Smoking still remains the leading cause of health and financial disparities for people living with mental illness and new and effective strategies are urgently needed. Growing evidence suggests that tobacco harm reduction with nicotine vaping could benefit this population.

People with mental illness have higher smoking rates, smoke more heavily, are more nicotine dependent and have lower quit rates than the general population. As a result, smoking prevalence is declining more slowly than in the wider community, especially among people with serious mental illness.

According to Public Health England, vaping products are significantly less harmful than smoking. They have become the most popular stop smoking aid in England, with up to 57,000 people using them to quit smoking each year.

There is an urgent need to address smoking-related inequalities in mental health. People with mental illness lose up to 20 years of life expectancy, mainly to consequences of smoking and often cancer.

While nicotine consumption has decreased in the general population, this has not been true for people with psychiatric disorders.

Quitting Smoking and Vaping and Psychiatric Medications

When treating smokers with mental disorders, experts note, it is important to pay close attention to the medications they are taking because smoking can alter the levels of psychiatric medications in the bloodstream.

Tars in cigarette smoke affect the rate at which the liver metabolizes certain medications, causing blood levels of antidepressant and antipsychotic medications to decline, decreasing the effectiveness of the medication. If a patient quits smoking, blood levels rise and his or her old dose can become toxic. Fortunately, nicotine-replacement does not interfere with antidepressant or antipsychotic medications.

Smoking cessation is an integral component of the management of patients with mental illness. Smokers with mental illness are more likely to die from a smoking-related disease than from their primary psychiatric diagnosis.


For smokers who are unable to quit with first line treatments and would otherwise continue to smoke tobacco, long-term substitution with a safer nicotine product could reduce tobacco-related harm.

Public Health England says switching to vaping can improve your mental health and one of the industry organisations has repeated the message following Mental Health week.

Public Health England’s Tobacco Control has said that vaping offers more benefits than just reducing harm from smoking; Martin Dockrell has argued that switching can also improve your mental health. Following the national Mental Health week, a leading trade body has added to the message that binning cigarettes and picking up a vape kit can be beneficial.

Martin Dockrell concluded that the use of electronic cigarettes “has increased in recent years and have become the most popular stop smoking aid in England, with the majority of users now ex-smokers have made the switch completely.

The UK Vape Trade Association harked to a statement from Public Health England that said 1 in 3 cigarettes are smoked by someone with a mental health condition”, so getting them to quit has become an “overriding priority.”

“Right now, recognising how effective vaping is in getting smokers to stop, many UK mental health trusts allow the use of vaping products on their premises in areas separate from regular smokers – many even provide e-cigarettes free to their patients.

Complete cessation of all tobacco and nicotine consumption is always the ideal goal. However, a large proportion of smokers living with mental illness are unable or unwilling to quit, therefore remaining at high risk of smoking-related death and illness.

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In practice, tobacco harm reduction involves encouraging smokers to switch from high-risk combustible cigarettes to a lower-risk nicotine alternative such as vaping. The main purpose of tobacco harm reduction is to reduce (not necessarily eliminate) the harm from smoking. The aim is not to stop nicotine as nicotine in low doses causes little harm.

Vaping is a form of nicotine replacement therapy that delivers the nicotine that smokers crave.

Vaping is unique it simulates the familiar behavioural, sensory and social aspects of the smoking ritual which can be so difficult to break.

People with mental illness are more likely to use a vaping product to quit than those without.

Vaping is more acceptable than nicotine replacement therapy in this population and is associated with greater compliance.

The UKVIA (UK Vaping Industry Authority)  highlights that it’s not just mental health services that are embracing e-cigarettes as the leading method to help people kick tobacco for good; in 2019, after several hospitals banned smoking altogether on their premises, two NHS hospitals took the bold step of allowing vape shops to open within their property.

Because the UK has some of the strictest rules on vaping regulating nicotine strength (2%) and liquid capacity it would be very difficult to increase the nicotine intake. Many countries offer higher strength nicotine vaping products which can range up to 10% nicotine.

Though illegal in the UK many companies and shops sell illegal disposables containing 5% nicotine and above.

I am frequently contacted by manufacturers in Asia looking to export their products.

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This brings me back to why you should always buy from a reputable supplier/shop and make sure your vape meets legal requirements, bearing in mind that as much as 1 in 3 vapes sold in the UK are fake. Top branded disposable vapes can be checked for authenticity online via the manufactures website by scanning the bar code on the box.

Illegal vapes can not only contain harmful high levels of nicotine, they can also contain liquids and chemicals which are illegal in the UK. One person contacted me regarding an Elf Bar they purchased from a privately run petrol station. Apparently every time the puffed on the device, they got a small electric shock sensation.

I’m sure you’ve all seen news articles pertaining to vapes exploding; another danger of buying illegal vaping products.

Smokers who switch to vaping may continue to benefit from the positive effects of nicotine. Nicotine modestly improves attention, working memory and sensory gating which are specifically impaired in schizophrenia.

Switching from smoking to vaping nicotine can also enable a reduction in the dose of some antipsychotic medications, notably clozapine and olanzapine.

Like cigarette smoking, vaping can help to alleviate boredom and can facilitate socialising in people with serious mental illness. These effects may help improve social interaction and reduce isolation which is otherwise difficult to treat.

Vaping nicotine is a legitimate, evidence-based option for reducing harm in smokers who are otherwise unable to quit. Psychiatrists need to be informed about vaping to answer patient questions, provide appropriate advice and counselling, write nicotine prescriptions and support smokers in switching to the safer alternative.