EDGE Best Practice Series: Which Alternative to Smoking is Best for Me?
Smoking cessation has become a major facet of modern-day healthcare services. Multiple organisations, from the NHS to private healthcare firms, actively drive public awareness and education around smoking, its dangers (which you can learn about here) and the best alternatives to the habit. Global attitudes are now more united than ever before in their goal to reduce smoking throughout society.
The UK is actively working towards achieving a “smoke free generation” via the rollout of a progressive “tobacco control plan. (17)” This plan is already underway and strives to reduce smoking among 15-year-olds from 8% to 3%, reduce smoking among adults in England from 15.5% to 12% or less, reduce smoking in pregnancy from 10.7% to 6% or less and reduce the “inequality gap in smoking prevalence, between those in routine and manual occupations and the general population – all by the end of 2022. (17)”
With significant action being taken and goals laid out by the government, UK smokers have more access to alternative products and stop smoking services than ever before. In this article we will explore the facts regarding the leading smoking alternatives available currently so that you can make an informed decision about your own journey.
What is Nicotine Replacement Therapy?
NRT is a collective name for a variety of smoking cessation products that provide an alternative way to deliver nicotine without the implied risks of smoking. Ultimately, NRT therapy helps to reduce the effect of withdrawal symptoms and manage cravings through the replacement of tobacco.
The vast majority of all stop smoking services available to the public, prescribe forms of medically licenced NRTs alongside behavioural therapies. However, there are also over the counter versions of NRT products that can be purchased in pharmacies, convenience stores and supermarkets.
Wherever you acquire NRT products, always ensure you consult your GP and thoroughly read any instructional information provided. NRT will involve the use of one, or a combination of the following products: (18)
Dermal (skin) patches (Available over the counter)
These are special adhesive patches that are designed to be worn for long periods of time. They slowly release nicotine into the body dermally (via the skin) to help you supress cravings throughout the day.
Nicotine gum (Available over the counter)
Simple in essence yet found to be effective by many, nicotine gum is medicated chewing gum that releases a dose of nicotine when consumed which is absorbed sublingually (under the tongue) and orally.
Inhalators & nasal sprays (Prescription only)
Most commonly taking the form of a plastic cigarette-style tube, the user inhales using the device to deliver a quick hit of nicotine which is absorbed through the mouth and lungs, or nose and throat in the instance of nasal sprays. Inhalators are the closest form of traditional NRT to vaping. Both methods are typically only available on prescription following consultation with your GP.
Tablets, oral strips & lozenges (Available over the counter and via prescription)
All of these NRTs are taken orally, they are placed in the mouth and release a dose of nicotine as they dissolve. Lozenges, tablets and strips release nicotine which is absorbed sublingually (under the tongue). Sublingual absorption is scientifically proven to take effect faster.
How Effective is NRT?
The effectiveness of any given NRT treatment can vary depending on a combination of factors. The products themselves come in varying nicotine strengths which you should take care to match to your needs. This alone could have a major impact on how effective the treatment will be for you personally. If you aren’t using a product with adequate dosing to suppress your cravings then relapse is far more likely.
A study hosted by the Australian Academic Press, and supported by Cancer Research UK, compared the effectiveness of different NRT methods. It displayed that when comparing nasal sprays, gums, lozenges and tablets, that the nasal spray was the most effective; delivering the most nicotine in the shortest time.
SmokeFree.Gov and the NHS state that most often, a combination of NRT therapies is the most effective way to relieve cravings; utilising a patch to manage background cravings while also using an inhalator or lozenge to deal with any sudden powerful cravings brought about during stressful events or other environmental, personal and social factors. It is also stated that greater success can be had when pairing NRT with behavioural therapy if the habitual actions of smoking prove as difficult to overcome as the nicotine craving itself.
However, NHS data over the past 11 years has shown a distinct reduction in NRT usage during quit attempts within the UK (see. Figure below). (19,-23)
We can also see from NHS data that the number of smokers setting a quit date using the Stop Smoking Services available has also been reducing since around 2011/2012. (19-23)
Is Nicotine Replacement Therapy Safe?
It is widely documented that NRT treatments are typically safe for use by most people, with minimal side effects reported, however you must carefully consider whether they are an acceptable alternative to the dangers posed by smoking itself. The NHS has stated that NRT is safe for use by the following groups: (20,24)
- Adults and children over 12 years of age – although children under 18 should not use the lozenges without getting medical advice first.
- Pregnant women – your doctor may suggest NRT if they think it would help you quit during pregnancy.
- Breastfeeding women – your doctor can advise you how to do this safely.
Ultimately, your GP should be the primary point of contact when considering incorporating NRTs into your lifestyle, especially for those who have suffered from a heart attack, stroke, kidney or liver problems.
- Irritation and redness of the skin
- Dizziness
- Nausea
- Headaches
- Racing heartbeat
- Muscle pain or stiffness
- Difficulty sleeping
- Unpleasant aftertaste
- Complications to dental work
- Jaw pain
- Coughing and sneezing
- Runny nose
- Watering eyes
- Hiccups
You should always remember that nausea, racing heartbeat, trouble sleeping, and headaches are side-effects directly caused by the nicotine itself and not the method of delivery. In most cases the prevalence of nicotine overdose as described above is very rare, and in many cases, the side-effects of NRT will subside after one to two weeks of treatment as the body adjusts, if they present themselves at all.
If any of these side-effects persist and become more severe, your GP should be contacted immediately as it is likely the NRT will need to be changed and your quitting plan amended.
What Is Vaping?
Vaping is the process of using an e-cigarette to vaporise nicotine-containing e-liquid. The aerosol created is inhaled, much like cigarette smoke, and then absorbed into the blood. There are a vast number of vaping devices and e-liquids available on the market which makes choosing where to start quite daunting. However, some companies offer starter kits that can make it easier to engage and experiment with vaping.
Different combinations of coils and e-liquids create different vaping experiences that must be tailored to your own needs - we will explain the basics below.
Vaping also comes with various control points that allow you to tailor your experience to your desired preferences. This can be done by adjusting the following:
- Power output
- Coils type
- E-liquid variety (HVG, standard 50-50, nic salt)
- Flavour
- Nicotine strength
To learn more about vaping, devices, and e-liquid in detail, you can read our Best Practice Guide Series: Which is the best vaping device for me, or, Which e-liquid is best for me?
Is vaping effective and is it safe?
Owing partially to myths and misconceptions around its safety and a lack of significant long-form research, vaping has not yet been fully adopted as a part of the UK’s national stop smoking services. This, however, is on the verge of changing as global attitudes shift, with several major organisations now rallying for vaping to be recognised as a viable alternative option for those looking to stop smoking.
In fact, research has found on multiple occasions that vaping is a more effective alternative than traditional NRTs. A 2019 study by the National Institute for Health Research states:
“Smokers who use NHS stop smoking services appear almost twice as likely to be successful for a year if they use e-cigarettes than if they use nicotine replacement therapy (NRT) products. (27)”
Similarly, in 2019, a randomised study comparing the effectiveness of e-cigarettes against NRTs and smoking found that “both e-cigarettes and nicotine-replacement products were perceived to be less satisfying than cigarettes. However, e-cigarettes provided greater satisfaction and were rated as more helpful to refrain from smoking than nicotine-replacement products. (28)”
Further showcasing the shift in attitudes towards viewing vaping as a possible alternative for cessation, a new landmark trial is currently underway in UK hospitals across the nation, in conjunction with the NHS (29). The trial will provide smokers visiting A&E departments the opportunity to receive a free vaping starter kit and relevant advice on quitting, to further assess if e-cigarettes are a viable option for improving the quit rate of patients.
E-cigarettes are not currently available on the NHS outside of trials, however, should it find success, there is a strong possibility that vaping technology will be incorporated into broader, official NHS schemes as an arm of their quit smoking service provision, as the UK works towards the government-led goal of a smoke-free future.
With Yorkshire Cancer Research’s landmark investigative film Vaping Demystified in recent memory, this study marks yet another step towards debunking vaping myths and cementing its place as a publicly viable cessation option. (30)
This trial came into reality following the latest update by PHE in February 2021 to their ongoing e-cigarette evidence review, which found vaping to be the most popular way for smokers to quit, with 27.2% using e-cigarettes, while only 18.2% utilised traditional NRT like patches and gums. The subsequent reports highlight a number of key stats that are the driving influence behind the enactment of the trial detailed above:
- Nicotine vaping products were the most popular aid (27.2%) used by smokers trying to quit in England in 2020.
- It is estimated that in 2017, more than 50,000 smokers stopped smoking with the aid of a vaping product who would otherwise have carried on smoking.
- 38% of smokers in 2020 believed that vaping is as harmful as smoking – 15% believed that vaping is more harmful.
- Using a vaping product as part of a quit attempt in local stop smoking services had some of the highest quit success rates according to the NHS – between 59.7% and 74% in 2019 and 2020.
There is now more evidence than ever which positions vaping as a less harmful alternative to cigarettes. Most famously evidenced by Public Health England’s landmark 2015 study which declared vaping to be “95% less harmful than smoking cigarettes. (31)”
Yorkshire Cancer Research recently produced an investigative film, bringing together leading minds in healthcare, smoking cessation and wellbeing. Combining their experiences and research to debunk some of the most dividing myths surrounding vaping and its safety.
If you are still unsure about where to start your cessation journey, check out our Switch With EDGE area for impartial support, designed to help you find your ideal solution, regardless of the form it may take.
Our Sources:
- https://www.gov.uk/government/publications/towards-a-smokefree-generation-tobacco-control-plan-for-england
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003586/
- https://smokefree.gov/tools-tips/how-to-quit/using-nicotinereplacement-therapy
- https://www.nhs.uk/conditions/stop-smoking-treatments/
- https://bmjopen.bmj.com/content/10/4/e036339
- https://www.ucl.ac.uk/hbrc/tobacco/pubs/Nicotine%20
absorption%20from%20seven%20current%20NRP_28.pdf
- NHS: Statistics on NHS Stop Smoking Services in England 2019
Q1-Q3 – Apr 2018 to Dec 2019
- https://www.webmd.com/smoking-cessation/nicotinereplacement-therapy
- https://www.gov.uk/government/publications/vaping-in-englandevidence-update-february-2021/vaping-in-england-2021-
evidence-update-summary
- https://publichealthmatters.blog.gov.uk/2020/03/05/8-things-toknow-about-e-cigarettes/
- https://evidence.nihr.ac.uk/alert/e-cigarettes-helped-moresmokers-quit-than-nicotine-replacement-therapy/
- https://www.nejm.org/doi/full/10.1056/NEJMoa1808779
- https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-tostop-smoking/
- https://yorkshirecancerresearch.org.uk/vaping-demystified
- https://assets.publishing.service.gov.uk/government/uploads/
system/uploads/attachment_data/file/733022/Ecigarettes_an_
evidence_update_A_report_commissioned_by_Public_Health_
England_FINAL.pdf
