Cigarette smoking remains the leading cause of preventable disease and death in the United States and one of the leading causes of death globally. Although 68% of people who smoke say they want to quit, only 10% of those who make a quit attempt remain smoke-free one year later.
There are several FDA-approved smoking cessation medications, including nicotine gum, lozenges, nasal sprays and patches. While the nicotine-based products can be effective, they deliver relatively low levels of nicotine and fail to fully replace the nicotine smokers obtain from cigarettes.
A new position paper by a working group from the Treatment Research Network of the Society for Research on Nicotine and Tobacco (SRNT) seeks to address this issue by recommending that clinicians include e-cigarettes in their discussions with adult smokers who are trying to quit. The paper summarizes the latest evidence and offers practical guidance to health care providers for discussing the risks and benefits of e-cigarettes with their patients.
“Are e-cigarettes safe? No, they’re not. Are they safer than cigarettes? Dramatically safer,” said one of the paper’s authors, Dr. Jasjit S. Ahluwalia, who is professor of behavioral and social sciences and medicine at Brown University and a member and former board member of the SRNT. “Many randomized clinical trials and systemic reviews—including the Cochrane ‘living’ review, which is updated as new evidence is published—report well-established evidence that e-cigarettes are associated with higher quit rates than other nicotine replacement therapies.”
Ahluwalia and co-authors, including Cara Murphy, assistant professor of behavioral and social sciences, stress that while e-cigarettes are not an FDA-approved smoking cessation medication, some have been authorized by the FDA’s Center for Tobacco Products as “appropriate for the protection of public health.”
“Evidence from clinical trials involving thousands of participants consistently shows that e-cigarettes can help people quit smoking more effectively than traditional nicotine replacement therapies, such as nicotine patches or gum,” Murphy said. “Importantly, those trials provide participants with clear guidance on how to completely transition away from cigarettes.”
“The concept is not that e-cigarettes are safe, but that they are harm reduction tools in the same way that one might use methadone for opioid addiction,” Ahluwalia said. “Harm reduction minimizes the dangers of smoking rather than focusing on abstinence as the only viable option.”