
EU Parliament pushes for less harmful alternatives to cigarettes
The EU Parliament supports the use of electronic cigarettes and tobacco heaters in smoking cessation. Some studies speak in favor of this, but the principle of risk minimization is currently not found in the relevant guideline.
The fight against cancer is currently a priority in the European Union. The EU Parliament has now adopted recommendations for a comprehensive and coordinated strategy to combat cancer. With an overwhelming majority, the MEPs took a stand on a highly controversial issue: so-called “harm reduction”. The European Parliament takes the view that electronic cigarettes, heated tobacco products and other new types of tobacco products could help some smokers to gradually quit smoking and calls on the European Commission to compare the risks arising from the use of these products to the consumption of other tobacco products, to be reassessed. At the same time, MEPs are calling for a ban on flavors in e-cigarettes so that these products are not made attractive to minors and non-smokers.
A strategy for heavy smokers
"Of course, it would be best if nobody stopped smoking," says Dr. Peter Liese, health policy spokesman for the European People's Party (EPP): Heavy smokers could, however, more easily quit cigarettes if they use e-cigarettes or tobacco heaters (heat-not-burn products). "These are much less harmful than cigarettes containing tobacco or other tobacco products," affirmed the German MEP. Although e-cigarettes and similar products contain nicotine, they are not as harmful as conventional cigarettes. "When heavy smokers switch from cigarettes to such products, their cancer risk is reduced."
Dropout rates lower than standard weaning
In terms of harm reduction, it is actually sensible to rely on substitute products instead of trying to force immediate and total abstinence from nicotine, agrees Prof. Dr. Heino Stöver from the Frankfurt University of Applied Sciences – referring to e-cigarettes as a representative.1 The therapist and patient could focus on reducing the intake of harmful substances from tobacco smoke first. Maintaining cherished rituals, familiar handling and the similarities between conventional tobacco products and electronic cigarettes make it easier for smokers to switch, reduce withdrawal symptoms and lead to lower dropout rates than established cessation therapies.
However, it is precisely these similarities that can delay or even prevent many people from finally quitting, the author points out: around 80 percent of nicotine addicts are still vaping e-cigarettes after a year and do not achieve complete abstinence. The expert emphasizes that this has health consequences beyond nicotine intake, especially with continued use. Finally, the vapor inhaled from e-cigarettes also contains pollutants.
Some studies show that e-cigarettes can accompany smoking cessation as effectively as nicotine replacement therapy with patches, chewing gum or spray, explains Stöver. The extent of possible side effects is also comparable. Electronic cigarettes and liquids are readily available and are now very much in the public eye. So it seems understandable that vaping is currently the most popular way of trying to quit tobacco smoking in Ireland.
Doubly Harmful
The aspect of harm reduction does not apply to the parallel consumption of conventional tobacco products and electronic cigarettes. Although this frequently practiced dual use reduces the absolute amount of tobacco smoke, it does not end the absorption of harmful substances. In addition, nicotine consumption often remains at the previous level. The probability of a permanent smoking cessation decreases.
Double use without benefit
The reduced exposure to the pollutants alone is so significant that the e-cigarette should definitely be considered in smoking cessation programs, says Stöver. However, there would only be advantages if the smoker switched completely from tobacco to electronic cigarettes (see box); dual use should only be a temporary solution. In his view, it is time to take into account the current state of knowledge on electronic cigarettes in the next S3 guideline on smoking and tobacco dependence. This would give therapists the opportunity to at least consider electronic cigarettes in smoking cessation. The recently updated guideline does not recommend e-cigarettes or heat-not-burn products for smoking cessation.