What do you think of e-cigarrettes?

[wolfvgang22]

I'm curious what you all think about e-cigarrettes.

A while back I had a patient with a long history of substance abuse who I had been using motivational interviewing with for several months to help him stop smoking. While speaking to him in the office one day, he got out his e-cigarrette and started fiddling with it. He stopped when he realized where he was, and apologized. I recommended that perhaps he shouldn't use e-cigarretes in the clinic in future, but commended him for taking steps to stop smoking.

Right now there doesn't seem to be much evidence regarding the health risks to users or bystanders around the vapors from e-cigarrettes. The hospitals and clinics I've worked in don't have any policy specific to e-cigarette use in the clinic or hospital.

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[shan564]

Useful for quitting tobacco, but probably shouldn't be used in a hospital until we have better data.

 

[rkaz]

During my med school clinical rotations, I often heard docs support patients who were considering using e-cigarettes as an alternative to smoking. So I always presumed it to be a strong positive step forward, without really knowing much about what they were. However, this week there has been a good deal of media coverage surrounding hazards of e-cigarettes that is concerning, and makes me feel like I need to know more before suggesting them as a reasonable smoking alternative for patients. https://www.sciencenews.org/article/health-risks-e-cigarettes-emerge

 

[MacDonaldTriad]

This is completely my conjecture, but it seems likely to me that covering nicotine receptors with e-cigarettes would be less toxic than doing it with cigarettes. I see that as a good thing as long as they do it away from me. It probably doesn’t make them any less addicted to nicotine, just a harm reduction thing. Maybe e-cigarettes are to cigarettes as methadone is to heroine (except for the effects on others around you thing).

 

[clusterF]

I'm not sure that e-cigarettes/cigs are the same as methadone and heroin. Otherwise it seems the patch and other solutions would work. I am not aware of the dangers of reasonable doses of nicotine by itself but it appears that smoking seems to be much worse.

BTW, also mostly conjecture.

 

[OldPsychDoc]

And then there's this different kind of second-hand health risk: http://www.cdc.gov/media/releases/2014/p0403-e-cigarette-poison.html

 

[wolfvgang22]

And then there's this different kind of second-hand health risk: http://www.cdc.gov/media/releases/2014/p0403-e-cigarette-poison.html

Kids will get into anything. I once ate my dad's pipe tobacco. It was cherry flavored. 🤢

 

[novopsych]

I'm a dancer and run a dance therapy clinic, so I'm obviously biased on this. There is just no way to say that an e-cigarette has any of the aesthetic qualities of a cigarette. I don't even like mentioning them in the same sentence. One is pure Americana; it is from the Earth, formed into an iconic paper tube; it is fire and smoke. The other might as well be some third-rate knock off MP3 player. They aren't even in the same category.

As far as safety, I am more concerned about the unlived life than I am a few puffs of smoke. For me, life is the dance, and the dance is life. And a few puffs of smoke floating off into the air is a dance in and of itself.

Could you imagine the travesty to art if the scene in Disney's Alice in Wonderland where the caterpillar is smoking a pipe and blowing rings were replaced with an e-cigarette? There is a tapestry to life that must be respected.

 

[Armadillos]

I'm a dancer and run a dance therapy clinic, so I'm obviously biased on this. There is just no way to say that an e-cigarette has any of the aesthetic qualities of a cigarette. I don't even like mentioning them in the same sentence. One is pure Americana; it is from the Earth, formed into an iconic paper tube; it is fire and smoke. The other might as well be some third-rate knock off MP3 player. They aren't even in the same category.

As far as safety, I am more concerned about the unlived life than I am a few puffs of smoke. For me, life is the dance, and the dance is life. And a few puffs of smoke floating off into the air is a dance in and of itself.

Could you imagine the travesty to art if the scene in Disney's Alice in Wonderland where the caterpillar is smoking a pipe and blowing rings were replaced with an e-cigarette? There is a tapestry to life that must be respected.

Isn't there some dance therapy forum you can clog up with your pseudo-intellectual gibberish? This is primarily a forum for medical professionals who are much more concerned with the well being of our patients than we are about spouting off idealistic naivety resulting from 200 years of the most vile and deadly advertising campaign ever concocted by an industry. Your nothing more than a parrot who learned its lines straight from big tobacco.

 

[slappy]

Novopsych is a physician.

 

[xlithiumx]

Novopsych is a physician.

YIKES. 😱

 

[novopsych]

Isn't there some dance therapy forum you can clog up with your pseudo-intellectual gibberish? This is primarily a forum for medical professionals who are much more concerned with the well being of our patients than we are about spouting off idealistic naivety resulting from 200 years of the most vile and deadly advertising campaign ever concocted by an industry. Your nothing more than a parrot who learned its lines straight from big tobacco.

Like I said, I'm biased. I'm a psychiatrist, but I was a dancer first. When you grow up in the dance, cigarettes are part of life. I don't advocate them to my patients because to be honest, while my patients dance, they are not dancers. There is a big distinction that a lot of people don't get. My patients do dance therapy. Light therapy doesn't turn you into a light bulb; dance therapy doesn't turn you into a dancer. But it works. So no, I do not advocate my patients to smoke. I don't advocate that dancers smoke either, but most will anyway because it's been part of the dance for so long. I'm just saying that from my vantage point as a dancer, e-cigarettes are an anathema.

 

[Leo Aquarius]

I think you can appreciate controversial objects in art without endorsing their use. I remember appreciating a painting with a gun in it. It looked oddly fitting, much better than a toy gun in its place. But never would I advocate violence.

 

[pitman]

Useful for quitting tobacco, but probably shouldn't be used in a hospital until we have better data.

This is what I did.

I chewed tobacco in the US for years. When I came to Australia and discovered that snuff is illegal to sell, I freaked and switched to cigarettes. I tried to quit for years, even importing snuff at times, but the Australian govt. taxes the stuff at levels many times higher than smoking tobacco and holds it up in customs. It would also take me about a week to switch between the two, with a fair amount of stress involved.

Then I got e-cigs and switched from cigs in a single day. NO cravings for cigs, as the route of exposure is so similar -- the physical ritual, the smoke sensation, pretty much everything connected to addiction (the drug itself is but one, albeit necessary, aspect of addiction).

It may be that the flavorings are found in 20 years to cause some health problems, but there is no way that they will be anywhere near as harmful as the volatiles found in combustion products, there is no meaningful 2nd hand smoke issue (albeit that for smoking is overblown) and water vapor just doesn't have the lung penetration that smoke particles have.

But, alas, I also don't see hospitals using them until there's better data. I could see passing them out to patients myself though.

 

[hamstergang]

When you grow up in the dance, cigarettes are part of life.

No, when you grow up around smokers, cigarettes are a part of life. That's not the same thing as growing up "in the dance."

 

[novopsych]

No, when you grow up around smokers, cigarettes are a part of life. That's not the same thing as growing up "in the dance."

I think that for me to try to describe the world of the dance would be like you trying to tell me what it's like to be a hamster enthusiast (just a guess from your name). I can tell you now that I would never get why someone would be enthused by a hamster, yet I still would respect a hamster enthusiast. I respect any way a person finds to live an authentic fully lived life. Yes, I would pet one if given the chance. If I were in Peru, I might even try eating one. But could I be a hamster enthusiast? It would never even occur to me. That's not who I am. So, I can see how it's problematic for me to discuss the dance among non-dancers.

 

[xlithiumx]

The sanctimony.

 

[OldPsychDoc]

Is special kind of hamster. Is filigree Siberian hamster. Only one in shop.

 

[notdeadyet]

Someone have BBC America, per chance?

 

[hamstergang]

I think that for me to try to describe the world of the dance would be like you trying to tell me what it's like to be a hamster enthusiast (just a guess from your name).

Someone else picked this name for me once; I've never had a hamster, nor do I know much about them. I was in the 'world of dance,' however.

 

[novopsych]

Someone else picked this name for me once; I've never had a hamster, nor do I know much about them. I was in the 'world of dance,' however.

I understand a bit now, I think. I've never known a dancer who's left the dance (the detritus falls away through the dance, but not the dancer). May I ask what happened? The dance can be a wonderful addition to anyone's life, whether dancer or not. I've seen patients return from pathetic-ness to life through the dance. What is your life passion if not the dance? I believe everyone has one, and I wasn't insincere when I wrote that it could be hamsters.

 

[strangeglove]

Like I said, I'm biased. I'm a psychiatrist, but I was a dancer first. When you grow up in the dance, cigarettes are part of life. I don't advocate them to my patients because to be honest, while my patients dance, they are not dancers. There is a big distinction that a lot of people don't get. My patients do dance therapy. Light therapy doesn't turn you into a light bulb; dance therapy doesn't turn you into a dancer. But it works. So no, I do not advocate my patients to smoke. I don't advocate that dancers smoke either, but most will anyway because it's been part of the dance for so long. I'm just saying that from my vantage point as a dancer, e-cigarettes are an anathema.

I suspect that dancers love to smoke so much because of the weight loss effects. The question, then, is whether e-cigarettes are as effective for this purpose.


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[greenlion]

Mental hospitals that don't allow smoke breaks to inpatients who are smokers? Your experiences and yay or nay?

 

[OldPsychDoc]

No smoking on hospital grounds/property. Ever.
Those days are over.
(Actually had a smoking room on our VA inpatient unit when I was an intern. One weekend attending actually went in there to round on the vets...my gawd...if I get lung cancer it will probably be from that one encounter!)

 

[notdeadyet]

Mental hospitals that don't allow smoke breaks to inpatients who are smokers? Your experiences and yay or nay?

Nay. We also don't allow patients to fix or drink...

 

[wolfvgang22]

There is no reason to let patient's have smoke breaks at hospitals anymore. They can be prescribed nicotine lozenges or patches.

But personally, I don't care if somebody uses any nicotine product to stop smoking in the clinic, including e-cigarettes around me.
If I had a private clinic, I might allow e-cigarettes in the clinic for harm reduction. I'm not convinced the vapor is more harmful than the baseline atmospheric environment already. Hmm...maybe that would be a good boutique practice - a "vape clinic" for smoking cessation and other psychiatric care
One could set aside a clinic room just for that...
I just want patients to not use tobacco.

 

[Ceke2002]

. When you grow up in the dance, cigarettes are part of life. I don't advocate that dancers smoke either, but most will anyway because it's been part of the dance for so long.

As one (former semi non professional) dancer - "When you grow up in the dance, cigarettes are part of life....it's been part of the dance for so long". Ah, okay and when exactly have cigarettes been inexorably linked to the art of dance, as you seem to be indicating, when you're performing the interpretive dance of the failing nicorette patches? 😵

 

[whopper]

NJ was the second state after NY to make smoking in hospitals illegal.

The day it was enacted, I was on call in a PES in residency in NJ. After I announced to all the patients claiming to be suicidal in the PES, almost all of them dropped their suicidal claims and all admitted to just wanting a place to stay and demanded to be let go.

 

[cookymonster]

Smoking induces CYP 1A2 metabolism (nicotine replacement does not), so if patients are going to resume smoking when they get back home, I think that's a pretty legitimate reason to allow smoke breaks in the hospital. Now, you could argue that the patient's outpatient providers can monitor and adjust for this, but based on the rapidity psychotic patients can decompensate, their poor follow-up, the ease of monitoring this factor in the inpatient setting, and the occasional lack of faith I have in rural community mental health providers, I do not think that this is nearly as effective.

You could make similar arguments for caffeine. Obviously we have to draw the line somewhere, since we never have and never will let our patients just snort as many 8 balls as they please during group.

With all that said, I have to conclude that the cons of allowing smoke breaks (promoting wellness, our own health as providers, reducing secondary gain, and yes, the smell) outweigh the pros. I usually don't make meds like Zyprexa my first choice in these patients though.

 

[slappy]

Smoking induces CYP 1A2 metabolism (nicotine replacement does not), so if patients are going to resume smoking when they get back home, I think that's a pretty legitimate reason to allow smoke breaks in the hospital.

That is a very good point.

With all that said, I have to conclude that the cons of allowing smoke breaks (promoting wellness, our own health as providers, reducing secondary gain, and yes, the smell) outweigh the pros. I usually don't make meds like Zyprexa my first choice in these patients though.

If you do use it and you are sure they would resume smoking the moment they walk out the door, you could consider upping their target dosage a little at discharge, up to a maximum of 30%. It's not a direct suggestion but a derivative of the suggestion made by the authors of the most recent meta-analysis on the topic published by BMJ Open (they recommended trying 30% less dose of olanzapine and 50% less dose of clozapine in non-smokers compared to smokers).

Of course, neither their suggestion nor mine had been tested in any controlled clinical study as far as I know.

 

[hamstergang]

Smoking induces CYP 1A2 metabolism (nicotine replacement does not), so if patients are going to resume smoking when they get back home, I think that's a pretty legitimate reason to allow smoke breaks in the hospital.

Seems like a legit reason to work with the patient on smoking cessation...

 

[slappy]

If only it were that easy!

 

[clusterF]

No smoking on hospital grounds/property. Ever.
Those days are over.
(Actually had a smoking room on our VA inpatient unit when I was an intern. One weekend attending actually went in there to round on the vets...my gawd...if I get lung cancer it will probably be from that one encounter!)

I remember the smoking "room" at the VA. It was a vomit green painted metal cage. Used to be filled every morning. Good times. You could still order beer for patients the last time I was at the VA too. Wonder if that is still around.

 

[Armadillos]

I remember the smoking "room" at the VA. It was a vomit green painted metal cage. Used to be filled every morning. Good times. You could still order beer for patients the last time I was at the VA too. Wonder if that is still around.

I doubt you could do it on a general floor, but I know the long term elderly care unit has a "therapeutic libation" order in the order list.

 

[novopsych]

As one (former semi non professional) dancer - "When you grow up in the dance, cigarettes are part of life....it's been part of the dance for so long". Ah, okay and when exactly have cigarettes been inexorably linked to the art of dance, as you seem to be indicating, when you're performing the interpretive dance of the failing nicorette patches? 😵

You have got some way with words, and it reminds me of one of my favorite authors, David Sedaris. You might not know, but smoking is also associated with great writers. And as much as I wish that smoking didn't cause cancer, I have to say David Sedaris' work has suffered ever since he quit smoking. I'm not saying he lost the gift, but sometimes when you work against the grain of your discipline and all that goes with it (good and bad), you find yourself with splinters in your fingers.

I'm sorry to hear you left the dance, but if you truly were a dancer, I doubt you really have left it. It's still there. I can tell you're an artist.

 

[HarryMTieboutMD]

Not a smoking cessation aid... the behavior still exists. And when the VAPE is gone, the smoker will revert to regular cigarettes. At best, for the smoker, it is harm reduction. As both a distance runner and a physician, I would much prefer second hand vapor (or whatever the vernacular is) to the real thing. A quick pubmed search shows that the data on second hand ecigarette exposure is still inconclusive...

 

[Ceke2002]

You have got some way with words, and it reminds me of one of my favorite authors, David Sedaris. You might not know, but smoking is also associated with great writers. And as much as I wish that smoking didn't cause cancer, I have to say David Sedaris' work has suffered ever since he quit smoking. I'm not saying he lost the gift, but sometimes when you work against the grain of your discipline and all that goes with it (good and bad), you find yourself with splinters in your fingers.

I'm sorry to hear you left the dance, but if you truly were a dancer, I doubt you really have left it. It's still there. I can tell you're an artist.

Thank you. I suppose my point was that you don't have to see the smoke, to become the smoke. And I do say this as a smoker myself. You'r right as well, the dance never leaves you, I can't dance to full capacity anymore (perhaps very rarely, but that's about it) but I still enjoy the art of body movement when I'm able. I dance for myself, and I dance for the joy of the music and the dance. I don't need anything extraneous on top of that, when that music is playing and I'm moving to it, I have all I need in the world at that moment.