Is smoking defined as the inhalation of nicotine, the use of tobacco, the exhale of smoke-like vapor/smoke, the ritual and emotional attachment of things one does as a smoker, or a combination of all those things? Who decides, and once decided, what happens next?
Electronic Cigarettes: More Questions than Answers
The use of electronic cigarettes is an evolving situation, one in which treatment protocols will change as new information is revealed. Currently, research is limited. The effects of long term use have not been studied, product safety is unknown, and e-cigarettes lack quality control oversight. That means marketing claims about e-cigs may not be/are not correct.
Depending on how one defines smoking, using an E-cig may or may not be considered smoking. The act of vaping is behaviorally identical to smoking, minus the tobacco and the smoke. E-cig manufacturers have declared their use a safer form of smoking. Some employers, states, towns, and insurance companies consider vaping to be smoking, and people who use the E-cig will test positive for nicotine. On the other hand, those who quit smoking tobacco cigarettes and use the E-cig often consider themselves quit.
Some establishments allow E-cigs only in designated smoking areas. Others allow their use in areas where smoking traditional cigarettes is prohibited. An increasing number of states are passing E-cig use and age of purchase restrictions. E-cig marketing promotes 'restriction-free' smoking among many other claims that may not be true. Nicotine free E-cigs may not really be nicotine free, but if they are that adds further question to what is or is not considered smoking.
From a tobacco treatment standpoint, the main components of a successful quit involve breaking the behaviors, habits, and emotional attachments surrounding the act of smoking. Letting go of nicotine is part of the quit process. Many E-cigs contain nicotine. All the FDA approved quit support options are designed to help a person quit smoking while breaking their lifelong behaviors associated with smoking. Lifestyle change is a necessary part of remaining a nonsmoker. By comparison, E-cigs are for the most part 'smoking to quit smoking'. Use of them does not offer room for new habits, new behaviors or new emotional coping tools. Depending on the E-cig chosen, it may not even remove inhaled nicotine from the equation.
Some people might quit smoking tobacco by using E-cigs. While vaping is currently believed to be safer than smoking a traditional cigarette, that is not the same as saying vaping is safe or healthy. E-cigs may or may not have a place in smoking cessation. There are no statistics available that measure actual quit success rates, relapse rates, or the number of would be quitters that now use E-cigs in addition to regular tobacco products. E-cig users may have a higher potential for relapse, given the perpetuation of smoking attachments and behaviors.
If you are contemplating using an E-cig to quit smoking, established research demonstrates your chance for success increases by choosing NRT, Zyban or Chantix instead. If you are already using an E-cig, it is wise to work towards becoming completely nicotine and cigarette free. Quitting smoking is the best thing you can do for your health. There is no safe way to smoke. The smartest choice is to stop inhaling from any type of cigarette.
Vikki Q CTTS-M
Master Certified Tobacco Treatment Specialist
Electronic cigarettes have been heavily marketed the past 5 years, first as a miracle quitting aid and now as a substitute for conventional smoking. As tobacco treatment specialists, we're in favor of anything that diminishes a smoker's odds of suffering tobacco-related illness or death, but should e-cigarettes be considered legitimate quit-tools?
Being a science-and-evidence-based quit-smoking program, QuitNet can only recommend treatments that are FDA approved, clinically researched, and proven effective. QuitNet does not include the use of e-cigarettes in its roster of suggested tobacco treatments, for the following reasons:
• E-cigarettes are not proven quit-tools
There is little research on the role of e-cigarettes in helping smokers become tobacco-free. A handful of limited and/or manufacturer-funded studies indicate a potential harm reduction benefit to users, but none have demonstrated a causal relationship between use and subsequent tobacco/nicotine abstinence.
• E-cigarettes are officially designated as tobacco products
U.S. federal courts ruled that electronic cigarettes cannot be considered quit-smoking aids by the FDA, but must be regulated as tobacco products. After this ruling, the largest distributors of e-cigarettes admitted their products were intended as smoking substitutes, not quit-aids:
“Understand that this is a cigarette. We are acting as a cigarette company. We have all the applicable warnings on all our packaging that actually backs that up...We do not represent the product as healthy or safe.” Ray Story, VP of Smoking Everywhere
“We can now market our product the way we always should have been able to...This is plain and simple [sic] an alternative to smoking for committed, longtime smokers." Matt Salmon, CEO of Sottera Inc
• E-cigarettes reinforce most aspects of conventional smoking
Unlike existing quit-smoking aids (including nicotine inhalers), e-cigarettes deliver nicotine directly to the lungs--making users potentially as dose-responsive to them as they are to conventional cigarettes. Unlike NRT, e-cigarettes allow users to continue engaging in most of the potentially harmful mental and behavioral patterns associated with smoking. Unlike NRT, e-cigarettes present multiple physical, visual and behavioral relapse triggers at every use.
• E-cigarettes are not the same as Nicotine Replacement Therapy (NRT)
NRT has been proven and designated a therapeutic quit-aid, not a tobacco product. The primary action of e-cigarettes -- inhaling nicotine directly into the lungs -- runs counter to the primary action of NRT. It’s the slow, measured uptake of small, standardized levels of nicotine that makes NRT so effective, as well as the breaking down of established smoking behaviors and routines (acquisition, preparation, lighting up, hand-to-mouth, etc) inherent in their use. Numerous inspections of e-cigarette products also demonstrate wide variations between claimed and actual nicotine doses (even from 'puff-to-puff'), making self-monitoring and/or 'stepping down/weaning off' unreliable and less effective.
• E-cigarettes are not proven safe
The short or long-term effect on the lungs of glycolized e-cigarette steam (containing nicotine and some identified toxins) has not been extensively studied nor deemed safe. Manufacturing standards have not been set, nor is any oversight entity charged with creating or enforcing them. Dosages vary widely, and some cartridges have been found to contain enough nicotine to kill an adult human if ingested.
In QuitNet's experience, smokers who switch to e-cigarettes have been more likely to relapse back to conventional smoking than abstainers, and ex-smokers with longterm quits have lost them completely after first succumbing to e-cigarette claims of safer-than-smoking. Ex-smokers in our own online community react negatively to promoters and/or users of e-cigarettes--so much so that we've had to place restrictions on discussion of them in the forums.
One of our greatest concerns is e-cigarettes' potential for renormalizing, even glorifying, social/recreational/therapeutic nicotine use. Worse, they may act as 'bridge' products back to smoking for the already-quit, or as 'starter' products' to attract non-smoking youth to nicotine addiction. The evidence so far indicates that they will have little positive effect on longterm abstinence rates, and will contribute to higher relapse rates among already-quitters.
Alan S. Peters, MTTS