Comment; Electronic Nicotine Delivery Systems (ENDS) can also be used quite successfully to promote cessation in a properly motivated patient with appropriate clinician input. SWITCH (NOT alternate!) to vaping and gradually decrease use. In appropriately motivated patients with other adjunctive measures (acupuncture works great!) can be very successful in helping patients attain long-term abstinence from nicotine.
by Dr. William Haning | Mar 12, 2019
FDA Commissioner Scott Gottlieb, Who Fought Teenage Vaping, Resigns
When Scott Gottlieb, MD was initially nominated as Commissioner of the Food and Drug Administration, concerns were expressed regarding his relationship with industry; and, without revisiting it at length, the approval process was difficult. In the interval since, Dr. Gottlieb has demonstrated his very serious concern and willingness to struggle for the American public. There is conjecture that his resignation derives from congressional and industry resistance to his proposals to control or restrict access to nicotine and other drugs which use “vaping” devices (electronic nicotine delivery systems, or ENDS). Strangely, some of the opposition encountered stems from the claim that ENDS offer a public health benefit, in reducing harm: It is difficult to find a position of reconciliation when both or all parties lay claim to the moral high ground.
The history of addiction is welded to systems of delivery. Most readers will be familiar with examples of this statement. Among the most prosaic are those involving alcohol: the “depth charge” involving a shot glass of whiskey dropped into a large glass of beer; ice cubes made with sweetened cocktails. Epidemic opium use in China required the technological development of long-stemmed pipes that would cool the super-heated opium gas prior to inhalation; this was not a small thing, as it arguably condemned China to two centuries of economic subjugation. The introduction of the hypodermic needle and syringe at the midpoint of the 19th century ensured high bioavailability of morphine, with the consequent development of at least as lethal an epidemic of opioid use among Civil War veterans as is being seen today. Volatilized cocaine, and subsequently methamphetamine, is as rapidly transferred across the pulmonary bed as the same substance injected; Hawai`i’s own experience with inhaled methamphetamine since 1990 has had a profound, negatively-transforming social impact. Given the inventiveness of Americans, little time was needed to elapse between the invention of the ENDS – essentially an electronic bong – and its adaptation as a delivery system for drugs other than nicotine. THC, spice, and bath salts begin the list. This is no more an argument for banning ENDS than it would be for banning hypodermic syringes, but it does emphasize that such devices carry substantial risks; and that it is disingenuous for industry and legislatures to minimize those risks.
– W. Haning, MD
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