The proposal links closely to work being carried out by British NHS-funded researchers, who are looking at the issue of helping those suffering from mental illness switch from smoking to vaping. Incidents of smoking in those with mental health problems is higher than that for the general population, and the majority of those who find themselves homeless suffer from mental health issues and are heavy smokers. Professor Ann McNeill said: “There is a great inequality leading to early death and years of chronic illness for many. E-cigarettes provide a new opportunity for people to move away from smoking and avoid the terrible burden of death and disease it causes.”
Dr. Travis Baggett in 2013, talking about difficulties the homeless face when trying to quit: “The circumstances of homelessness add to these barriers. Whereas most homeless shelters no longer permit smoking indoors, smoking around shelters is commonplace and contributes to a culture of tobacco use that makes quitting more difficult and relapse more likely. The psychological stress of fulfilling survival needs, the physical hazards of daily living, and the attendant expectation of premature death diminish the perceived benefits of smoking cessation in this population. Indeed, homeless people may view smoking as one of the few life domains over which they have control. Tobacco use thus becomes an expression of autonomy in the face of desperation and a source of comfort in the midst of chaos.”
Alyssa Best, Cancer Research UK: “E-cigarettes offer another opportunity for smokers with mental health conditions that haven’t been able to stop using other methods. They should be offered as a legitimate method of quitting across all mental health settings."
In the Canadian study, Pakhalé is seeking to enrol around 200 homeless people in and around Toronto and Ottawa. Half will be provided with free traditional quit products (such as gum and patches), while the rest will receive free electronic cigarettes.
She explained: “We’re trying to understand if e-cigarettes can be in our toolbox since they have some features that could be attractive. They can deliver calculated doses of nicotine in an inhaled fashion, and, secondly, they can give smokers that hand-to-mouth gesture that they crave.”
She added: “Even in the health care field we don’t treat tobacco as a chronic disease for homeless people, which is what we should be doing. From head to toe, each and every organ is affected by smoking. To make matters worse, homeless people often can’t afford the therapies that might help them quit smoking. That’s one of the problems that the randomized controlled trial is designed to address since participants will receive nicotine replacement therapies for free.”