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Are e-cigarettes a good option for smoking cessation?

December 2nd, 2013

by Tiffany Zehel, PharmD student

In 2011, an estimated 43.8 million U.S. adults were current cigarette smokers,[i] and currently, estimates of over one billion people worldwide are smokers.[ii] Cigarette smoking is a global epidemic that can give rise to several serious diseases with nearly 6 million deaths annually.[iii] The risk of serious diseases is significantly reduced after one quits smoking and maintains life-long abstinence. Unfortunately many nicotine replacement therapies (NRT’s), such as the patch or gum, have a low efficacy rate in real life practice.[iv] Many studies evaluating the use of nicotine replacement therapies find that while traditional NRT’s provided the chemical need for the individual, the behavioral and psychological needs of the individual were not being met.[v],[vi],[vii]

 The electronic cigarette (e-cigarette) was introduced to the U.S. market in 2007 to provide smokers with more freedom to smoke as well as a safer alternative compared to tobacco cigarettes.[viii] The standard e-cigarette is a battery powered electronic nicotine delivery device (ENDD) that resembles a cigarette, and delivers nicotine in a vaporized solution. The acceptance of the e-cigarette is attributed to the similarities of smoking, including the hand-to-mouth repetitive motion and the visual cue of the vapor, addressing the psychological and behavioral aspects of the addiction.[ix]

According to an article published in The Lancet, E-cigarettes were not shown to have a statistically significant difference in individuals that quit. However, they significantly reduced the amount of traditional cigarettes an individual used in a given day compared to the patch.[x] In this news article e-cigarettes are celebrated based on the fact that they show promise to eliminate tobacco smoking completely in the future, but not so much for the promise of helping people break their addiction. Smoking tobacco is very harmful and traditional cigarettes contain toxins that are carcinogenic. In that respect, e-cigarettes should be admired for their ability to replace cigarettes. The issue is that e-cigarettes are not regulated by the FDA like other NRT’s, and their safety has not been extensively researched, due to the recent emergence of the product.

The article also had several limitations. First, the study was underpowered, meaning any effect could have gone undetected, so the results may not be reliable. Another limitation is that there was a high drop out rate in the group given the nicotine patch; this is speculated to be due to the participants wanting to try e-cigarettes but instead where randomly assigned to receive the patch. A third limitation is that the e-cigarette, that this particular study group used, contained less than optimal amounts of nicotine and delivered nicotine inefficiently. As technology advances and e-cigarettes become more efficient in nicotine delivery, e-cigarettes may be proven more effective. The final limitation is that this study was over six months while the amount of time to quit cigarettes can be much longer depending on the individual.x The short amount of time also provided little ability to evaluate adverse effects that the e-cigarette may cause. Due to these obstacles, it is difficult to say whether e-cigarettes would or would not be better than the nicotine patch.

In an article published in the journal of Addiction Science and Clinical Practice (ASCP), a group of people that regularly used e-cigarettes were followed through a forum and interviewed regularly. One repetitive theme in the article was that the subjects, who identified themselves as “vapers,” drew a line between smoking cessation and nicotine cessation. They claimed that they wished to stop smoking because of the health ramifications, but because of the convenience and perceived safety of the e-cigarettes, they had no desire to quit their nicotine addiction.[xi] Up to this point, smoking cessation and nicotine cessation went hand-in-hand. NRT’s were prescribed to step the patient down from their nicotine addiction; currently e-cigarettes are not set up in this way. So now that we have this unique delivery system on our hands, we need to decide if nicotine cessation is as important as smoking cessation. We also need to do further studies on the long-term effects of e-cigarettes to evaluate their benefits over the alternative.

I do not think that replacing one addiction with a modified version of it is the best idea. While it does reduce the health risk, it does not solve the issue of nicotine addiction, the possible long-term effects, and the cost of feeding the addiction. However, I think that e-cigarettes can be beneficial for smoking cessation and nicotine cessation with proper monitoring from healthcare professionals and social support.

 Do you think that smoking cessation is more important than nicotine cessation? Do you think e-cigarettes should be utilized for nicotine-cessation?

References

[i] Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—United States, 2011. Morbidity and Mortality Weekly Report 2012;61(44):889–94 [accessed 2013 Nov 29]

[ii] Available at: http://ash.org/resources/tobacco-statistics-facts/. Accessed November 29, 2013.

[iii] Polosa R. Rodu B, Caponnetto P, Maglia M, Raciti C. A fresh look at tobacco harm reduction: the case for the electronic cigarette. Harm Reduction Journal 2013;10(19)1-11 [accessed 2013 Nov 29].

[iv] Casella G, Caponnetto P, Polosa R: Therapeutic advances in the treatment of nicotine addiction: Present and Future. Ther Adv Chronic Dis 2010, 1(3):95-106 (accessed Nov 29).

[v] Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, William J, Walker N. Electronic cigarettes for smoking cessation: a randomized controlled trial. The Lancet. 2013;382(9905)1629-1637 [accessed Nov 29).

[vi] Barbeau A, Burda J, Siegel M.  Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach. ASCP Journal 2013;8(5):1-7 (accessed 2013 Nov 29).

[vii] Cahn Z and Siegal M. Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes? Journal of Public Health Policy 2011;32(1)16-31 (accessed 2013 Nov 29)

[viii] Pozin I. Electronic cigarettes : booming industry or health fiasco?; Forbes.com; http://www.forbes.com/sites/ilyapozin/2013/04/11/electronic-cigarettes-booming-industry-or-health-fiasco/; (accessed 2013 Nov 29)

[ix] Polosa R. Rodu B, Caponnetto P, Maglia M, Raciti C. A fresh look at tobacco harm reduction: the case for the electronic cigarette. Harm Reduction Journal 2013;10(19)1-11 [accessed 2013 Nov 29].

[x] Kelland K. E-cigarettes as good as nicotine patches in helping smokers quit. http://news.yahoo.com/e-cigarettes-good-nicotine-patches-helping-smokers-quit-220346477.html (accessed 2013 Nov 29)

[xi] Barbeau A, Burda J, Siegel M.  Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach. ASCP Journal 2013;8(5):1-7 (accessed 2013 Nov 29).

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4 Responses to “Are e-cigarettes a good option for smoking cessation?”

  1. Megan McNicol Says:

    This was very interesting to read. I was not very informed on the uses of e-ciggarettes and didn’t even realize that they still contained nicotine. I believe that there are some advantages to e-ciggarettes in that they do not contain the many carcinogenic additives that traditional cigarettes do that have so many health risks associated with them. However, I would fully agree with Tiffany in saying that replacing one addiction for a “lesser addiction” is not the best approach.

    Smoking is a serious problem today and is one that must be dealt with from the root of the issue which is the nicotine addiction. With the transition to the e-ciggarettes you are treating the symptoms but not dealing with the root of the issue. With that being said, I can see how the e-ciggarette could be beneficial as a form of smoking cessation therapy. Because there has been limited efficacy proven for many other smoking cessation therapies, I think e-cigs could be a possible treatment option. However, I would also desire to see implementation of a structured program to then take the patient from the nicotine dependent state of using the e-cig to a complete cessation of smoking and nicotine addiction. I think the goal should be cessation from smoking and nicotine, not just eliminating smoking.

  2. Jacob Farran Says:

    Until I read your article, I always thought that e-cigarettes were just a vapor. I did not realize that they actually contained nicotine. Essentially e-cigarettes are just cutting out the tobacco, which seems to be the most harmful part of smoking since it causes cancer. I think that smoking cessation is more important than nicotine cessation because cutting out the tobacco is most important since it causes cancer. E-cigarettes could be used for nicotine cessation, but I think they would need to be regulated by the FDA first so there is a standard amount of nicotine in them. It is interesting that the E-cigarettes in the study had less nicotine because they delivered it inefficiently. I agree with you that they may become more effective if the nicotine is more efficiently delivered. E-cigarettes could be successful as a smoking cessation option in the future, but they need to develop a bit and be regulated by the FDA. Since you smoke them like a cigarette they resemble real cigarettes much more than a nicotine patch or gum. At the end of the day the goal for smoking cessation is to quit altogether so E-cigarettes are just a stepping stone to get to that point. Eventually people need to quit both tobacco and nicotine. Doing this one step at a time with E-cigarettes could become an effective smoking cessation method.

  3. Derrick Chapman Says:

    I enjoyed this blog post. The smoking delivery form of a drug was something that i was just recently discussing with my preceptor. He said that no other medicinal drug is administered in that way. The generally accepted consensus is that many of the harmful effects associate with smoking is due to the inhalation of the smoke, tar, and other toxins of the tobacco. However, I had recently been thinking that the NRT’s goal is to stop smoking, not necessarily the actual nicotine addiction. In your research, did you come across any serious adverse effects of continuing the nicotine addiction even if smoke inhalation was not involved? In my opinion, from a moral and health standpoint, I think we need to work towards techniques and therapies to treat the entire addiction, not only the smoking aspect.

  4. Jacob Coleman Says:

    I liked how you differentiated between smoking cessation and nicotine cessation. I think that E-cigarettes are definitely an effective step towards reducing the incidence of health problems related to smoking and reducing smoking addiction overall. I would say E-cigarettes could also be used as one more useful tool for people trying to quit their nicotine addiction. At the same time, however, we may have non-smokers (those without any nicotine addiction whatsoever) start using these E-cigarettes now that they know they are a safe alternative. Some other thoughts about E-cigarettes: should they be allowed in public facilities/workplaces/on planes since they don’t create the same toxic smoke? Will they have the same regulation as tobacco products in regard to marketing to minors, taxes, advertising, etc.?

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