Doctors need data on smoking cessation

Governments, medical associations have a role to play,

Canadian physicians appear to be ill-prepared when it comes to discussing the variety of alternatives available to help smokers quit, according to a survey conducted for the Consumers’ Association of Canada (CAC) by Research Co. Only 25 per cent of the 456 physicians surveyed recommended electronic nicotine-delivery systems (ENDS), such as vaping devices and electronic cigarettes, within the past year even though 63 per cent believe them to be less harmful than cigarettes.

Only 37 per cent have read research on electronic nicotine-delivery systems within the past six months and discussed it with patients (42 per cent in Western Canada and 32 per cent in Eastern Canada), 29 per cent more than six months ago (18 per cent in the West and 40 per cent in the East), while 34 per cent have not read research (40 per cent in the West and 28 per cent in the East).

It’s a troubling statistic when we consider the number of people who credit these products for helping them to become smoke-free.

Over the course of the past year, only 25 per cent (29 per cent in Western Canada and 21 per cent in Eastern Canada) of physicians surveyed have recommended that patients who currently smoke tobacco products use electronic nicotine-delivery systems to help them reduce or quit their tobacco consumption, while 75 per cent have not (71 per cent in the West and 79 per cent in the East).

And 63 per cent of the physicians (63 per cent in the West and 61 per cent in the East) believe that electronic nicotine-delivery systems represent a harm-reduction approach for patients who currently smoke traditional cigarettes, 26 per cent do not (21 per cent in Western Canada and 32 per cent in Eastern Canada), while 11 per cent of the physicians are not sure (15 per cent in the West and eight per cent in the East).

Vaping products are the most common type of ENDS, and are devices that do not burn or use tobacco leaves but instead heat up to vaporize a solution the user then inhales. The number of smokers interested in ENDS has likely increased since vaping products were legalized in 2018, but Canadian physicians are not up to speed on these products nor are they given any formal guidance by governments or medical associations that would help them to confidently recommend vaping as a real alternative to smoking.

The picture is very different in other countries, particularly in England, where professional medical associations like the National Institute for Health Care Excellence (NICE) and bodies such as Public Health England offer evidence summaries and practical guidance to their members.

In a guideline published in March 2018, NICE states that smokers should be told that many people have found e-cigarettes helpful aids to cessation and the evidence indicates that e-cigarettes are substantially less harmful to health than smoking, although not risk-free.

In a report published in February 2018, Public Health England goes as far as to recommend that vaping products should be prescribed to smokers, and two hospitals in England now allow vape shops to support their move to become smoke-free premises.

Although Health Canada has recognized on its website that ENDS deliver nicotine in a less harmful way than smoking and that it may help smokers quit, it offers no guidance to health-care practitioners who routinely have conversations with smokers.

The gap between the number of physicians who believe that vaping is less harmful than smoking and the number of physicians actually recommending these products to smokers demonstrates the need for Health Canada or a professional association to provide some guidance on vaping products. There are various studies that show vaping is a less risky way to consume nicotine, and the more smokers turn to vaping, the more the harms associated with smoking are reduced.

But there is also a great deal of negative information on vaping. Physicians should not be left to sift through the research on their own to form a medical opinion.

Offering reliable, practical guidance to physicians will ensure that physicians are able to fulfil their responsibility to make smokers fully aware of all options that are available.

Although vaping products are less harmful than cigarettes, they do contain nicotine and are not harmless.

For that reason, the CAC supports government regulations to keep vaping products out of the hands of Canadian youth while allowing proper communication and access to information so adult consumers can make informed choices.