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Cigarette substitutes: how safe or effective are the alternatives to tobacco?

Blog post | 12 Nov 2019

Some things in life are indisputable. Puppies are cute, Bill Gates is rich, the Earth is round. And smoking cigarettes is bad for you.

Cigarettes are very addictive and can cause cancer. Alternatives are available, but just how safe are they (and can they help you quit)?

Are e-cigarettes a good alternative to smoking?

Evidence is emerging of a link between e-cigarettes (electronic cigarettes) and lung disease requiring intensive care. Several deaths in the United States have been linked to vaping.

An e-cigarette is a battery-operated device that heats a liquid to produce a vapour, which users inhale. This is often referred to as 'vaping'.

E-cigarettes' fruity flavours might make them sound less dangerous than tobacco-containing cigarettes, but the levels of chemicals in e-cigarettes may be very harmful. They include toxins such as solvents, heavy metals, particulate matter and flavouring chemicals.

One study found e-cigarettes and tobacco cigarettes produced about the same amount of formaldehyde.

Not enough is known about the health effects of vaping. And e-cigarettes are not proven to be effective in helping people give up smoking.

UPDATE: Under existing state and territory laws in Australia, the sale of nicotine e-cigarettes and liquid nicotine to someone without a doctor’s prescription is illegal. But this does not guarantee all e-cigarettes sold legally are nicotine-free.

From 1 October 2021, importing nicotine e-cigarette products and refills from overseas websites without a valid doctor’s prescription will also be illegal.

Learn more at the Therapeutic Goods Administration website.

What about cigars and shisha?

Cigars are just as dangerous as cigarettes (if not more). On average, cigarettes contain about 8.4 milligrams of nicotine. Some brands of cigar contain between 20 and 50 times that amount, while also containing more toxic and cancer-causing compounds such as ammonia and cadmium.

A person who smokes 5 cigars a day has the same risk of developing cancer as a person who smokes a pack of 20 cigarettes a day.

Shisha is smoked using a 'hookah', a glass device that allows fruit-flavoured tobacco smoke to pass through a water chamber and be inhaled slowly through a pipe. Like cigars and e-cigarettes, it's a common misconception that shisha is safer than tobacco cigarettes.

It's not. The water in the pipe does not filter harmful chemicals, and a person can end up inhaling more smoke from a shisha than a cigarette because they're likely to take deep breaths and smoke for longer in one sitting.

In 2017-18, just under 1 in 7 Australians (2.6 million adults) were daily smokers. —Australian Bureau of Statistics

Are nicotine products better than smoking?

Nicotine itself has not been found to cause cancer or heart disease, so it's safer to use nicotine-replacement treatment (NRT) products than to smoke cigarettes. Nicotine products, such as patches, gum, tablets and inhalers, are available to buy in pharmacies and some supermarkets.

According to Quitline, if you're addicted to smoking, correct use of nicotine-replacement medications may double your chances of quitting successfully.

NRT products are usually available over the counter, but you can also get them on the Pharmaceutical Benefits Scheme (PBS). This means that if you get a prescription from a doctor, you can buy nicotine replacements at a reduced price.

  • A nicotine patch is a 'steady response product'. Attached to your skin like a Band-aid, it gives you a steady dose of nicotine while you're wearing it. It can take a few hours for nicotine levels to rise after you apply your first patch of the day.

  • Nicotine chewing gum, lozenges, tablets, mouth sprays and inhalers are 'quick response products'. They can deliver nicotine as soon you're craving it, which helps if your need to smoke changes throughout the day.

Combining 2 forms of NRT seems to work better than one since they work in different ways.

There is limited evidence that e-cigarettes are effective in helping people give up smoking in the short-term, but, it is not clear whether they help people to quit in the long-term, or if they are as effective as other methods such as nicotine replacement therapy (NRT).

Prescription medication can help with withdrawal

Quitting smoking can lead to withdrawal symptoms such as sleeping problems, irritability, hunger and restlessness. Two types of prescription medicine can help reduce withdrawal symptoms while helping with smoking cessation: Champix (varenicline) and Zyban (bupropion).

Champix also blocks the nicotine receptors in the brain, making smoking less satisfying.

Ready to quit? Ask your doctor about these medications, both of which are on the PBS. You are entitled to 3 courses of Champix per year, and 2 courses of Zyban per year, provided you accept coaching support from Quitline or a health professional.

These medicines, however, are not suitable for everyone. Bupropion, for example, is not recommended for people with a history of seizures, and side effects include insomnia and nightmares.

Get help to quit smoking

Smoking is the leading preventable cause of death in Australia. Tobacco use increases your risk of cancer, heart disease, type 2 diabetes, stroke, emphysema and eye diseases. It's important to try to quit — but not, for example, by replacing cigarettes with vaping or shisha.

The good news? Your body starts repairing itself as soon as you stop smoking. For help and more information:

  • Speak to your doctor or pharmacist.
  • Call the Quitline on 13 7848 — even if you're not ready to quit yet.
  • Build a 'quit plan' here. Follow the steps to design a plan that suits your life.
  • Download the free My QuitBuddy app to quit when you want to, on your own terms.

Want more like this?

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