s not forget, we’re working in uncharted territory here, without any Standard Operating System – it is not an attempt to get vapers to stop vaping. I’ve come across a number of healthcare professionals, stop smoking service providers, commissioners in Public Health, and the general public too, asking how soon people should come off their vaporisers, and suggesting that ecig users could use the stop smoking services for support to do just that.
It’s understandable, given a long-standing antipathy towards nicotine, commonly described as more addictive than heroin or cocaine. However, let’s remind ourselves that this does not seem to hold true for nicotine once it is separated from the cigarette smoke. In both nicotine replacement therapy and in ecigs, it seems to be far less dependency-creating, and users seem to manage to either titrate down or go for reasonable periods without any nicotine at all, once the actual smoking stops.
When stop smoking advisors ask what to say to people wanting to ‘come off ecigs’, I say just advise that this can be managed adequately by reducing the dose at a pace the person feels comfortable with. This is about self-management, and the anxiety about reducing to zero vaping as soon as possible often seems to have been fuelled by negative comments from a GP, or a friend who’s read scare-story in the papers. Once people are reassured that there is no rush to stop using their vaporiser, they tend to relax about it – some may stop soon because they want to, some may gradually reduce their use because they want to, and some may continue indefinitely, again, because they want to. My aim is to help people be smoke-free, not nicotine-free, and I’m coming around to thinking that longer-term (clean) nicotine use could well provide a protective element that stops people relapsing to smoking when they have a crisis.
So having dealt with what it’s not, what does ecig-friendly really mean…?
For me, it is welcoming people who want to stop smoking, and who might want to use an ecig to do that. They may have lots of questions, and we shouldn’t pretend to know anything that we really don’t, so being ecig-friendly can mean admitting your limits and signposting people to other sources of information, like vaping groups, sympathetic retailers who want to help, or the New Nicotine Alliance, a charity that educates and advocates for vapers: the New Nicotine Alliance.
It’s also being prepared to seek help ourselves, and educating ourselves, with a sense of diligent enquiry, about issues that are at times incredibly complex and confusing, but being prepared to put some work in and remain open-minded.
It means having the courage to take some risks, to stand up for the rights of people to be heard and to have their experiences accepted as valid, despite the crushing weight of disapproval from a hostile sector of ‘experts’.
It means developing a team of people who chat to vapers in social settings, always keen to learn more about choices, flavours, health changes, problem-solving. (The picture is our Tina, chatting to the gas-men digging a trench outside our office – every one of them had a vaporiser!)
It means remembering that as stop smoking teams, we have heaps of experience helping people to stop smoking – we know how to make it more likely they will succeed, by changing routines, by building motivation, and by showing that we really care about the outcome. We’ve made this same journey with so many diverse people who aspire to no longer smoke, and we often know many more choices than people are aware of, such as different ways of using nicotine replacement therapy, which appears to work rather well with ecigs..
Recently I’ve thought of the advisor/service user relationship more like a coach with a sportsman or woman in training – the coach is there to help set goals, to improve performance, to urge on, to get the person back on track when they despair. Mostly though, a coach can see the desire for success in their trainee’s eyes, and they don’t deter them or send them away saying they can’t help them.
An ecig-friendly stop smoking team will welcome anyone who wants to stop smoking, and they will work with them, listen to them, encourage them, and respect them. It’s the way of the future.
Louise Ross
Stop Smoking Service Manager, Leicester City
Associate of the New Nicotine Alliance
Follow Louise on Twitter: @grannylouisa
July 2015
What a splendid blog! This should be circulated to Doctors, Public Health Orgs and all the relevant Charities, and, most importantly of all, to every M.P in every constituency – mine will certainly be getting a copy if you will permit?
Wonderful progress. Heartfelt thanks to Louise for the achievement, and to Clive for the support.
Perhaps we could take stock of what we know about nicotine, and what the position might be in say 10 years:
1. There is no such thing as a published clinical trial investigating any dependence potential for nicotine. All such references lead to trials of smoking, smokers or ex-smokers, and we know that smoking can lead to dependence on nicotine. If pure nicotine had any measurable potential for dependence in never-smokers, you could safely take a £10 million bet that there would be multiple clinical trials reporting it, considering the immense interest in this topic and the significant commercial value in demonstrating any ‘addictive’ potential. There are no such trials. No clinical trial exists of pure nicotine in never-smokers to investigate any potential for dependence.
2. Clinical trials of nicotine for treatment of multiple diseases and conditions, using pure nicotine and non-smokers including never-smokers, report that no subject has ever shown any sign of withdrawal symptoms, reinforcement, continuation, or dependence in any form – even after high doses administered daily for 6 months. It doesn’t matter how much nicotine you give never-smokers, or for how long: you can’t get anyone to show any sign of dependence.
Of course, some people are vulnerable to dependence on just about anything; as an example there are reports of a couple of cases of dependence on carrot juice. We might expect the same sort of measure for nicotine dependence in new users of clean nicotine delivery systems (one in 10,000 or thereabouts). This level is clinically and statistically invisible, and has no possible negative indications – especially considering that no clinical harms from nicotine can be demonstrated (nicotine has no association with cancer or CVD).
3. Everyone consumes nicotine in the normal diet, and everyone tests positive for nicotine and/or its metabolytes. Benowitz gives a figure of 3ng/ml plasma nicotine level as the cutoff point above which a person is likely to be a regular smoker (or Snuser), and below which the nicotine comes from other sources. Since it is not just unlikely that everyone is exposed to massive levels of ETS now, but probably close to insane to even suggest it, we know that the nicotine comes from the diet. No person has ever tested negative for nicotine no matter the size of the clinical study, including one of 800 people. Nicotine is part of the normal diet, and not only that, there are very strong signs that it is an active component with definable functions.
4. You feed your baby nicotine in her mashed-up vegetables, and no one has yet been crazy enough to suggest this is a bad idea.
5. As (a) nicotine’s sister compound, nicotinic acid, is an agreed vitamin (vitamin B3), and as (b) nicotine and nicotinic acid share many active roles in the organism, and as (c) we know that nicotine prevents and treats several neurodegenerative and auto-immune diseases, it is not unreasonable to suggest that in a few years’ time, when the nicotine taboo lunacy has passed, nicotine itself will be allocated a B vitamin number too.
6. It is reasonable to assume that, if after testing hundreds of subjects in over a dozen clinical trials and you can’t get anyone to exhibit any sign of dependence after dosing them with the nicotine equivalent of 15 cigarettes a day for 6 months; and if nicotine shows very strong potential for both prophylaxis and treatment for multiple neurological conditions; then there is not only little to worry about but perhaps the climate of opinion is erroneous and needs correction.
N.B.: it is easy and straightforward to get ethics panel permission for clinical trials exposing never-smokers to high doses of nicotine for several months. There are multiple such trials for disease treatment investigations, and of course non-smokers have to be used for such trials as otherwise the tests would be pointless.
7. Nicotine is an active component in the diet. Depending on genetic make-up, some people need supplements, which is hardly anomalous. Depending on genetic make-up, some people become ill or under-perform if they don’t get enough. Again, this is hardly anomalous for active dietary components.
Citations to support all these statements are available on the Ecigarette Politics site, References pages; or refer to the work of the current world authority on practical nicotine issues, Dr P Newhouse of Vanderbilt. Quote: “The risk of addiction to nicotine alone is virtually nil.” He should know, as he has given more of it, to more never-smokers, for much longer, than anyone else. It’s probably best to listen to a real expert than to the usual corrupt liars.
Excellent – thanks for this contribution Chris…
Great work by Louisa.
Good reporting Clive.
Gr8 nicotine summary Chris.
Well done to all of you :)
EVERYONE: There is a tweet button: USE IT.
This is great news from Louise. The fact that a number of NHS stop smoking services in the North-East are following her lead is a significant achievement, and I hope others will follow.
I live in Coventry, which is not far from Leicester, and is completely different. There’s a big notice on the door of my GP’s surgery telling people not to vape, but to use “our” service instead. The main hospital in Coventry doesn’t allow e-cigs to be used anywhere on it’s grounds, even if you are in your own car. Maybe I should move to Leicester!
Dear Louise:
It took this long for me to see the attitude you have displayed. IMO, it’s the right one. When we vapers gave up smoking, we were looking for the recognition, understanding, and willingness to learn from our experience that few in public health have yet displayed toward the actual cure for tobacco dependency.
Thank you, bless you, and I hope that other so-called experts (kudos for admitting vapers have self-educated to the point they frequently know far more on the topic than the health pontificators have yet to display) pay attention and realize they should be part of the solution, not pretend the solution is part of the problem.
I can’t like your attitude and willingness to help enough. I hope that other health pros take notice, and follow your lead. Then we can finally work together as we’ve wanted to all along.
It sure beats a black market! )
This is not only well written and informative, but so frickin’ important.
Thank you, Louisa! Leadership=doing stuff that others aren’t (yet). You are leading–please don’t stop.
Joe
Excellent article, tweeted and shared on FB :-) Thanks very much as always to Louise for the sterling work that you are doing!
Excellent, thank you very much!
And very interesting thoughts, Chris!
What a great post!
Wish that here was more bloggers and people like this in Finland, where I live. The government tries to reduce smoking, but all they do is set more rejections. That doesn’t really help it in my opinion.
Excellent , very informative .
I want to suggest the vape lovers to visit on the site
Ecigwarehouse UK for Awesome products with Discount price.
Link :
https://www.ecigwarehouse.co.uk/