Not just the nicotine: consumers speak

Much attention is given to ‘expert’ views on the use of SNP. Little attention is paid to the millions of ex-smokers who benefit from SNP and who will suffer should legislation grow increasingly prohibitionist.

We interviewed consumers from around the world, hearing how they left smoking behind.

Smoking per se is not a disease and even if many smokers wish they could quit (or at least wished that they wanted to quit), they do not regard themselves as ‘ill’ or ‘patients’ needing ‘treatment’.

The social, cultural and psychological dynamics of smoking are complex. In his book Ashes to Ashes, Richard Kruger eloquently explores what he calls the ‘protean usefulness’ of the cigarette, capturing the essence of the pleasure principle. This extract gives a flavour of what smokers are expected to give up and why they find it so hard, especially if they are long time smokers.

“The smoker smokes when he feels up or in the dumps when too harassed or overburdened or too unchallenged and idle, when threatened by the crowd at a party or when lonely in a strange place. A smoke is a reward for a job well done, consolation for a job botched. It can fuel the smoker for the intensity of life’s daily confrontations yet seem to insulate him from the consuming effects of any given encounter. It defines and punctuates the periods of the smoker’s day.”⁶⁶

Older smokers and THR

In Chapter 7, we look at the plight of those we call ‘the left behind’, including those with mental health and substance use problems or living within minority communities whose smoking rates can be much higher than in the general population. But because the debate about SNP is often focused on the problems that might be faced by young people, the problems of the older smoker are largely ignored.

The unspoken narrative appears to be that ‘it’s too late for them to switch anyway’. However, while surveys of the older vapers and users of other SNP are lacking, there is plenty of anecdotal evidence of older people who have quit smoking for vaping and enjoyed an enhanced quality of life.

It is estimated that people who smoke through their adult life will lose 10-13 years of life compared to non-smokers.⁶⁷ But research shows that smokers can significantly reduce the risk of lung cancer if they can stop smoking early enough. Those who quit before they are 40 have a 90 per cent reduced risk of a smoking-related death.⁶⁸

It may be harder to convince older smokers to switch because of a smoking habit ingrained over many years. A clutch of surveys reveal the issues; some smokers believe they are ‘bulletproof’ and will avoid the worst outcomes of smoking;⁶⁹ others believe that the risks of smoking have been exaggerated and they can do little to change habits anyway;⁷⁰ some believe that it is the nicotine that causes the damage meaning that low nicotine cigarettes are safer.⁷¹

The consumer evidence shows much higher uptake of vaping among younger smokers (up to age 44) than among older smokers.⁷² They are more likely to be comfortable with the new technology and willing to experiment. For most older smokers, just cracking open the cellophane of the packet, taking out a cigarette and lighting it is so much easier.

Switching in later life does not necessarily undo all the damage of decades of smoking and elderly vapers may still suffer smoking-related diseases, but those who do make the switch usually report a much better quality of life. And as many countries are facing the health and social care costs of an ageing population, public health campaigns should be aimed at older people, and specialist retailers finding ways to attract older smokers into their store. But probably the most effective switching mechanism is for younger smokers who switch to introduce the idea to those older relatives who still smoke.

Consumer stories from around the world

There are two main takeaways from these interviews. Most were smokers from an early age and experienced dramatic health improvements once they switched to SNP. The second is how anti-vaping rhetoric is making it harder for people to access safer products, particularly in the early days of their transition from smoking to safer forms of nicotine consumption. Two of our interviewees in Chile and India were able to benefit from vaping as they were relatively early adopters, before public health officials and politicians got in the way of smokers’ health in those countries.

Vaper from Ireland

When did you start smoking?

I was smoking from about the age of 20; I started on about 10 a day and then the law changed, and they banned the sale of packets of 10 cigarettes so I started buying 20s and was smoking 20 a day. That went on for 19 or 20 years.

Why did you consider switching to vaping?

My father died very young, just turned 56; he had lung cancer and a brain tumour and smoked from the age of 12. So, switching was something I had thought about a few times. I was one of those people who thought nicotine and vaping was every bit as harmful as smoking. But I started asking a few people and then curiosity got the better of me, so I decided to buy one and see how it went. I was just so shocked at how well it worked.

What devices did you try?

I was a dual user for about two weeks, but even in that short space of time I was able to identify a problem: the device wasn’t effective enough. So I started looking online and I found a vape shop, there was actually a vape shop in Dublin. I contacted the owner and asked for his advice and he advised me on something else. He talked to me for a long, long time about it.

I would say that within a week or two of getting a better device, a Kangertech Protank 3, that wasn’t even expensive – about £30 for the whole thing – I stopped smoking completely. I’m not one of those people that got cravings or relapsed even once or twice, I mean I literally never, ever wanted to go back.

What do you use now?

For convenience I have a little pod system and that’s perfectly fine but if I’m at home or relaxing, I would definitely use a box mod because I like the flavour and I make my own juice as well. And I went from 15mg to 1 mg in maybe four months, so it was a massive reduction in nicotine for me.

I’ve been making my own recipe for a long time because of cost when I switched from the Protank 3 to the sub ohm tank. I got talking to a few guys on forums and started making my own.

Did you see any benefits from vaping?

Just being able to go upstairs and not being out of breath. Your lungs clear out. The sense of smell and taste is crazy. I just don’t think you realise how smoking affects your sense of smell and taste. It comes back and you’re tasting food that you haven’t in 20 years. It’s quite a drastic change.

My background was in research and development for an American multi-national so I started researching into the science, because I couldn’t believe the change in my health. I was one of those guys who said nicotine is just as harmful.

What do you think of the law on e-cigarettes?

You can’t buy the high strength nicotine to make your own. But I still have stuff that I bought pre-TPD [the EU Tobacco Products Directive]. Nicotine keeps for a long time if you store it correctly, so I have loads there.

There are ways to obtain the nicotine but it’s not something that I am looking forward to [when my supplies run out] because it is from informal sources, as they say. I know other vapers who struggled after the [EU] TPD law changes because it made it so much more expensive, especially with people who don’t know how to handle nicotine, mixing into short fills.⁷³ It’s a bad, bad policy. Very little thought or research went into it because they were arbitrary numbers just plucked out of the sky.

What about friends and family?

Well, there’s my mum and I’ve got an aunt and a cousin that are around about the same age as my mother, late 60s, early 70s, and they’re all vaping now and they were all smokers for 45 plus years. My brother is still a smoker, he likes it but also smokes some weed as well. But I really don’t know a lot of vapers where I am, it’s quite shocking when I go to bigger towns, I’m in quite a rural area [and] it still shocks me the amount of smokers I still see compared to vapers. Media has a big part to play in that.

Vaper from the US

How did you discover vaping?

I started smoking cigarettes when I was 18 – I am 54 now. I smoked until my late 30s and then I had gall bladder surgery. I actually quit then because after surgery you cannot smoke and went smoking cold turkey for two years. I picked up smoking again but not cigarettes; instead I was smoking expensive Davidoff cigarillos.

Last June, I happened to see my food delivery person was vaping. I had already tried JUUL once, I had seen the JUUL commercials about how they helped people switch, but it gave me a horrendous headache. I wasn’t looking to quit, just looking to maybe cut down. JUUL didn’t work for me because I didn’t smoke cigarettes, I smoked cigarillos, so the ‘draw’ from JUUL was too high for me and I think that’s why I was getting this headache. So, I saw this delivery guy and I asked him about it. He had a Smok Novo [pod system]. I did research on Google and YouTube and I watched the documentary put out by Public Health England with the experts and they were explaining how it was safer, so I did a little more research. It quickly evolved from the Smok Novo to an Innokin device. I use what they call free base nicotine e-liquid.

I started with 3 mg but that wasn’t cutting it and I was vaping so much extra I became dehydrated. Then I went 6mg and that wasn’t cutting it then I watched a YouTube channel dedicated to giving smokers information and advice on vaping and they were saying that sometimes you have to up your nicotine a little bit to satisfy a nicotine craving so I used 12mg and I have been using 12mg since the end of August 2019 and I am quite satisfied.

I started with the fruity flavours, but I found them to be too sweet. I actually did the opposite that most people do, I quickly transitioned away from the fruity flavours and I now I mostly vape tobacco flavours.

What about your health?

I’m a little different from most smokers as I actually didn’t have any health problems while I was smoking cigarillos. But I used to exercise a lot and run marathons and half marathons and smoking does damage your lungs, so vaping to me is like I no longer live in fear. Even though I was healthy, every time I coughed I would always spit mucus into a paper towel and look at it to find blood and the first sign of trouble is when you constantly cough and coughing up blood. Since I started vaping, I haven’t really coughed a lot.

Did you continue smoking cigarillos while vaping?

I used both for about two months because I got dehydrated and then I got sick and was back in hospital so I stopped. But if you try to smoke after you have vaped, it tastes really bad, so slowly, without making a conscious decision, I just cut down until finally one morning the first thing I did was not light up that cigarillo, but reached for the vape.

How easy is it for you to obtain what you need?

When I started in June, I had no idea about all this anti-vaping propaganda that was going on. Shortly after I started vaping, I realised every place is trying to ban this thing. I stepped into a mess. But luckily, when I was researching for the e-liquid on Google, I guess because I did smoke more expensive cigarettes and cigarillos, I was looking for more of a premium artisan e-liquid and then I come across 5 Pawn. It happened that 5 Pawn is next door to where I exercise so very convenient for me to get my e-liquid.

Have you tried other ways to stop smoking?

A long time ago my doctor prescribed Wellbutrin, but the first day I was having heart palpitations, so I stopped it. A couple years later my cardiologist prescribed Chantix. At that time Chantix was not covered by insurance and was quite expensive.

I started reading about side-effects and it mentioned epileptic seizures. My mum said, this is not good especially if you are living by yourself and have a seizure. I tried the patches a couple of times – they also gave me the heart palpitations and then right before I started vaping, I ordered the lozenges from Amazon. I took them twice and they gave me horrible stomach cramps. My family doctor actually said for now go back to smoking as this is not good at all. I even tried hypnosis, but it didn’t work, because the hypnotist kept telling me to think of the positive health benefits you are going to get from quitting smoking and I was like well, I run, I’m not overweight, I’m not out of breath, so I couldn’t see the benefits, Plus I fell asleep.

Snus user from Sweden

How long and how regularly were you smoking before you switched to safer nicotine products?

I was smoking about 10 a day for at least 30 years.

Why did you switch to a safer nicotine product?

I was using snus from when I was 18 or 19 years old but back in those days – I am 62 now – people were smoking, drinking and partying so I sort of stuck to both smoking and snus. It was only the loose, tobacco-flavoured snus and I still love the tobacco flavour as well as the salmiak, which is sort of salty liquorice.

Ultimately, I threw away the cigarettes. It was a few days before the Gulf war broke out and I was working in Saudi Arabia as a Chief Financial Officer. My family and I were evacuated with the very last plane and almost missed it. Once I got on the plane, I took the pack of cigarettes and just tore it apart and stuck to snus instead.

Did you notice any impact on your health from switching to snus and stopping smoking?

Yes definitely, I could run much longer, I didn’t cough in the morning and there was no stench indoors. And thankfully in Sweden, snus has been allowed for more than 200 years and it’s probably very much the reason why Sweden has the lowest prevalence of smoking in the whole EU as well as the lowest prevalence of smoking mortality.

Have you tried any other safer nicotine products?

Yeah, some years ago, I bought an e-cigarette with a tank and I enjoy vaping on Saturdays along with the snus, and the combination beats smoking cigarettes 100 times anyway.

Do any of your family and friends use safer nicotine products?

I meet many people in my regular life who are using snus and due to my advocacy for tobacco harm reduction, I have contact with thousands of people, men and women from a hundred nations, over 80% of whom are former smokers.

Vaper from India

When did you start smoking?

I smoked for over 16 years from the age of about 14.

What impact did that have on your health?

From an early age I went swimming and went to the gym. During school days I was very active in sports, I was the sports captain for my school. Smoking for me was always this childhood dream kind of thing because my entire paternal and maternal side used to smoke, so I was pretty infatuated with it. I got hooked on smoking and as I started smoking more regularly, all the physical activity that I was involved in went down. I was not able to swim as much, not able to play sports or go to the gym. By a decade or so later, I was really in bad shape, chain smoking 40 a day or more. I did not have proper sleep, I used to have a lot of colds, lot of wheezing, I had to keep going to the doctor again and again. That’s when I started researching e-cigarettes.

How did you find out about e-cigarettes?

Our entire group was trying to quit smoking because all of us knew this was really not going our way. In 2013, a friend who used to go to America frequently, brought back these e-cigarettes – the first one where you breathe in and it glows red, but it didn’t work out. Then in 2014 I got into vaping for about 6 months, but the devices were no good and the liquid that I started off with was 36 mg nicotine, so it was really not a pleasant experience. But, after 12 years of smoking, I was able to get off cigarettes for 6 long months. That was my first attempt back in 2014.

I was convinced that e-cigarettes could actually work but what was available in India was obsolete, we had old-fashioned stuff, so I went back to smoking. But as soon as I went back to smoking, the old issues started coming back; the colds, the wheezing, the lack of sleep and everything. Eventually, in January 2016, I finally made up my mind that I was going to give up completely. I started connecting with people on Facebook and that is where I landed on the Facebook group consisting of vapers across India. That really helped me and since then I have never gone back to smoking.

By 2016, had access to products improved in India?

Initially it was a bit of a struggle but when I started exploring on Facebook and got into that group, I connected with vapers who were senior to me and they were getting stuff from China. Once I got in touch with them, there was no looking back. I reached a point where last September I was sponsored by three of the Chinese companies and were promoting them on Instagram as an advocate.

What product do you use?

I use a Rebel single battery device and now I’m more of a hobbyist. I am no longer dependent; I can go an entire week without nicotine or just vaping 3mg. I like any of the sweet flavours.

What difference has quitting cigarettes made to your life?

The first difference was being able to taste everything better. I work in the food industry so for me a refined palette means a lot. The other thing was sense of smell; I can’t stand the smell of somebody smoking now, it gives me a headache and I realise how non-smokers feel. I sleep better; I am not a heavy sleeper, but my entire sleep used to be restless. Now I sleep how I used to sleep when I was a teenager before I began smoking. I have gone back to working out and the difference is visible. I am able to do more and my days are longer. I am up and about the moment I wake up.

How easy is it for you to buy what you need now?

Our government has gone the route of no research: they have just banned everything. For me it is not too difficult to source because I am well connected with the vaping community in India. But for people who are newcomers it is going to be near impossible because nobody is going to sell them anything. I must have converted close to 100 people but if vapes were not banned this number would have gone up and up and more people would have started vaping.

Do your friends and family vape as well?

My maternal uncle switched to vaping and he has been a smoker for 30 years – I was able to convince him off cigarettes.

Are you his supplier then?

No. Initially, anyone I convert to vaping, I make the selection for them depending on their needs. I give them the device in their hands that would suit them best and once they become familiar with that device, I say now you go and explore on your own. So that’s what I did with my uncle. I gifted him a device and gave him a bottle of liquid and I told him to try it for a month. In the first month he cut down smoking by half, then he came in the second month and told me, ‘Let’s go buy another device, I want another device’. Then I got him connected to the seller and now he stocks himself.

Before you switched to the vape, had you tried any other products such as a patch or a gum?

Yeah, I have, I tried the gum. I used to smoke while chewing the gum, the gum used to spoil the taste of my mouth and it never went away. I tried the patch once, but it’s not as fast as being absorbed in the lung. I think these things are good, but only for people who used to chew tobacco, not for smokers. Vaping replaced the action of smoking. Smoking is a ritual – the hand to mouth action. Vaping replicates a lot of that muscle memory, even if you are just vaping 0 mg. The one thing that vaping does is that it makes you less dependent over time. When I started vaping, I was consuming 200ml a month, now I’m down to 60ml.

Vaper from Chile

When did you start smoking?

I started smoking at 11 until I was 29 and by then I was smoking two packs a day.

And what damage was that doing to your health?

Problems playing sports, running, walking up stairs, lack of smell and taste and my skin and whites of the eyes were yellow.

What prompted you to switch to a safer nicotine product?

I was trying to quit smoking for a long time and tried all the possibilities. I tried patches and I got very nauseous, I tried quitting cold turkey but nothing helped. Only once I was able to quit for like 8 months, but it was like torture each day thinking about cigarettes, especially if I smelled them.

There was no knowledge about e-cigarettes at the time, but in 2009, a friend got one for Christmas and when I took my first puff it was like ‘wow, this could help’. But I was not even thinking about quitting, just tried for that one day. The next day, I said I will try keeping going with it, however at 3pm it ran out of battery, so I needed to smoke. That night was the 31st December, New Year’s Eve, I said this will be my last cigarette because this thing works, and I never smoked again – no pain, no problems, and it’s been 10 years and 2 months.

Do you remember what the first device was? And what do you use now?

I think it was the very first Blu. I used to have lots of different devices – many, many boxes of various products. I have tried all of them. I was part of a group working to get better products in Chile. Some months ago I was using G-class with an RDTA [rebuildable dripping tank atomiser] but I switched back to pods. The pod I like most is the Joytech Exceed grip, but I used to try different things.

For flavours, I go for ice and fruits. We’ve got some very good stuff here from an alchemist called Blue Metha, the most sold liquid in Chile.

What was the effect on your health? Did you see much improvement?

It’s amazing because most of the benefits you do not know until you quit smoking. The obvious ones are like having a much better physical state, you can walk, you can run, you don’t feel tired walking up the stairs, you can do sports and also the colour of my skin changed.

Something that was really amazing to me was that my eyes became whiter. I regained my taste, my smell, even the hair became brighter. I don’t know if there is something in tobacco smoke affecting hair, but also the nails became a better colour and more healthy.

When you smoke you are always coughing. When breathing very deeply it felt like a squishy thing in my throat, you can feel something that’s not going well. I get less ill from colds during winter. Also in the way you react to other people who smoke. Now, when you go out and you meet a smoker, it’s like ‘Oh my god, I used to smell this way’.

How easy is it for you to obtain the products you need in Chile?

For me, it is actually very easy because I know the market, but in Chile there is a minister who tried to ban the e-cigarette in 2010. I was in charge of the campaign against him – and we were able to stop him. But then at midnight without anyone knowing, he signed a decree against selling nicotine and only gives power to pharmacies to sell nicotine. So, getting liquids with nicotine is harder for people in Chile. You can find it, but for a newcomer it is difficult because no one will sell to anyone they don’t know because they can get in trouble. So, for a normal vaper it is quite easy, but for the ones that are starting, many shops will not sell them nicotine.

Do any of your family or friends use safer nicotine products?

I have switched many people personally; the most difficult person to switch was my mum. She continued to smoke and it was very difficult to get her off the cigarettes. It was a pity because I was an activist and the person I loved most was still smoking, but with this new pod of Joytech, she was able to quit and she now has her own pod and I am really happy about that. And she is even vaping without nicotine, so that’s nice. She has had a better physical state and can do loads of other activities.

An HTP user from Taiwan

When did you start smoking?

I started smoking when I was about 22, I’m 37 now, so that’s 15 years. There was nothing in particular affecting my health. But every morning when I would wake up it felt like there was something stuck in my throat and I’d have to spit it out, the colour would be brown or black. After I switched to an HTP that was just gone.

Did you try any other SNP before trying an HTP?

Vaping and HTP are both illegal in Taiwan, but I did try vaping about three years ago. When vaping kits came out on the market unofficially, I saw advertisements on Facebook, and then I went to a private store and I got this vaping kit and some e-liquid. The experience was quite different from smoking a cigarette, so that didn’t last long. I only vaped for maybe a month or two. When I stopped, I just put it in my drawer and never took it out again. I stopped vaping in 2017 and went back to smoking, and then started using an HTP last January.

What was the motivation to try an HTP?

Before I bought it, I’d been to Tokyo and seen this product quite a few times there and seen it on the street and in smoking areas in Taiwan. I thought I should give it a try because it looked like people were changing their ways of smoking to this electric thing. So, why not? I bought it and tried it for a week, while smoking at the same time, then found I couldn’t bear the smell of smoking. I didn’t really have a reason to quit smoking, I wasn’t really trying to quit, I just thought maybe this is a better way. When I have people around me with an HTP, it doesn’t smell bad compared to cigarettes and when it cleared up my chest and phlegm, I thought yes, it is better.

So, you were a dual user for a while?

I started to use the HTP on a daily basis and I still smoked cigarettes, but not for long, I think a week. After I finished all my cigarettes, I quit cigarettes. Even now when I’m drinking with friends and they are smoking I sometimes would borrow one and try to smoke it but that smell and fragrance, I can’t take it anymore. The burning smell of cigarettes really stinks.

How easy is it to obtain the products you need?

Because of the law in Taiwan, before COVID, I bought what I needed when I or friends go to Japan. COVID means no one is going out or coming in to the country, so I have to buy from the black market where the prices are 50 per cent higher.

Can you buy the products online?

I think I can order online, and they can deliver, but everything is happening inside the country, not coming from overseas. The people who I buy from have already bought from overseas, then pack the goods in Taiwan and send to me.

Do any of your friends or family use SNP?

My sister smokes but she’s not a regular smoker, she smokes when she drinks. I can only think of one friend, my ex-boyfriend. I introduced him to HTP because I think it’s healthier, it’s cleaner. Now he can’t smoke cigarettes anymore even though cigarettes are much cheaper. One pack of 20 cigarettes costs about $3 or $4 but it’s $7 or $8 dollars [US] for HTP. So I try to cut down using an HTP because it’s so pricey.

Individual health to public health?

As this chapter has shown, consumers have experienced major health benefits from switching from smoking to safer nicotine products. These benefits have been publicly acknowledged by US government officials at the highest levels of public health.