Using e-cigarettes to quit smoking
- 06 Jul, 2020
Last fact-checked 6 July 2020 | Report a factual error on this article
All around the UK, millions of smokers have used e-cigarettes to help them quit tobacco footnote 1. Having quit tobacco with e-cigarettes ourselves, we know that a well-dosed vape can help you to manage cravings and wean yourself off nicotine for good. But what’s the official UK guidance on using a vape device to quit cigarettes? What are the risks, and how can you improve your chances of quitting?
Vaping can definitely help you quit smoking footnote 2, but it’s not a magic bullet and it’s not your only option. Quitting tobacco takes support, planning and commitment, and you can increase your chances of success if you speak to a medical professional.
In this quitter’s guide, we’ll explain how to use e-cigarettes to help you quit tobacco, where to go for help if you need it, and what pitfalls to avoid.
First off, there’s one very important point we have to make. When you use a vape to help you quit smoking, you have to stop smoking at the same time.
The NHS say “You will not get the full benefit from vaping unless you stop smoking cigarettes completely” footnote 3 and we couldn’t agree more. You should swap smoking for vaping completely — a half-and-half approach rarely works. If you continue to smoke while vaping, you miss out on the health benefits of stopping tobacco, and you open the door to becoming a smoker and a vaper, which is not a helpful situation when you’re trying to quit cigarettes.
There’s no question that smoking is much worse than vaping. Smoking is much worse than most legal activities — it is the biggest cause of preventable deaths in England footnote 4 .
What’s less clear is precisely how safe vaping is in relation to smoking. Vaping is still a relatively new phenomenon, and there aren’t as many long-term or large-scale medical studies on vaping as there have been with cigarettes. Based on what UK medical experts and public bodies know so far, the official guidance is that vaping is at least 20 times safer than smoking. Here’s what the experts have to say...
Public Health England’s most recent report on the health risks of e-cigarettes quoted data that showed “the cancer potencies of e-cigarettes were largely under 0.5% of the risk of smoking” (in other words, about 200 times less likely to cause cancer than smoking). The same report made clear that “more research is needed” footnote 5 , but as a starting point this is good news for anyone who wants to quit with a vape device.
Cigarettes don’t just cause cancer, however - there are other dangers to consider. Looking at vaping more generally, the PHE estimates that vaping is 20 times safer than smoking. This estimate is based on two things: the harmful chemicals that are in cigarette smoke and are not in vapour, and the safety record of the chemicals most commonly used in e-liquid footnote 6.
A commonly-quoted study that took place in the UK is “Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study”. This study was carried out at University College London (UCL) and funded by Cancer Research UK in 2017. Researchers took samples of saliva, breath and urine from 181 smokers and ex-smokers and tested the samples for toxic chemicals. Unsurprisingly, the study found “significantly lower levels of toxic chemicals and cancer-causing substances (carcinogens) in the samples of those of former smokers who had been using e-cigarettes or nicotine replacement therapy (NRT) footnote 7 compared to current smokers.” footnote 8
The only problem with this UCL vaping safety study is that the sample size isn’t very big. 181 smokers or ex-smokers were recruited, which is a tiny number compared to most of the tobacco studies conducted over the past half-century. For instance, the American Cancer Research Institute’s landmark study in 1955 (the first long-term cohort study to prove a link between cigarettes and cancer) involved 188,000 subjects footnote 9.
The Royal College of Physicians (RCP) see the use of e-cigarettes as a major step forward in harm reduction. The RCP have published a substantial 200-page report which explains their position on e-cigarettes and vaping in detail, but one of their key recommendations is that “in the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK.” You can read more about the RCP’s research, and download your very own copy of their 200 page report, from this page on the RCP website
We don’t have as much independent peer-reviewed research on e-cigarettes as we would like yet, but new academic and medical studies are taking place all the time. We’re confident that, as time goes by, we’ll all get a much better understanding of the safety of vaping.
Nicotine is as addictive as ‘hard’ drugs such as heroin. Let’s repeat that: Nicotine is as addictive as ‘hard’ drugs such as heroin. That’s a direct quote from Professor John Moxham in the BMJ footnote 10. It’s a shocking comparison, but we have to remember it. Quitting tobacco is hard because quitting nicotine is hard. When you quit tobacco, your strategy shouldn’t stop at ‘no cigarettes ever again’ — you have to confront the nicotine addiction as well, and take all the help you can get.
Nicotine “alters the balance” of two naturally occurring hormones (dopamine and noradrenaline) in your brain. That’s why, when you smoke a cigarette, your mood and concentration levels change so rapidly. When you quit, those hormone levels go out of balance again. You can get irritable, anxious and depressed because your brain isn’t getting its usual rush of hormones, and it has to figure out how to operate without its expected hit of nicotine footnote 11.
Nicotine is an addictive substance, but it’s nowhere near as toxic as the tar, carbon monoxide and other poisonous ingredients in a typical cigarette. The NHS promote and encourage Nicotine Replacement Therapy because if your body is suffering from nicotine withdrawal then the temptation to have another cigarette is going to be very strong footnote 12.
One of the main advantages of using e-cigarettes as a quitting tool is that they give you that familiar sensation of smoking whilst delivering the nicotine your body is craving. You can also adjust your e-liquid nicotine strength and wean yourself off slowly.
Vaping works best when it’s combined with other forms of Nicotine Replacement Therapy (NRT), and the support of a health professional. This last bit is important. The Royal College of Physicians state that “nicotine replacement therapy (NRT) is most effective in helping people to stop smoking when used together with health professional input and support, but much less so when used on its own.”
Some official statements (including the BMJ report) put a tobacco quitter’s chances of success (using just willpower alone) as low as 2%. You need to improve those odds as much as possible, and the NHS Stop Smoking Service is an absolutely critical part of that. Nicotine is a powerful substance, and if you want to quit, you need to do what you can to stack the odds in your favour. The NHS Stop Smoking Service is there to help you, and you can get patches and other NRT treatments on prescription.
Public Health England also say that e-cigarettes are helpful, but that for your best chance of quitting with an e-cigarette, you need to combine vaping with “expert behavioural support” from your local stop smoking service. Here’s an eye-opening infographic on the success rates of tobacco quitters footnote 13:
The biggest benefit of vaping, when used as a quitting tool, is its closeness to the sensation of smoking. When you use a vape instead of a cigarette, you will get the familiar cloud and the nicotine hit, but none of the tar or carbon monoxide of a cigarette. It’s enjoyable, too.
Gareth and I both used e-cigarettes to quit tobacco, and we’re completely free of cigarettes now. Not only that, but quitting cigarettes has led us both to found a business we’re both very proud of. E-Liquid is more than a job to us - it’s our passion - and we discovered all of this because we took that first step and quit cigarettes.
Vaping worked for us, and it can work for you too. Talk to your NHS Stop Smoking Service if you’re starting your quitting journey. It’s proven to increase your chances of success.
And please get in touch if you have any questions. We’re not doctors, but we are ex-smokers, and we know our product lines very well. We’re always ready and willing to offer guidance where we can.
- John Boughey
Links & Citations
“Stopping smoking is hard and many smokers are turning to e-cigarettes to help them in their attempts. In 2016 it was estimated that 2 million consumers in England had used these products and completely stopped smoking and a further 470,000 were using them as an aid to stop smoking.” - page 15 of the UK Department of Health’s document titled “Towards a Smokefree Generation - A Tobacco Control Plan for England”, which is visible at the link below:
“A major UK clinical trial published in 2019 found that, when combined with expert face-to-face support, people who used e-cigarettes to quit smoking were twice as likely to succeed as people who used other nicotine replacement products, such as patches or gum.”
- quote taken from the “Using e-cigarettes to stop smoking” guide on the NHS website (see the link below)
“You will not get the full benefit from vaping unless you stop smoking cigarettes completely. You can get advice from a specialist vape shop or your local stop smoking service.”
- quote taken from the “Using e-cigarettes to stop smoking” guide on the NHS website (see the link below)
“Smoking is the leading cause of preventable illness and premature death, killing 78,000 people in England each year.”
Quote taken from Public Health England’s guidance, “Smoking and Tobacco: applying All Our Health”, on the Gov.uk website (link below)
Quotes taken from the “Health risks of e-cigarettes” section (page 19) of Public Health England’s “Evidence review of e-cigarettes and heated tobacco products 2018“ - this report can be read in full at the link below.
A short official explanation of the reasons behind Public Health England’s 5% estimate can be found on “Underpinning evidence for the estimate that e-cigarette use is around 95% safer than smoking: authors’ note”, which you can read here:
NRT stands for Nicotine Replacement Therapy. You can find more information about NRT here:
This 2017 study is an interesting study, summarised on the NHS website at the link below:
If you want to read the research yourself, the full academic citation is Shahab L, Goniewicz MJ, Blount BC et al (2017) Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study. Annals of Internal Medicine 166(6):390-400
You can learn more about the 1954 cohort study, “The Relationship Between Human Smoking Habits and Death Rates: A Follow-Up Study of 187,766 Men”, at the link below: https://www.cancer.org/latest-news/the-study-that-helped-spur-the-us-stop-smoking-movement.html
The “Nicotine is as addictive as ‘hard’ drugs such as heroin“ quote comes from Professor John Moxham and can be read on the BMJ website at https://www.bmj.com/content/320/7232/391
You can read more about why smoking is addictive, and the power of nicotine addiction, on the NHS website at https://www.nhs.uk/common-health-questions/lifestyle/why-is-smoking-addictive/
You can learn more about nicotine cravings and NRT on the NHS website at the link below:
This infographic, and other stop-smoking facts, can be found on the Gov.uk website at the link below: