ACS to Clinicians: Vaping is an acceptable last resort…

…but we still want it regulated like cigarettes.

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In February, The American Cancer Society (ACS) published a partial change in their position on the role that vapor products can play in helping people quit smoking. By way of summary, ACS has updated their advice to clinicians regarding vapor products by recommending that “clinicians support all attempts to quit the use of combustible tobacco,” even if it involves vaping. Patients having limited or no success with other quit methods, or are resistant to using FDA approved cessation products, “should be encouraged to switch to the least harmful form of tobacco product possible.”

CASAA acknowledges that ACS’s updated position on vaping is a very small step in the right direction and appreciates that, as supporting evidence continues to emerge, they are willing to adjust their messaging to medical professionals. But when considering the entirety of ACS’s statement, it is clear that the organization is not offering an endorsement of harm reduction. Instead, the ACS continues to advocate for policies that regulate smoke-free products just like cigarettes. “The difference between the ACS message then and now is that vaping was simply bad, bad, bad; now vapor products would be good, if they weren’t bad, bad, bad. Clearly we still have a long way to go before the ACS catches up with the available science.” said Bruce Nye,RN – CASAA Board Vice-President.

As CASAA explains on its tobacco harm reduction web page:

“It is widely acknowledged that discontinuation of all tobacco products confers the greatest lowering of risk. However, approved smoking cessation methods have a 90% failure rate, when used as directed. In addition, there is a considerable population of smokers who are unable or unwilling to achieve abstinence. Harm reduction is likely of substantial benefit to these smokers and public health. Providing reduced-harm alternatives to smokers is likely to result in lower total population risk than pursuing abstinence-only policies.”

Put simply, harm reduction is all about empowering consumers to choose safer alternatives to products which are known to be hazardous rather than pushing or shaming people into abstinence.

While the ACS goes a very short distance toward acknowledging that vapor products are a less harmful substitution for smoking, they continue their campaign of exclusively negative information about vaping. By presenting information about smoke-free alternatives as an equivalent risk to smoking, they reinforce their position that complete tobacco and nicotine cessation is the only acceptable goal. Moreover, this update fails to acknowledge that smokeless tobacco products such as Swedish snus and moist snuff (which actually contain tobacco) are also very low-risk alternatives to smoking. If there is any acceptance of tobacco harm reduction in ACS’s updated position, it seems to be limited to products that ACS would like to ultimately see regulated as a medicine and marketed strictly as a means to ending nicotine use altogether.

The ACS also fails to recognize dual use of smoke-free products and cigarettes as a transitory phase. As a practical matter, discouraging “dual use” presents smokers with a one-or-the-other decision. This is a source of grave concern because human nature often dictates that we stick with the devil we know. Instead, smokers need encouragement to explore smoke-free alternatives until they find what works best for them.

From an advocacy perspective, manufacturing fear about the alleged harm of dual use works to support calls for stricter regulation on where smoke-free products can be used. While, in reality, people who use smoke-free products are obviously compliant with most smoke-free air laws, the ACS and other anti-tobacco activists have convinced many lawmakers that these products exist mainly to “circumvent” place bans. This kind of messaging from ACS reinforces the belief that smokers and vapers are social deviants who need to be separated from the general population into designated areas. This narrative is part of an enduring shame offensive that the ACS has supported for decades.

Moving forward, we expect that as evidence continues to mount about the low risk of vaping and other smoke-free tobacco products, more organizations like ACS will publish their own updated positions. CASAA urges our members to read these updates with a critical eye for details. Are anti-smoking and anti-nicotine organizations really on your side, or are they moving the goalposts to support a prohibitionist agenda? Vapers might be living smoke-free, but the ACS is recommending to your doctor that “these individuals should be regularly advised to completely quit using all tobacco products.” And if the regular badgering from clinicians doesn’t convince you to quit, ACS will continue to devote resources to forcing people to change their minds.

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The American Cancer Society’s position statement regarding vaping and vapor products is available here.

CASAA’s Tobacco Harm Reduction webpage – Click here.