Pharmacy U presenter Todderick Prochnau: Emerging trends in tobacco use disorder - Canadian Healthcare Network

Todderick Prochnau will be presenting at Pharmacy U Toronto on April 1, 2023.

The prevalence of smoking tobacco in Canada is about 10% (1 out of 10 Canadians on average; higher in marginalized communities). Because smoking remains a significant public health threat, the Government of Canada has announced a goal of reducing smoking rates to 5% or less by 2035. 

Pharmacists and other health professionals continue to support patients ready to quit smoking by utilizing nicotine replacement therapy (NRT), prescription bupropion or prescription varenicline. Unfortunately, until recently, there were no other options to support patients unable or unwilling to quit. 

Smoking tobacco causes a range of health consequences including cancer, cardiovascular disease and respiratory disease. Most of the harm caused by smoking is a result of the combustion (burning) of tobacco. When tobacco is combusted (burned) it produces thousands of toxic substances many of which are carcinogenic. Although nicotine is highly addictive, it is not the cause of significant health consequences related to smoking.  

NRT has been used for many years as a tobacco harm reduction option. NRT provides nicotine without the toxins and carcinogens produced when smoking tobacco. While NRT remains an option for some patients, others are not able to transition from smoking tobacco to NRT. 

Electronic smoking/vaping devices that contain nicotine are licensed in Canada for use by adults. These devices are commonly known as "vapes" or e-cigarettes. E-cigarettes have a battery powered heating element that heats a liquid containing nicotine. This produces a tobacco-free vapor that the user inhales. E-cigarettes are not risk free. However, when compared to conventional cigarette smoking e-cigarettes substantially reduce an individual’s exposure to toxic and cancer-causing chemicals. In 2018, Public Health England recommended the following statement be used by health professionals: Stating that vaping is at least 95% less harmful than smoking is a good way to communicate the large difference in risk unambiguously. 

Another new category of devices available in Canada is known as heated tobacco products or heat-not-burn products. These devices are similar to e-cigarettes however they contain a tobacco stick instead of a nicotine liquid. These devices heat the tobacco to produce a tobacco vapor that the user inhales. There is no combustion (burning) of tobacco involved in their use. If an individual switches from conventional cigarettes to a heated tobacco product they will reduce their exposure to some, but not all, harmful toxins and carcinogens. In the United States the FDA has authorized one of these products to be marketed with claims that "fully switching from regular cigarettes to this system can reduce a person's exposure to harmful chemicals". 

If a person smokes conventional cigarettes, they should attempt to quit using one of the first-line options (NRT, bupropion or varenicline). However, for individuals who are unable or unwilling to quit there are now alternatives. E-cigarettes or heated tobacco products can be considered as harm reduction options. This allows pharmacists and other health professionals to meet patients where they are at and offer support for those not ready or able to quit.

1. Statistics Canada. Canadian Tobacco and Nicotine Survey (CTNS) 2020. Accessed 10AUG2022; Online: https://www.canada.ca/en/health-canada/services/canadian-tobacco-nicotine-survey.html. 

2. Connors, C & White Markham, A. (2017). Tobacco Education Workbook. Caledon, ON: Canadian Network for Respiratory Care.

3. Tobacco Harm Reduction - E-Cigarettes - Clinical Support Primer [Internet]. Alberta Health Services (AHS) c2022 [updated FEB2022; cited 1MAR2022]. Available from http://www.albertahealthservices.ca.

4. Selby P et al., The Lower Risk Nicotine Use Guidelines (LRNUG) [Internet]. Centre for Addiction and Mental Health (camh). c2022 [cited 3MAR2022)]. Available from http://www.nicotinedependenceclinic.com.

5. Centers for Disease Control and Prevention (CDC). Heated Tobacco Products [Internet]. [cited 23FEB2022]. Available from https://www.cdc.gov/tobacco/basic_information/heated-tobacco-products/index.html.

Todderick Prochnau will be presenting at Pharmacy U Toronto on April 1, 2023.

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Pharmacy U presenter Todderick Prochnau: Emerging trends in tobacco use disorder - Canadian Healthcare Network
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