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