An interesting discussion emerged from Dr. Nathan Cobb’s presentation on E-cigarettes. First and foremost, he asked, they not be called E-cigarettes, because it implies it is from tobacco, which E-cigs don’t contain tobacco. Rather, they are Electronic Nicotine Delivery System, or ENDS for short. In my own home state some people are looking towards ENDS as a cessation mechanism, and to that I would say “not so fast” after seeing Dr. Cobb’s presentation.
While ENDS would potentially be a safe way to deliver nicotine (although Nicotine itself is still not considered a safe substance), trace amounts of Tobacco-specific N-nitrosamines were found in some of the products tested by the FDA along with acetaldehyde, acetone, and formaldehyde. What’s more scary is that different chemicals were found not just with differing brands but also even within the same brand. There were also inconsistencies in the amount of nicotine in each puff, even within the same brand, and varied within the same cartridge from puff to puff. Last, the level of nicotine in the blood was very low and didn’t do much to reduce urges in smokers.
That means that ENDS would not be a good cessation device even just for its nicotine delivery properties. But that’s not the only danger. Think about this: you’re helping your friend quit, and everything is going perfectly, then she says “Oh, I don’t have to worry about quitting anymore ‘cause there’s these electric cigarettes that are safe”. Her motivation just went out the window, and you may have to work double time to get her into the preparation or action stage of quitting. Because ENDS are bad for notice delivery chances smokers will relapse because they’re not getting the needed nicotine in their blood system. So not only does it have the potential to screw with someone’s self-efficacy to quit but also may be setting them up for failure because of the low nicotine levels it delivers.
But consider this: snus on the other hand does deliver an adequate amount of nicotine but in some cases is less than half as dangerous than smoking, that’s according to the presentation by Dr. Lois Biener. Here’s the danger, as she presented: tobacco companies are not marketing snus as a harm reduction approach, rather as an addition to smoking. A Marlboro snus add Dr. Biener showed us clearly showed Marlboro trying to brand snus as another way smokers can get a nicotine fix, perhaps in the face of new bans around the country? Can’t smoke in the job? Just pick up a pack of snus and feel good until the next time you smoke. It could also be a way to undermine a smoker’s quit attempt. Most smokers WILL quit cold turkey, even though it may not be the least painful way. Is this a way for Marlboro to get in the middle of someone who wants to quit smoking by creating a middle step between an ex-smoker and a current one? With Marlboro deciding your quit plan I would venture to say you’re probably not going to quit for good.
But seriously, what if snus was remarketed and was aimed a people who wanted to quit smoking as a nicotine delivery aid? While snus is definitely NOT safe, the difference in deadly risks between smoking and snus is large. Will the tobacco field ever go into the realm of other public health disciplines that utilize harm reduction techniques? What do you think?