Amy Copeland, Ph.D.

Cycles of Addiction

Are E-Cigarettes Helpful for Smokers?

E-cigarettes may be more effective than nicotine replacement therapy.

Posted Feb 28, 2019

Pixabay
Source: Pixabay

Electronic cigarettes (e-cigarettes), electronic nicotine delivery systems, are battery-operated devices used to inhale an aerosol, which typically contains nicotine (though not always), flavorings, and other chemicals.1

Are E-Cigarettes Harmful?

Scientists agree that e-cigarettes are safer than traditional combustible cigarettes; however, their safety and long-term health consequences have not been established. E-cigarettes pose similar risks as regular cigarettes for nicotine addiction and long-term harm to lung health and brain development. There is also evidence showing that the additives in e-cigarettes themselves have harmful effects. These additives include benzene, diacetyl, and metals such as nickel, tin, and lead. In addition, the smoker and others close by are exposed to the aerosol they inhale from e-cigarettes, which can contain harmful chemicals. The use of e-cigarettes in adolescents has been termed an epidemic, and unfortunately, many young adults are initiating nicotine use with e-cigarettes and subsequently going onto smoke traditional cigarettes once they are addicted to nicotine.

Can E-Cigarettes Help Me Quit Smoking?

E-cigarettes have been shown to reduce craving and nicotine withdrawal symptoms in smokers, and 85% of adult e-cigarette users report explicitly using e-cigarettes to quit smoking. There is currently mixed evidence that e-cigarettes may be an effective cessation tool for short-term success in quitting smoking. Recently, a large randomized clinical trial was conducted in the U.K. in which the use of e-cigarettes was compared to nicotine replacement therapy for smokers trying to quit.2 The participants also received weekly behavioral support for up to four weeks. At one year after treatment, almost twice as many individuals in the e-cigarette group (18%) were smoke-free, as compared to the individuals in the nicotine replacement group (9.9%). Smokers rated e-cigarettes as more satisfying and helpful in cessation than nicotine replacement and reported using e-cigarettes more frequently and for a longer period of time than nicotine replacement. In fact, in one year, 80% in the e-cigarette group were still using e-cigarettes, whereas only 9% in the nicotine-replacement group were still using nicotine replacement.

This study provides useful information: e-cigarettes were more effective for smoking cessation than nicotine replacement therapy when both products were accompanied by behavioral support, but e-cigarettes were being used long-term, versus the relative short-term use of nicotine replacement therapy.

What Does This Mean for Smokers?

Smokers need to keep in mind that e-cigarettes have yet to be approved by the FDA as a smoking cessation aid, whereas other cessation aids that are available over-the-counter (e.g., nicotine replacement therapy) or by prescription (e.g., Chantix; Zyban) have been shown to be as effective, are FDA-approved, and are recommended for relatively short-term use. As such, experts are making the following recommendations regarding e-cigarettes:3

  • E-cigarettes should be used only when behavioral counseling combined with FDA-approved treatments are not successful.
  • Patients should be advised by their health care professional to use the lowest dose possible to cope with their cravings and to use e-cigarettes for only a circumscribed period of time.
  •  E-cigarette use should be monitored by health care professionals, as are other pharmacologic smoking cessation treatments.

References

1.     National Institute on Drug Abuse (2018). Drug Facts. Electronic Cigarettes (E-Cigarettes). https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes.

2.     Hajek, P., Phillips-Waller, A., Przulj, D., Pesola, F., Myers Smith, K. et al. (2019). A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. N Engl J Med; 380:629-637. DOI: 10.1056/NEJMoa1808779

3.     Borrelli, B. and O’Connor, G. T. (2019). E-Cigarettes to Assist with Smoking Cessation. N Engl J Med; 380:678-679. DOI: 10.1056/NEJMe1816406