Understanding the vaping pathways
In this article, we want to talk about why people vape, as the reasons aren’t always the same and therefore the products available are designed to meet different needs.
Vaping, for clarity is used for two purposes:
1.??????Alternative Nicotine Delivery System (ANDS):
a.??????Smokers looking to maintain the habit without ingesting the 7,000 odd toxic constituents of tobacco smoke
2.??????Inhalable Nicotine Replacement Therapy (INRT):
a.??????An inhalable alternative to nicotine replacement therapies (patches/gums) that covers the Physiological as well as the Behavioural impacts of smoking.
When a smoker first moves from smoking to vaping, they talk about vaping in the absence of a positive. Meaning, they vape because that don’t want to smell (like they did when they smoked) or they don’t want to pay the price for cigarettes, or it worked for my friend but not because they want to enjoy vaping. ?
They can define the benefits when asked but it is not the reason for vaping in the first place, they did it to quit cigarettes.
Once they start vaping, they’ll take several paths:
·????????Quit vaping and go back to cigarettes
·????????Actually start liking vaping as an alternative to smoking (ANDS)
·????????Use vaping to get off nicotine addiction and quit altogether (INRT)
Before I get all the vape communities start to write hate mail, I’m not here to provide an opinion on which is the right method, just here to state that both exist.
This article is for doctors and pharmacists, who are starting to learn about the category, and need to know, when asked to write a script, or for a pharmacist looking to fill a script, what type of patient are they working with.?
Start simple with smokers new to vaping
Smokers will start on journey with vaping, because they want to quit cigarettes, with the destination not yet clear.
Some may have friends who have quit using a vape or know friends who vape and it is a fully fledged part of their being. Again, adults make choices and they are free to do so.
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What is clear, is the path of how your patient quits smoking, using a vape product, won't be clear from the outset.
We recommend the first script be for a product that is self contained, doesn't require vaping product knowledge and can simply be charged and used.
To ensure the product is to Australian standard, it should be dispensed from a local Australian pharmacy (they can only dispense Australian standard vape products).
First 4 to 6 weeks
In the first 6 to 12 weeks, the new vapers will make a decision on which pathway they prefer. They'll have already understood:
With scripts lasting 3 months, by the time the patients comes back they'll fall into one of these three boxes.
Second prescription
For the patients that fall into buckets 2 or 3, they are going to be asking for a second prescription. We would recommend for both groups, that they should be seeking a lower dose script, reducing their nicotine dependency.
For those still looking to quit, remaining on a simple vaping product is easiest. Vaping is a tool to help them quit, complexity is not something they'll be looking for.
For those looking to explore, they may want to move to a juice only script. For these consumers, nicotine strengths are between 3mg and 6mg per 1ml. The patient will need to understand that they are going to need to do their research. I would suggest they invest in Dr Colin Mendelsohn's book 'Stop Smoking Start Vaping' to get a professional opinion on a direction best suited to their needs.
Conclusion
Vaping is a 2nd tier NRT product which smokers can work with you on, to quit smoking. If vaping works for them, understanding what type of vaper they are, will help navigate what is the best type of script for them.
This article is written to provide category knowledge we have gained over 7 years, not to influence how you treat your patients.
Hopefully the knowledge shared goes some ways to having a more involved discussion with your patient.