Engaging the Professionals

Back in August I had the distinct pleasure of meeting Nicky from the Harrow Stop Smoking Service to talk about all things vaping. Talking about the devices, reasons for using them, differences, experiences and all that. It was a really good positive meeting and could quite easily have gone on for far longer than the time allotted.

The recent event was a heavily condensed version of that meeting with a guest speaker, Jessica Harding and myself. It was publicised as a ‘Stop Smoking Service Annual Update Meeting’ which would include the latest information on vaping, with an emphasis on the PHE Review. This post will include commentary from Jessica (in blue) along with both our thoughts and impressions on the event and those who attended.

After all, the subject of vaping is a very broad and diverse one, with so many nuances that one meeting really isn’t enough to cover it all. In fact, a dozen meetings probably isn’t enough, so when I received an invite to attend the Harrow SSS Annual Update to answer questions about vaping, I enthusiastically said yes. As the day drew nearer, I began to get incredibly nervous. I’ve never done this kind of thing before, had no idea what to expect. I suspect that it’s somewhat easier to engage with the professionals now than it was two or three years ago when there was far less research and far more unanswered questions.

It almost feels too easy to talk to the professionals now, with the plentiful research bookmarks to draw upon to aid explanations, but the key factor is and always has been, the user experience. No amount of research can tell our stories, describe what we go through and how we feel. Opportunities to tell our stories to those who help others that choose to give up smoking are invaluable.

Instead of approaching politicians (i.e. “the front door”) with our stories and experiences which may or may not sway them, approaching those on the front line (i.e. the “tradesmen’s entrance”) can be far more effective as the directors of these services see the bottom line, and it’s always just figures. How many have remained off smoking after four weeks and so forth, they don’t see the people (normally). This information gets passed up the chain to councillors and then up to the politicians and policy makers. It’s a much slower route to get things done, but it certainly seems to be an effective one.

The evening kicked off with some food and general networking, though me being me, I decided to keep to myself at the “back of the class”, mostly because I was hungry having driven to the event straight from work, while awaiting the guest speaker – Professor Peter Hajek and my “partner” in vaping Jessica Harding, both traffic and trains were proving to be “problematic”.

After everyone had settled in the evening commenced with a review of the service presented by Carole, the full document (linked) makes for a very interesting read as does the full report. It was very interesting to hear the facts and figures on the service performance, such as adult prevalence being at 12.8% and the number of successful quitters at 4 weeks being far lower than the overall average across the country.

It turns out that attendance to the service is significantly down, which frankly doesn’t surprise me. We’ve already seen that Scotland are seeing the same thing where they are suggesting that the rise in vaporisers may be a “plausible explanation” for the drop. It seems that Harrow may be seeing something very similar. Of course, the drop in attendance may not be fully accounted for simply by looking at the rise in vaping prevalence, there are bound to be other factors, such as folks really not wanting to stop smoking.

After the review and some awards, it was time for the main event. Professor Peter Hajek. I’ve not had the pleasure of being in the same room and listening to Prof. Hajek before so I sat with rapt attention trying to digest as much as I could. Most of what Prof. Hajek covered myself and Jess are fully aware of, but he definitely had the attention of the other ~70 attendees, but the really interesting point was when the slide on perceptions of harm of e-cigarettes was shown.

When Prof. Hajek asked the audience, the majority of the attendees raised their hands when asked if e-cigarettes were “safer but we need to know more” with only a few raising their hands for the “substantially safer with minimal risk” option. This doesn’t quite tally with the overall perceptions from the general public, with the latest ASH figures showing around %22 believing that e-cigarettes are as harmful or ‘more harmful’ than combustible cigarettes. It does however demonstrate that clear and concise information is needed in the public domain, sooner rather than later.

Technically both answers are “right”, there is still more to learn, but at the current research level we can deem vaping “safe enough”. It seemed to me that some felt that vapour products were only slightly safer, but no-one raised their hand when that question was asked from what I could see. It was clear that many of the attendees believed that vaping was safe, but more needed to be known.

This is an irrefutable fact, there is still much to learn about the subject from a scientific point of view, particularly when it comes to flavours and the ‘long-term’ effects. A topic that Prof. Hajek touched on, mentioning that short-term is fine, long term is probably fine too but more information is needed. Too soon it was time for myself and Jess to do our little Q&A section, I could have listened to Prof. Hajek for hours.

Professor Hajek’s presentation should be filmed and shown to every pharmacist and stop smoking advisor in the country.  He anticipated and addressed the audience’s concerns whilst firmly being on their “side” (he said that vaping should be recommended along with NRT and behaviour therapy). I suspect that the PHE 95% safer announcement helped a lot too.  It seemed to me that his address was really well received.

During the questions following Prof. Hajek it transpired that the Royal College of Pharmacists has not revised its previous advice to pharmacists not to sell vaping products – and, understandably, pharmacists are reluctant to act against their college’s advice.  In light of the PHE announcement this is ridiculous – let’s hope that they will offer better advice very soon. 

After giving a brief overview of my story, it was time to answer a few questions. What did surprise me was how few question there actually were. Questions like “did you try NRT before” and “what nicotine level are you using” were kind of expected and easily answered as I had tried NRT before with very little success. From the looks on the attendee’s faces, this answer seemed to be a common one. Judging by the information I’ve seen on quit attempts, I’m surprised there hasn’t been more of an effort by NRT manufacturers to improve their effectiveness or appeal.

One question caught me a little off-guard, the usage pattern question. It’s very strange as it is not something I’ve given much (if any) thought to at all. For example, I’ve been writing this post for about two hours now and haven’t touched my mod once. On the flip side, if I was still smoking I would probably have had 3 or 4 smokes in the same time. Putting that into coherent words was a little difficult, especially as the “usage pattern” varies wildly depending on where I am or what I’m doing.

I did make a point of taking in as many expressions as I could while I answered that question and there were more than a few that looked a little stunned that a 60 a day smoker turned vaper didn’t actually know the usage pattern or didn’t pay much attention to it. Then there was that “aha!” moment in a lot of faces as the message I was trying to convey sunk in. Not only was I telling them I’d stopped smoking, I’d completely changed my behaviour patterns. Unlike smoking when there was a “ritual” to when I smoked, that’s now gone. There isn’t a dependence on vaping for me. This did lead to the most obvious question: what nicotine level did I start at, what level am I at now and did I plan to stop vaping?

The first two parts (asked by Prof. Hajek) of that are easy. 18 and now at 6 or 12 depending on the device and flavour. The third and final part is a little difficult. Initially when I started the plan was to eventually stop. Initially. But I enjoyed smoking, and I enjoy vaping. The sensations, the hobbyist side of it, the social side (yes there is one honest!). I may decide at some point in the future to stop or I may not, but it is my choice.

We were asked about vaping in public places, such as bars, clubs, restaurants and such. This particular topic is fairly divisive within the vaping community, but for me it’s simple. “If you don’t know, ask”. More often than not, if you ask, you are generally allowed to vape.

It was also an opportunity to highlight that if the staff say “no” then it isn’t a big problem. Emphasizing the earlier message on the lack of dependence on vaping. Common courtesy goes a long way, if I’m allowed to vape in a pub I go a step further and just have a quick chat with anyone nearby just to give them a “heads up” about what I’m doing and to not worry. If it bothers them I’ll either move if I can or stop. It really is that simple.

But it did highlight the fact that because vaping looks so similar to smoking that it has the same level of stigma associated with it in the eyes of the general public, which is incredibly disappointing and one of the key reasons why many of the advocates do what they do. To differentiate vaping from smoking and to point out in the simplest of terms that the vapour is effectively harmless. It is also one of the primary reasons Public Health England released their review of the current body of evidence in the way they did with the infographic and the general media. There are bound to be some that will try to use a vapour product where they aren’t supposed to, but the majority will most likely use them in the same places that they used to be able to smoke. Service update meetings involving vapers such as this are key to helping the service providers understand these potentially un-thought of scenarios, it’s just one item out of many that the services need to be aware of when helping smokers make the switch.

Prof. Hajek put it succinctly, “vaping is being banned due to ideology, because someone doesn’t like it“. The evidence collected to date demonstrates no harm to bystanders, a fact that Prof. Hajek strongly emphasized in his keynote.

The last “formal” question that was asked referred to the provision of vaporisers in pharmacies. It wasn’t a question aimed directly at myself or Jess, more of a general question to the floor but it did set me thinking. Remember, vapour products are not medicines, but then again the majority of products in a pharmacy aren’t necessarily medicines either. Most pharmacies can offer general advice on certain topics related to health and well-being, mostly based on the product ranges they have on the shelf or more often in broad general terms.

In this case, having pharmacies offering vapor products, I’m leaning more towards the negative side of the debate. As in, no pharmacies _shouldn’t _be stocking them. My simplistic reasoning behind that is the same reasoning behind my stance on a medicalised vapour product. By putting a consumer product in a pharmacy (and granted there are other consumer products stocked by some), the perception it creates can go one of two ways:

• Stocked by a pharmacy, can be considered safe to use, but from over the counter “clinical” places
• Stocked by a pharmacy, may very well be safe, but likely to be dull

Most pharmacies, especially in my area are very….clinical in nature which can put people off from buying a particular product; location, location, location. On one hand I can understand why the question was asked, it’s an opportunity for both the service and the pharmacy to continue to encourage smokers to quit by offering the widest possible array of options to enable said smoker the best possible chance of succeeding.

On the other hand, I’m wary of having vapour products stocked in a pharmacy because of the impressions that can give. I mentioned that the service in Bristol had an arrangement with a local vape shop where smokers wanting to try to quit using vaporisers were “referred” to the shop, and those who went in to the shop looking for other options were referred to the service.

Unfortunately, it seems that there aren’t many (if any) vape shops in Harrow, there’s at least one further afield in Watford and possibly one in Wembley (to the best of my knowledge) so such an arrangement would not be feasible or possible, so it seems that having the products stocked in the pharmacies is probably the only way to incorporate their use as part of the SSS line-up. In my mind it’s far from ideal, but then again when is anything actually ideal?

I think Paul and I differ on what vaping products pharmacists should sell – I think they should sell as varied a range as they can.  There’s a shortage of vaping shops in many areas (including Harrow) which means that vaping isn’t being taken up as quickly as it could be (where there are vaping shops there are vapers). The costs of running a shop in the South East are prohibitive – I don’t think we will ever have enough vaping shops. E-cigs often need to be sold alongside other products and not in dedicated shops (e.g. in London there are several hairdressers which also sell vaping stuff).

It would be a wasted opportunity if pharmacies only sold boring and ineffective e-cigs. Yes, there is a perception that pharmacies sell healthier stuff – but those e-cigs aren’t healthier than the more exciting ones.  As we know (and Prof. Hajek emphasised) people need to find a set-up which works for them – which can mean trying different combinations. I suspect that there are a significant number of smokers who will only try vaping once it is offered in conjunction with Stop Smoking Services and endorsed by pharmacists.  The people who find it too clinical won’t be the people who have signed up to the service.

This also raises another pertinent point related to footfall in the service outlets themselves. There’s many factors to take into consideration which Lorien and Sarah go into here and here ranging from economic to social and even as far as cultural. There’s also the mind-set when someone mentions the word “practice” (in the medicalised sense) or “clinic”, in a lot of people it can bring forth some vehement reactions and intense negativity towards any effort to stop smoking; the “fail before you try” mind-set.

When it comes to stopping smoking it is difficult to do, I “tried” a number of times that I eventually gave up trying, not least of which the fact that I really didn’t want to anyway, a point that I’ve only fairly recently come to acknowledge, but most of all I had no interest in attending a clinic or practice because smoking is not a disease to be treated it is in fact a choice.

As I discovered in the informal chats after the event had officially ended, many of the attendees were positive about the inclusion of vapor products and were keen to understand them, though a few were seemingly surprised when I mentioned that I chose to smoke, then vape rather than view vaping as a way out of smoking; it was amusing to see eyes widen in both surprise and bemusement at that response, both in the formal Q&A and the informal chats after.

Overall, I had the impression that Prof. Hajek encouraged many to consider the idea of embracing vaping, some seemed unconvinced, but I didn’t see any negativity on any of the attendee’s faces at all. After having no idea exactly what to expect from the evening, I came away with a very positive outlook and it seemed that the experience of myself and Jess would prove to be invaluable to those in attendance, after all we could have been one of their service attendees asking them for help to stop smoking by vaping.

The evening made me very aware that most people know very little about vaping – and I very much doubt that pharmacists will be happy selling e-cigs without learning a lot more about them.  Bridging that knowledge gap will be quite a challenge.  I hope that this is something which the New Nicotine Alliance can help with.

I’d like to proffer my thanks to Nicky for the invite, Simon and Carole for making me feel comfortable at all times during the event, and of course to Prof. Peter Hajek for his keynote. I do hope that between us, we can continue to make good positive progress.

Yes it was such an interesting evening.  Thank you very much to Smokefree Harrow for inviting us.