OFFERING RECALCITRANT SMOKERS, A NEW HOPE AT SMOKING CESSATION

Abstract

Smoking remains one of the leading contributory causes for disability and deaths. A tough challenge to healthcare professionals is handling recalcitrant smokers, who slide back to cigarette smoking despite all efforts and interventions to make them quit. The current pandemic has magnified the smoking problem, considering the already increased health risk of active smokers, which is aggravated should they develop coronavirus disease 2019 (COVID-19). Smokers with chronic obstructive pulmonary disease (COPD), a complication many recalcitrant smokers are likely to have already, are at an increased risk leading to much poorer clinical outcomes. The conventional smoking-cessation interventions like nicotine replacement therapy, drugs, behavioral counselling, hypnotherapy, or even acupuncture have proven unsuccessful in weaning the far bigger majority of smokers who wish to quit, but could not help but slide back to cigarette smoking after a short period of complete abstinence. This predicament with recalcitrant smokers has prompted doctors, dentists and other healthcare professionals to reconsider and explore alternatives that could at least mitigate the health risks of recalcitrant smokers. The use of electronic nicotine delivery systems (ENDS)—including heated tobacco products (HTPs) as a smoking-cessation tool in recalcitrant smokers who really could not attain total and sustained smoking cessation despite the use of conventional smoking cessation measures—can increase the chances of success in weaning. Though not considered completely safe, the use of ENDS and HTPs has been shown to reduce the amount of toxic substances a smoker gets up to 95% less, compared to traditional tobacco smoking. Even the youth that are current cigarette smokers, consider it beneficial, and the feared potential ‘gateway effect’ is not borne out in real-world data. Though ENDS, including HTPs, may be considered a pragmatic middle ground for recalcitrant smokers, the long-term nicotine addiction could still pose a problem, for which legislative and regulatory control measures are imperative. This is to prevent the youth and other adult nonsmokers from trying them and being subsequently hooked to it.