Health experts advocate e-cigarettes as smoking cessation tool when other methods fail

E-cigarettes can help patients stop smoking: ©Andrey Popov - stock.adobe.com

In commentary published in Nature Medicine, experts from the Medical University of South Carolina (MUSC) Hollings Cancer Center, in collaboration with the U.S. Food and Drug Administration (FDA), are urging health care providers to consider e-cigarettes as a viable tool for adult smokers struggling to quit traditional combustible cigarettes.

Led by Dr. Benjamin Toll, director of the MUSC Health Tobacco Treatment Program, and Dr. Tracy Smith, associate professor in the Addiction Sciences Division of the Department of Psychiatry and Behavioral Sciences, the commentary highlights the relative risks of e-cigarettes compared to traditional cigarettes. While both products pose health risks, scientific evidence suggests that e-cigarettes generally carry lower risks.

"It really bothered me that there are well-intentioned, smart health care providers who think that e-cigarettes are worse than smoking cigarettes," said Toll in a statement. "It's simply not true."

The commentary underscores that neither option is ideal for health, and youth or non-smokers should not be encouraged to use e-cigarettes. However, among adults who have unsuccessfully tried FDA-approved cessation medicines, a complete switch to e-cigarettes may be a preferable alternative to continued smoking.

Toll, currently serving as president of the Society for Research on Nicotine and Tobacco, emphasizes the importance of expanding the conversation around smoking cessation methods among health care providers.

While there are seven FDA-approved smoking cessation aids available, including medication and nicotine replacement options like patches, the addictive nature of nicotine leaves many individuals struggling to quit. This is where e-cigarettes may offer a potential solution.

“Doctors and other health care professionals don't know what to say or how to talk about it,” Smith said. “I always say, ‘If you have somebody who smokes cigarettes, they are standing in a convenience store every single day, buying the most harmful tobacco product they could possibly be buying.’ And it’s a real injustice not to say to them, ‘Hey, there are nicotine products you could buy every day that would be a whole lot less likely to kill you.’”

However, the experts are specific about recommending only FDA-authorized e-cigarette products, of which there are currently 23. These products are tobacco-flavored and do not include fruity or candy-like flavors.

Smith said the FDA has two paths for e-cigarette authorization, one being for smoking cessation, but that no company has marketed their products as smoking cessation devices thus far. The rigorous review process ensures that authorized e-cigarettes are appropriate for adult smokers and outweigh the known risks, particularly regarding youth appeal.

Despite controversies surrounding e-cigarettes, recent studies published in reputable journals like JAMA Internal Medicine and the New England Journal of Medicine suggest their efficacy in smoking cessation. Additionally, a Cochrane Review concluded that e-cigarettes are more likely to help people quit smoking compared to nicotine replacement therapy.

"For me, having less harmful alternatives out there for adults, especially if we can reduce the appeal to youth, is really important," stated Smith.