E-cigarettes: out of addiction at full speed

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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E-cigarettes are viewed with suspicion in this country. There is much to suggest that they are more effective in helping people say goodbye to tobacco cigarettes than nicotine patches & Co. In a position paper, German researchers, addiction doctors and psychologists are now calling for a rethink.

Under the direction of Prof. Heino Stöver, addiction researcher at the University of Frankfurt, they invited experts to lectures followed by a discussion as part of an online symposium last week.

That's how the British do it

According to the report, the British could serve as a role model in this matter: "They are not doing so well on other health issues, but they are number 1 in Europe when it comes to tobacco control," says Dr. Leonie Brose from the Institute of Psychiatry, Psychology and Neuroscience, King's College London. Germany, on the other hand, occupies the disgraceful last (36th) place in European statistics. While 26.5 percent of adults in Germany still smoke, it is in the United Kingdom thanks to a whole package of measures, only 14 percent.

Steaming instead of smoking?

One building block of the British strategy is the promotion of e-cigarettes to quit the smoking career - ideally in combination with behavioral therapy. Even campaigns by the National Health Service advertise on posters, as a matter of course, to switch to e-cigarettes if it is not possible to completely refrain from smoking.

"In Great Britain, many who work in this area come from practical work with people who are addicted to hard drugs," Brose explains when asked by Instead of stubbornly insisting on the safest way, as in Germany, namely abstinence, in the United Kingdom, if that is not possible, harm minimization is used. “We have to move away from moral ethics to ethics of responsibility,” emphasizes her colleague Stöver.

And the e-cigarette could play a not insignificant role in this. With heroin, too, it was only the substitution with methadone that enabled broader success in addiction therapy, according to Brose. British doctors are now even calling for e-cigarettes such as nicotine patches to be prescribed by prescription.

Twice as effective as plasters & Co.

Even hard addiction medicine facts speak for themselves: With the help of e-cigarettes, twice as many smokers succeed in quitting than with pure nicotine replacement products. Specifically, a year after the hoped-for last cigarette, around 20 percent of vapers gave up tobacco cigarettes, while the number of users of other nicotine replacement preparations was less than ten percent, according to a highly regarded British study.

The recommendation is supported by a recently published Cochrane Review, which evaluated the results of 50 high-quality studies on the subject. Here, too, the researchers came to the conclusion: E-cigarettes could help tame addiction better than pure nicotine replacement preparations.

E-cigarettes reduce psychological withdrawal

The reason for this is obvious: while nicotine patches and chewing gum only alleviate the physical aspect of the addiction, namely nicotine withdrawal, e-cigarettes also serve the more serious psychological aspect. The power of habits and personal rituals should not be underestimated and the highest hurdle for a long-term exit from the smoking career: the habit of putting something in your mouth, holding something in your hands, the cigarette after dinner, the smoking break during the smoking break of the long working day.

Another great advantage: The proximity of the e-cigarette to the tobacco cigarette can also encourage people to give up tobacco who cannot imagine a life without cigarettes.

Avoid Millions of Deaths

“The potential for this approach is immense,” write the researchers in their position paper. In the United States alone, e-cigarette replacement could result in 6.6 million fewer premature deaths over a 10 year period.

Electric butts are also having an effect in the United Kingdom: 600,000 people there are now vaping e-cigarettes with the aim of getting rid of tobacco. 1.2 million have made it this way - including 750,000 people who now also give up e-cigarettes.

More than 90 percent fewer pollutants

Even if there are still no long-term studies, there is hardly any doubt that e-cigarettes cause considerably less damage than cigarettes. When inhaling classic cigarettes, a toxic cocktail of around 7,000 substances enters the lungs with every breath - 70 of which can cause cancer. In e-cigarettes, these are either not found at all or in much smaller quantities.

According to Public Health England and the German Federal Institute for Risk Assessment (BfR), e-cigarettes are 95 percent safer than smoked tobacco. Even with so-called tobacco heaters, in which heated (unburned) tobacco is used instead of a vaporized liquid, the pollution is still 10 percent below that of classic cigarettes.

The signatories of the position paper therefore write that it should be formulated "that e-cigarettes and tobacco heaters are not harmless, but represent a less harmful alternative to continuing to smoke if it is not possible to do without the far more dangerous tobacco cigarette."

Many overestimate the danger

Nevertheless, the public perception is often different. A survey by the Federal Institute for Risk Assessment revealed alarming gaps in knowledge: 61 percent of the population consider e-cigarettes to be at least as dangerous as their tobacco-containing counterparts. Many doctors also have this misconception.

Among other things, many citizens are convinced that it is largely the nicotine that causes the cancer risk of cigarettes - but that is not the case. Nicotine is primarily addictive and can be toxic in high doses. But it is not carcinogenic.

There is even evidence that e-cigarettes are less addictive: Research has shown that nicotine floods the brain less quickly when used - this is a decisive factor in addiction.

The long shadow of mysterious deaths

The overestimated danger of e-cigarettes is also related to the puzzling cases of severe respiratory failure that occurred among e-cigarette users in the USA in 2017 and startled vapers and doctors alike. More than 2500 people were affected and more than 50 died. In Germany, too, the media reported extensively on the "e-cigarette, or vaping, product use associated lung injury", or EVALI for short. Then the phenomenon disappeared again.

In the meantime, however, it seems to have been established that almost exclusively consumers who had consumed illegal liquids were affected. These had contained the cannabis active ingredient THC - and had been diluted with vitamin E acetate. Still, the overall vaping remained on the minds as a potentially fatal hazard.

E-cigarettes are not a gateway drug

The widespread concern that e-cigarettes could pave the way for young people to embark on a smoking career does not seem to be true either. Current figures from Germany show no evidence of such an effect: The number of smokers among the kids continues to decrease, the proportion of young people vaping is very low. In fact, in surveys, less than one percent of teenagers said they vaped without ever having used tobacco cigarettes.

Abstinence remains the best alternative

However, doctors and researchers on both sides of the English Channel agree on one point: Getting rid of nicotine completely remains the most desirable goal. Because long-term damage from e-cigarette consumption can still not be seriously assessed.

"We have no evidence of long-term damage - but we also have no evidence that it does not occur," says Prof. Wolfram Windisch from the University of Witten / Herdecke, one of the speakers at the symposium. He also reports possible risks that have so far received little attention: “Occupational strain on the lungs, medication, flu, Covid-19 - we do not know how such factors affect e-cigarettes. We have to reckon with the fact that there can be more difficult courses under these conditions. "

Changing is better than continuing to smoke

The conclusion of the researchers after the symposium: The best that smokers could do for their health is to quit immediately. For tobacco smokers who cannot or do not want to quit smoking, the complete switch to alternative products that do not burn tobacco (e-cigarettes, tobacco heaters, tobacco-free nicotine products) is a recommended way of minimizing damage.

"It is important that a complete switch takes place and that people do not continue smoking at the same time," emphasize the researchers. The so-called dual use is acceptable for a short transition period, but must be ended as soon as possible in favor of a complete switch - because smoking fewer cigarettes a day is also associated with high health risks.

Struggle for the new guideline on harmful tobacco use

So far, the German S3 guidelines on “Screening, diagnosis and treatment of harmful and dependent tobacco consumption”: “E-cigarettes should not be recommended until they have been tested under the conditions of drug testing for their effectiveness and tolerability in harm reduction and smoking cessation have been examined. "

But there is a ray of hope: the revision of the guideline on tobacco consumption is nearing completion. As usual, experts can add comments and suggestions.

The signatories of the position paper want to take the opportunity to stand up once again in favor of recommending e-cigarettes as an exit aid. What then actually appears in the guidelines will determine the therapeutic use of e-cigarettes and tobacco vaporizers for years to come.

Tags:  stress home remedies palliative medicine