Nicotine or Tobacco?
Although e-cigarettes are not FDA-approved as a nicotine replacement therapy (NRT), they are still being marketed as a tool for smoking cessation. Cigarette smoking is the most important cause of premature mortality in the world and quitting can reduce many health risks, such as lung cancer, cardiovascular disease, stroke, etc. There are many approved nicotine-replacement products that are known to help with smoking cessation, such as the transdermal patch, gum, lozenges, nasal sprays, mouth sprays, etc. But, do e-cigarettes provide a better technique for smoking cessation than the ones that already exist?
What We Know From Clinical Studies
One of the best studies we currently have is a randomized controlled trial that assigned 886 adults who were trying to stop smoking to either NRT products of their choice (and they can combine and switch between products) or an e-cigarette starter pack. Along with this, the participants were also receiving weekly behavioral support for 4 weeks.
The primary outcome was to see if the participants could abstain from smoking for one year. The 1-year abstinence rate was almost twice as high in the e-cigarette group compared to the NRT group, with 18% and 9.9% respectively. The e-cigarette group also reported less nausea, coughing, and phlegm in the 1-year abstinence compared to the NRT group. This suggests that, when combined with behavioural support, e-cigarettes were more effective for smoking cessation than nicotine-replacement products.
However, they also found that 80% of individuals in the e-cigarette group who completed the 1-year abstinence were more likely to use their assigned product at the end of the 1-year abstinence than only 9% of those in the nicotine-replacement group. This suggests that e-cigarettes could be more addictive than the nicotine-replacement products. Meanwhile, the e-cigarette group had more frequent reporting of throat or mouth irritation than the nicotine-replacement group.
Is It Better to Switch to E-Cigs?
The honest answer is that we really don’t know yet. This study has many positive and negative takeaways. The positive thing is that the e-cigarettes did help a lot more people quit smoking than the approved nicotine-replacement products. When you compare combustible cigarettes to e-cigarettes, the latter definitely has fewer carcinogens and co-carcinogens, and thus it reduces health risks and helps with smoking cessation.
But is it really any better to switch from an addiction to tobacco to an addiction to nicotine? There is a concern that e-cigarettes could be more addictive than nicotine-replacement products. Depending on the amount of nicotine in the juice, e-cigarettes could still be detrimental. For example, 1 JUUL pod contains as much addictive nicotine as a pack of cigarettes (1 JUUL pod = 20 cigarettes).
Although the study found that e-cigs were more effective than other nicotine replacement products for smoking cessation, there is still not enough information on the safety and health effects of e-cigs. The very few studies that do exist have pointed out negative health effects, such as potential cardiac and pulmonary risks. Even if more studies find that e-cigarettes are a more useful tool for smoking cessation, there is still the underlying notion that e-cigarettes might be just as addictive as regular cigarettes.
Currently, the AAFP (American academy of family physicians) does not endorse e-cigarettes as a cessation device. Instead, they support behavioral interventions and FDA-approved pharmacotherapy to help tobacco users quit.
So yes, e-cigarettes may be less harmful than regular cigarettes, but that does not mean that they are harmless. More studies need to be done on the addictiveness of nicotine and its long-term health effects to obtain a fully comprehensive view of the potential effectiveness and/or harmfulness of e-cigarettes as a nicotine-replacement product before making any solid conclusions.
References
Hajek, P. M., Phillips-Waller, A. J., Przulj, D., Pesola, F., Smith, K., Bisal, N., … Mcrobbie, H. (2019). A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. New England Journal of Medicine, 380(7), 629–637. doi: 10.1056/nejmoa1808779
Crawford, C. (2019, February 13). Study: E-cigarettes Top Nicotine Replacement for Quitting. Retrieved November 22, 2019, from https://www.aafp.org/news/health-of-the-public/20190213NEJMe-cigstudy.html
