Kanabo today announced that its unique CBD and nicotine formula for help in quitting both e-cigarettes and traditional cigarettes has moved from the Patent Cooperation Treaty (PCT) phase to National Phase in the U.S., U.K., and E.U. countries. It’s the last phase before becoming an internationally approved patent.
Credit: Kanabo
One of Europe’s fastest-growing medical cannabis and R&D companies that focuses on the distribution of cannabis-derived products for medical patients, and wellness CBD consumers, Kanabo’s says the smoking cessation market is expected to reach £50 million within a few years. “Kanabo’s unique, high potency CBD and nicotine and standalone CBD formulas, delivered by their proprietary cartridges and VapePod, can be used to treat nicotine and tobacco addiction, with evidence so far suggesting the program significantly reduces physical and psychological nicotine withdrawal effects,” a press release states.
Covered under the Kanabo patent application is a new formula development of specific naturally derived terpenes to allow the application of a “very consistent and reproducible, high concentration of CBD throughout the life of the Kanabo cartridge.” Initially, CBD is combined with nicotine, which is then reduced over several weeks until there is zero Nicotine presence. Tests with a small group of volunteers cigarette smokers that participated in Kanabo’s trial showed an “average reduction of 70 percent in their cigarette consumption” and did not experience physical or psychological withdrawal effects
“Our unique patent pending CBD formulations and controlled and consistent delivery device, the VapePod, represents an excellent opportunity for governments to quickly end the reliance on tobacco for millions of citizens worldwide,” said Avihu Tamir, CEO for Kanabo. “Our tests show a dramatic reduction in nicotine consumption, whether in cigarettes or e-cigarettes, which can only be good news for health services around the world.”
New technologies that deliver nicotine without combustion present a substantial opportunity to end the death and disease associated with tobacco use, especially in low-income and middle-income countries (LMICs), according to the International Commission to Reignite the Fight Against Smoking.
In a new report, the commission offers facts, analysis and recommendations aimed at reinvigorating an effort that has stalled, “mired in an outdated paradigm that has been superseded by new technology, new ideas and new concerns for neglected communities.” The fact that there are still more than 1.1 billion tobacco users worldwide proves that the fight against smoking requires new ideas and ambition, its members note.
Among other recommendations, the commission calls for risk-proportionate tobacco policies and better access to harm reduction in LMICs (where most smokers are located). It also encourages medical bodies to reestablish the leadership role of doctors in ending smoking and urges tobacco companies to have a clear plan to phase out high-risk combustible products.
Tobacco harm reduction advocates welcomed the report. “This report thoroughly documents the global health toll of smoking, now and in a likely future,” said Donald Kenkel, Andrew Dickson White professor in the Cornell Jeb E. Brooks School of Public Policy and the Department of Economics at Cornell University.
“But the report also shows that through continuing technological innovation, tobacco harm reduction is an immediate, achievable goal. Evidence-based economic policies and regulations that support tobacco harm reduction offer real hope to help people quit smoking and improve their health.”
The report was prepared by James K. Glassman, former U.S. undersecretary of state for public diplomacy and public affairs; Rosemary Leonard, general practitioner; Kgosi Letlape, president of Africa Medical Association and president of Medical Councils of Africa; Vivan Sharan, Koan Advisory; and Tikki Pangestu, former director of research policy and cooperation at the World Health Organization.
A new study by Queen Mary University of London, published in Addiction, shows that e-cigarettes are more effective in achieving long-term smoking reduction and cessation than nicotine-replacement therapies (NRT).
The study randomized 135 smokers who had been unable to stop smoking with conventional treatments into two groups—one received an eight-week supply of their choice of NRT and the other received an e-cigarette starter pack with instructions to purchase further e-liquids of their choice of strength and flavor. Products were accompanied by minimal behavioral support.
After six months, 27 percent of those in the e-cigarette group had reduced smoking by at least half compared to 6 percent in the NRT group. Of the participants in the e-cigarette group, 19 percent had stopped smoking altogether versus 3 percent in the NRT group.
“These results have important clinical implications for smokers who have previously been unable to stop smoking using conventional treatments,” said Katie Myers Smith, lead researcher and health psychologist, in Eurasia Review. “E-cigarettes should be recommended to smokers who have previously struggled to quit using other methods, particularly when there is limited behavioral support available.”
“This study shows e-cigarettes can be a very effective tool for people who want to stop smoking, including those who’ve tried to quit before,” said Michelle Mitchell, CEO of Cancer Research U.K., which funded the study. “And research so far shows that vaping is far less harmful than smoking. But e-cigarettes aren’t risk free, and we don’t yet know their long-term effects, so people who have never smoked shouldn’t use them.”
Juul Labs announced findings from its science and research program at the 2021 Annual Meeting of the Society for Research on Nicotine & Tobacco (SRNT), which was held virtually. The studies presented covered a wide range of topics that contribute to the growing body of scientific evidence on ENDS products, including information about their harm reduction potential as well as rates of complete switching to ENDS among adult smokers.
To better understand patterns of tobacco product use among adult smokers, Juul Labs has developed an extensive behavioral research program that includes measurements of complete switching from combustible cigarettes to the Juul System among adult smokers. Among the data presented at SRNT are the results of a longitudinal study which found that more than 50 percent of adult smokers who purchased the Juul System reported complete switching at a 12-month follow-up assessment. Complete switching was defined as no cigarette smoking in the past 30 days.
Another new study presented this week examined trends in dual use of the Juul System and cigarettes among adult smokers who recently purchased Juul products, as well as any changes in cigarette consumption among these dual-users. While dual use of Juul products and cigarettes was initially high, it declined over time, and most adult smokers who began by dual-using ultimately switched completely away from cigarettes 12 months after initial purchase. Additionally, over 60 percent of dual-users at 12 months substantially reduced their average daily cigarette consumption. Researchers concluded that dual use is often a transitional stage characterized by reductions in cigarette consumption followed by complete switching away from cigarettes.
Nicotine vaping products were the most popular quit-smoking aids (27.2 percent) in England in 2020, according to Public Health England’s (PHE) seventh independent report on vaping, carried out by researchers at King’s College London. Using a vaping product as part of a quit attempt in local stop smoking services had some of the highest quit success rates—between 59.7 percent and 74 percent in 2019 and 2020. An estimated 50,000 smokers stopped smoking with the aid of a vaping product in 2017.
Despite these trends, 38 percent of smokers in 2020 believed that vaping is as harmful as smoking; with 15 percent believing that vaping is more harmful
The coronavirus pandemic is likely to have had an impact on smoking and vaping behaviors in both adults and young people. However, it is still too early to assess the full effect of the pandemic, with much of the data examined in this report being pre-pandemic.
Vaping has plateaued in adults and young people since the last PHE report in March 2020. Around 4.8 percent of young people (aged 11 to 18 years) reported vaping at least once a month—the same as last year—and most of these were either current or former smokers (only 0.8 percent of young people who had never smoked currently vape). Smoking prevalence among young people, including those who smoked sometimes or more than once a week, was 6.7 percent in March 2020, similar to March 2019, at 6.3 percent.
Similar to last year, around 6 percent of adults are current vapers, equating to about 2.7 million adult vapers in England. Smoking prevalence continues to fall and is between 13.8 percent and 16 percent depending on the survey. Vaping prevalence was between 17.5 percent and 20.1 percent among current smokers, around 11 percent among former smokers and between 0.3 percent and 0.6 percent among those who have never smoked. The proportion of vapers who also smoke, or “dual users,” has declined since 2012.
“Our report draws together findings from randomized controlled trials, stop-smoking services and population studies and concludes that nicotine vaping products are an effective way of successfully quitting smoking,” said Ann McNeill, professor of tobacco addiction at King’s College London.
“What is concerning is that smokers, particularly those from disadvantaged groups, incorrectly and increasingly believe that vaping is as harmful as smoking. This is not true and means fewer smokers try vaping.
“The goal for 2030 is to be smokefree in England. The development of a new Tobacco Control Plan and this year’s review of the Tobacco and Related Products Regulations 2016 is an opportunity to ensure that the regulations around vaping are appropriate. The regulations are also hoped to help smokers to quit, while not attracting people who have never smoked.”
The nicotine delivery of Juul products available in the United States and Canada (59 mg/mL or 5 percent nicotine by weight) more closely resembles the nicotine delivery and experience of cigarette smoking than Juul products available in the European Union, which contain 18 mg/mL and/or 9 mg/mL of nicotine, according to a new study from Juul Labs published in Nicotine & Tobacco Research.
Researchers posited that heavier and more dependent smokers in particular may require the greater nicotine delivery of the higher nicotine concentration Juul pods (59 mg/mL) in order to successfully transition away from cigarettes.
The new study, which consisted of 24 adult smokers, assessed the nicotine delivery and subjective effects of combustible cigarettes compared to the Juul system with three nicotine concentrations: 59 mg/mL (U.S. and Canada), 18 mg/mL (U.K. and Canada) and 9 mg/mL (U.K.).
At each of five study visits, participants used one of four Juul products or smoked their usual brand of cigarette during controlled (10 puffs) and ad libitum use (5 minutes) sessions. Blood samples were collected, and levels of nicotine in the bloodstream were measured for each study product. Subjective effects, including relief of craving for cigarettes and withdrawal symptoms, were assessed 30 minutes after participants used each product.
The higher concentration (59 mg/mL) Juul product delivered significantly greater levels of nicotine and significantly reduced craving and withdrawal compared to the Juul with 18 mg/mL and 9 mg/mL nicotine concentrations. Researchers concluded that the lower nicotine delivery and craving relief from the 18 mg/mL and 9 mg/mL Juul pods available in the EU may limit the product’s ability to provide a satisfying alternative to cigarette smoking—particularly for more dependent adult smokers living in that region.
“When considering laws and regulations governing nicotine concentration in ENDS, policymakers should bear in mind that the availability of a variety of alternative nicotine products may facilitate even more smokers transitioning away from cigarettes,” said Mark Rubinstein, vice president of global scientific affairs at Juul Labs.
Advocacy organization’s roots are based in giving consumer’s access to lower-risk nicotine products
By VV Staff
In the early days of e-cigarettes, the U.S. Food and Drug Administration (FDA) began seizing the next-generation products. In response to the federal action, a group of enthusiasts and dedicated vapers became concerned that consumers would lose access to the potentially life-saving technology. That led to the creation of the Consumer Advocates for Smoke-Free Alternatives Association (CASAA). Alex Clark, CEO of CASAA, said the organization soon started building an army of consumers dedicated to keeping vapor products on the market.
“We truly are a grassroots consumer organization,” explains Clark. “We speak from the heart. And it is our needs as consumers, as people who are choosing a better path in the way that we consume nicotine and tobacco products; that’s where we’re speaking from, and that’s what sets our policy agenda.”
Speaking during the Global Tobacco & Nicotine Forum (GTNF) in late Sept., Clark disclosed that CASAA does accept donations from a variety of stakeholders, including industry stakeholders, but the organization does not have any policy, legislative messaging or financial agreements with any of its supporters. Clark says that the conversation surrounding vaping is centered in harm reduction and that is the mission of CASAA.
Alex Clark / Credit: CASAA
“Vaping … has become this conversation about tobacco harm reduction, [it] is a consumer-driven movement. I don’t think there’s anything groundbreaking in that statement,” he said. “But I bring it up because I believe—and I think many of us believe—that the industry and policymakers need to be reminded of that, that as people who used to smoke, we have endured years of other people telling our story.”
CASAA grew as a community organization through its “tight feedback loop” between consumers and independent manufacturers. Clark likened the early days of the not-for-profit organization to the local food movement, where “if you wanted to know where your cheeseburger came from, you could drive down the road” and visit the farm.
“I think we can all come to embrace that spirit and that side of the industry as an asset, not necessarily something that needs to be regulated to within inches of its life,” Clark said. “As consumers, we are very deeply afraid that is what’s going to happen. That as larger firms are able to make it through the [premarket tobacco product application (PMTA)] process, that we [will] lose that very important retail experience to be able to walk into a vapor shop and learn about the products, but also discuss the challenges that we’re facing in transitioning away from smoking.”
Clark says that a major concern for CASAA and its supporters is that the U.S. Food and Drug Administration (FDA) PMTA process is too expensive and arduous for small business owners. He says the organization worries that if only large tobacco companies can sell vapor products, consumers will lose the ability to have a place to learn and understand the choices available, through different types of products, to help them stop smoking.
Clark mentioned a study that evaluated the long-term success rates of quitting smoking for people who visited specialty vape shops versus people who bought their products at convenience stores. That study found that consumers that visited vape shops were more successful at stopping smoking. “They were more likely to transition completely and they were more likely to stick with the products for longer,” said Clark.
Because of the success vape shops have had at helping people quit smoking, they began to move away from the stigma they carried in local communities early on as being businesses where “potentially unsavory elements go to get their drugs,” according to Clark. He says that, today, vape shops are seen for what they are: a contact point for public health messaging and people who smoke. “People who are looking for a way to move away from combustible tobacco visit vape shops, and it’s a very casual setting,” he says. “It’s a place where people can feel safe, and welcome, and being able to just share our stories with one another. It is very helpful, and it really looks a lot like a community support [group for smokers].”
Clark said this distinction is important for regulators and anti-vaping groups to understand. Smokers began making the decision to quit using cigarettes by switching to vapor products of their own accord. There was not a government agency telling them that e-cigarettes had the potential to help them quit deadly smoking and small, family-owned vape shops is where the conversations and mass conversions began.
“We have made this decision on our own, which is a bit challenging to the dominant narrative painting people who smoke as victims. I, honestly, don’t feel like a victim,” he says. “I started smoking in the mid-90s. Certainly, I was subject to all kinds of messaging about why I shouldn’t smoke. Not only why it would be negatively affecting my health, but why it was essentially a character flaw and I was a bad person.”
Clark says vape shop owners need to help keep vape shops available to smokers by taking steps to continue to change people’s perceptions of them. Owners need to keep their shops clean and sanitary. Don’t have such a thick cloud of vapor when opening the door that potential customers are driven away. Vape shops should have an open and welcoming environment.
“You need to have a place for your customers to talk with one another. People behind the counter need to be very knowledgeable about the products that they are selling. Regulations [need to allow] people [to] have candid conversations about these products. As it stands now, I think even sharing your personal story about making the switch while standing behind the cash register could get people into a lot of trouble,” he says emphatically. “There’s a lot of room for regulations to improve in terms of allowing people to receive important information and also the education that needs to happen among people working in vape shops.”
People often internalize messages that are intended to encourage them to change their lives for the better, according to Clark. He says people also internalize messages about being deficient. Some of the rhetoric surrounding vaping and the misinformation about its harms is detrimental to public health. Vape shops create an environment where people feel comfortable discussing their goal of quitting cigarettes. Anti-vape groups, however, are putting these “safe zones” for smokers in jeopardy.
“We have already seen the legislative agenda of the anti-vaping, anti-nicotine campaigns which is to go after flavors, which very obviously shuts down vape shops and takes away that very important element of providing a space for people to come together and support one another,” Clark told attendees. “We must be prepared to take on these fights at the local and state level.”
Fighting the types of legislative challenges that the vapor industry is facing is complicated. Clark says that when attempting to tackle many legislative issues in the United States, it is like dealing with 50 different countries. “Certainly, you can see this in our patchwork of responses to the [Covid-19 pandemic],” he says. “Within those 50 countries, we have 39,000 local governments and all of these are potential pressure points where anti-nicotine activists will promote anti-harm reduction policies. If we don’t stand up for ourselves, we can’t rely on other people to do it for us and we cannot surrender our voice to either anti-tobacco activists or the tobacco and nicotine industry.”
In the form of mass-marketed consumer products, e-cigarettes do not help smokers quit cigarettes, according to a new study published Dec. 22, 2020, in the American Journal of Public Health by researchers from the University of California San Francisco.
The authors examined both observational studies, which question people “in the wild” without specific guidance to quit, and clinical trials, in which smokers trying to quit were given free cigarettes under medical supervision.
While e-cigarettes led to more quitting than some other therapies in clinical trial settings, the authors noted no such effect in observational studies.
Richard Wang
“It’s important to recognize that in clinical trials, when certain e-cigarette devices are treated more like medicine, there may actually be an effect on quitting smoking,” said study leader Richard Wang.
“But that needs to be balanced against the risks of using these devices. Also, only seven e-cigarette devices were studied in the clinical trials. Whether the effect observed with these seven devices is the same or different than that of the thousands of different e-cigarette products available for sale is unknown.”
The 2009 Family Smoking Prevention and Tobacco Control Act charges the U.S. Food and Drug Administration (FDA) with allowing e-cigarettes on the market only when manufacturers can prove their tobacco-based products are “appropriate for the protection of public health.” The FDA is currently evaluating thousands of applications to sell e-cigarettes.
“If e-cigarette consumer product use is not associated with more smoking cessation, there is no population-level health benefit for allowing them to be marketed to adults who smoke, regardless of the relative harm of e-cigarettes compared with conventional cigarettes,” said Wang.
“Moreover, to the extent that people who smoke simply add e-cigarettes to their cigarette smoking—becoming so-called dual users—their risk of heart disease, lung disease, and cancer could increase compared with smoking alone.”
E-cigarettes showed considerable promise as a smoking-cessation aid during a study in the U.K. that was recently published by Reed Wellbeing.
The health and lifestyle service engaged in a one-year pilot from February 2019 to February 2020 to independently assess the impact of directly supplying e-cigarettes as a form of nicotine replacement therapy (NRT) to up to 200 participants though the One You Haringey stop-smoking service.
Participants were given a choice between NRT, e-cigarettes or Champix. Those selecting e-cigarettes were provided with a device and pods free of charge and were supported to quit in line with treatment guidelines from the U.K. National Centre for Smoking Cessation and Training.
E-cigarettes outperformed both NRT and Champix in first-attempt quits during the trial. The devices achieved a 93 quit rate when used alone and a 72 percent quit rate when combined with NRT. NRT use resulted in a 49 percent quit rate and Champix achieved a quit rate of 57 percent.
Twelve weeks after the trail, 100 percent of e-cigarette users were still refraining from smoking, compared with 96 percent of participants who used e-cigarettes and NRT, 84 percent of those who used NRT and 91 percent of Champix users.
The U.K. Vaping Industry Association (UKVIA) has welcomed new research that has found that vaping is 70 percent more effective in helping smokers to quit cigarettes than nicotine replacement therapy (NRT), such as patches and gum.
The study undertaken by Cochrane, which reviewed 50 studies across the world, with more than 12,000 participants, also showed that an additional 60 percent could potentially quit smoking with nicotine containing electronic cigarettes. In addition, the review found that “there was no evidence that people using nicotine containing e-cigarettes reported more serious health problems than people using nicotine-free e-cigarettes, NRT or no therapy at all.”
John Dunne
John Dunne, director general at the UKVIA, said the findings add to a growing catalogue of evidence supporting vaping’s role in smoking cessation.
“Quitting cigarettes can be difficult, which is why adult smokers must have access to the most effective tools available,” he said. “This review underlines the enormous potential vaping holds for public health, particularly as the government aims for a smoke-free U.K. by the end of the decade. We call on all stakeholders, from policymakers to health professionals, to seize the opportunity which vaping represents, and to give smokers the best chance of quitting successfully.”
According to Dunne, the recent review builds on research by the National Institute of Health Research and Cancer Research UK, which shows that vaping was far more effective than nicotine replacement therapy products.
