Your daughter hands you a vape and says it must be better than twenty a day. A friend at the club switched two years ago and has not smoked since. The pharmacist mentions that the HSE does not recommend them. Your GP says nothing, because you have never brought it up. If you are over 50 and still smoking in Ireland, that is the quality of advice you are working with, and almost none of it was written with you in mind.
TL;DR
- The Healthy Ireland Survey 2025 found 17% of adults smoke and 8% vape. Half of vapers are ex-smokers, a third still smoke.
- Cochrane’s living review, current to 1 January 2026, found high-certainty evidence that nicotine e-cigarettes beat nicotine replacement therapy for quitting at six months or longer.
- The HSE still does not recommend vaping and offers free NRT plus a Stop Smoking Adviser instead. Both positions are defensible once you see what each is answering.
- Stopping the smoke changes how your body handles clozapine, olanzapine and theophylline. Tell your GP the date you switch.
- Disposable vapes are banned here from January 2027, with flavour restrictions following.
What Irish adults are actually doing
The Healthy Ireland Survey 2025 puts current smoking at 17% of the population, 13% daily, barely moved since 2019. Eight per cent use e-cigarettes: half of them ex-smokers, a third still smoking. Public debate here is almost entirely about teenagers, and the headline figure supports that focus, with the highest daily vaping rate belonging to women aged 25 to 34 at 12.8%. But the highest daily smoking rate belongs to men aged 35 to 44, who are now in their late forties and fifties. The people with most to gain from stopping are the ones nobody writes guidance for.
The evidence, honestly
Cochrane maintains a living review of e-cigarettes for smoking cessation, re-run as new trials appear rather than published once and left. The version current to 1 January 2026 concluded, with high certainty, that nicotine e-cigarettes increase quit rates at six months or longer compared with nicotine replacement therapy. The relative risk was 1.59, roughly four extra quitters per hundred who try, with adverse events probably similar between groups. High certainty is not a phrase Cochrane hands out casually: it means further research is unlikely to overturn the finding.
Why the HSE says something different
The HSE does not recommend vaping as a way to stop smoking, and says it is not confident vaping is a safe or effective route. That reads like a flat contradiction. It is not quite. The HSE is answering a wider question: what should a health service fund, supervise and put its name to? Its own offering is free NRT as patches, sprays, mists and lozenges alongside a Stop Smoking Adviser, which it reports makes you up to four times more likely to stop for good. Those are licensed medicines with decades of safety data in older adults. A forecourt product with no long-term data in people who will use it into their seventies is a different proposition, even when the trials look good.
The practical reading after 50: start with the free, supported route, because it works and it is monitored. If you have tried it more than once without success, vaping is a reasonable next step rather than a failure, and worth telling your GP about rather than doing quietly.
Dual use is the trap
A third of Irish e-cigarette users still smoke, and that is the outcome to plan against. It is easy to drift into: the vape indoors and in the car, cigarettes with a pint or after dinner. Harm from smoking does not scale neatly with the number of cigarettes, and cardiovascular risk rises steeply even at low daily amounts, so cutting from twenty to five removes far less risk than the arithmetic suggests. If you switch, switch completely, and pick a date.
The bit nobody mentions: your other medicines
This is the point most likely to matter after 50, and it is almost never raised at the moment of switching. It is not the nicotine that interferes with your medicines. It is the smoke.
Polycyclic aromatic hydrocarbons from burning tobacco induce a liver enzyme called CYP1A2, which speeds up clearance of several drugs, so smokers need higher doses to reach the same blood levels. Dose-corrected olanzapine concentrations have been found around five times lower in smokers, and theophylline clearance is raised by 58% to 100%. Stop inhaling smoke and that induction fades within days, so levels climb. Reported consequences include seizures, tremor and rapid heart rate. Clozapine, olanzapine and theophylline matter most, with warfarin and caffeine worth watching, which is why some people feel jittery on their usual four cups after quitting.
Crucially, this applies just as much if you switch to a vape as if you give up nicotine entirely, because you have stopped the combustion either way. Tell your GP or pharmacist the date you stopped smoking, and if you take any of those medicines, have that conversation before you switch. Our guide to managing multiple medications after 50 covers how to run that review.
What we know and do not know about harm
Vaping is not harmless and it is not equivalent to smoking. Nicotine raises heart rate and blood pressure in the short term, which matters if yours is already borderline, and dry mouth, gum irritation and throat irritation are common early on. Keep an eye on dental health after 50 if you switch.
One clarification is overdue, because the headlines stuck. The severe lung injury outbreak reported in the United States in 2019, known as EVALI, was traced to vitamin E acetate used as a thickener in illicit cannabis cartridges, not to regulated nicotine e-liquid. The genuine unknown is duration: nobody has forty-year data, because the products are not forty years old. That uncertainty is real, but it sits against a known quantity, which is what another twenty years of cigarettes will do.
Ireland’s laws are about to change
The Public Health (Single-Use Vapes) Bill 2025 completed its passage through the Oireachtas in July 2026. It prohibits the retail sale of disposable vapes, with a six-month window for retailers to clear stock, taking full effect in January 2027.
The Public Health (Tobacco Products and Nicotine Inhaling Products) (Amendment) Bill 2026 goes further: flavours restricted to tobacco or unflavoured, limits on colours and imagery, no advertising in retail outlets, no point-of-sale display in shops and garages, and the first Irish provisions naming nicotine pouches, banning their sale to under-18s.
If your quit depends on a disposable device in a particular flavour, it is built on sand. Move to a refillable one now, and do not let a product vanishing off a shelf put you back on twenty a day.
Coming off the vape
Vaping at year three is not a failure, but it is not the finish line either. Step the nicotine strength down gradually, then reduce how often you reach for it, and finally break the hand-to-mouth habit that outlives the craving. NRT is free through the HSE and perfectly usable to come off a vape rather than off cigarettes. Four things worth asking your GP or pharmacist:
- Do any of my medicines need a dose review if I stop smoking?
- Can I combine free NRT with a Stop Smoking Adviser, and how do I arrange it?
- Is my blood pressure being checked often enough while I use nicotine?
- What is the plan for coming off the vape, and when do we revisit it?
Free help runs all year: the HSE QUIT service on freephone 1800 201 203, at quit.ie, or a Stop Smoking Adviser arranged through your GP or pharmacist. Quitting at 55 or 65 still buys back years and function, as we covered in our guide to quitting smoking after 50. At Críonna Health we write about the parts of Irish healthcare nobody explains at the counter, and the choice between a vape and a patch is one of them.
This article is general information, not medical advice. Never stop or change a prescribed medicine without speaking to your GP or pharmacist first. If you develop chest pain, severe breathlessness or a sudden irregular heartbeat, call 112 or 999.
📷 Photo by Annie Spratt on Unsplash
