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E-Cigarettes Aren't for Quitters

  
  
  

 

e-cigs aren't for quittersElectronic 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

 

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Comments

The picture of the guy smoking could be a trigger for someone trying to quit.
Posted @ Sunday, November 20, 2011 6:15 PM by Nancy
Thanks for your feedback, Nancy. Since this blog is directed at smokers as well as as ex-smokers, we revisit the issue of visual and other triggers with every post. In this case, a point we want to make is that e-cigarettes themselves are visual triggers, and that's an e-cigarette he's puffing on. We'll take your feedback into account next time.
Posted @ Monday, January 02, 2012 10:55 AM by Alan Peters
I tried e-cigs and nicorette inhalers last time but it wasent really being smoke free....
Posted @ Monday, March 05, 2012 9:36 AM by saint2012
Thank you, when making my quit plan someone asked me about the e-cigarettes. I made the decision that it would only reinforce the habits I was trying to break so I did not include them in my plan. After reading this I am so glad I did not. Thank you for the great information and for reinforcing my decision not to use them.
Posted @ Saturday, March 10, 2012 11:43 AM by Donna
While I understand how everyone feels about the e-cig, I am going to disagree strongly. I smoked for 46 years. I tried to quit a few times but I guess I am a weak person when it comes to smoking. When the doctor finally said quit and live or smoke and die I decided I had no choice. I have a lung disease, so to me there was no choice. I went and got a e-cig, menthol as matter of fact and smoke it for a week off and on. Then the second week I bought strawberry flavored refills and smoked them. I didnt sit outside and smoke for a half hour like I used to. I would go outside and take a couple puffs and come back in. Pretty soon I was keeping myself busy and it would be hours before I would go out for 1 puff. It took about a month and I had painlessly quit smoking completely. There are times i have hard days but I don't give in and the urge goes away quickly. I quit smoking aug. 24, 2011, and I am completely sold on using the e-cig as a form of quitting. It worked wonders for me.
Posted @ Friday, March 23, 2012 10:15 PM by emc1969
I also have to strongly disagree. THINK on this-> the ecig solved my every craving with the look, feel, red glow, (water) vapor smoke and nic hit BUT WITHOUT the 3,000 other bad cig chemicals. PLUS no smell in house or second hand danger or burn holes. These are ALL HUGE to me!  
 
 
 
And as said, an ecig is a few puffs and you are done. I just smoke a "real" cig when I want to take a 3-4 minute "cig" break. Usually I am busy and just need an ecig hit or 2. My true cigs went way down and I dont need many ecig "hits" in a day. 
 
 
 
Yes, due to FDA changing rules & import blockings, its hard to get quality control but you can "load" your own cartridges. FDA is known hugely driven by lobby money and it plainly shows here. Ecigs rock for me.
Posted @ Tuesday, May 01, 2012 2:06 AM by Dixie
I have been using e-cigs for a month so has my BF. This to me has been the best way to work towards quitting. I have not had a real cig in over a month, I take a couple puffs a day on the e-cig. This has been the best way that I have found to get off the REAL stinky cigs and man do they stink now ICK. When the craving comes the e-cig is a better solution than the real thing. I have tried it all the Chantix (makes you crazy), welbutrin does nothing, inhaler tastes awful and give you a tummy ache, the gum, ick, the pathes I am allergic too so I had really run out of options so I tried this and I am sure glad I did.
Posted @ Wednesday, October 03, 2012 7:21 AM by GG63
We're hoping that some of the positive experiences with e-cigs, outlined above, get proved out by research. Until then, QuitNet can't endorse them, being a science and evidence based plan. Meanwhile, tobacco companies are getting into the game; something tells me they know more about e-cig effectiveness than they're letting on.  
 
http://www2.journalnow.com/business/2012/may/27/wssunbiz01-electronic-cigarettes-important-new-nic-ar-2310136/
Posted @ Wednesday, October 03, 2012 1:29 PM by Alan Peters
I smoked for 35 years, tried quitting many times with every various ways, nothing worked. The ecig is my miracle!!! Only took one month to go from 2 packs a day, to none! I have been cig free since 8/01/11, and still no desire to go back. I have many friends and family quit now with the ecig after they saw how it worked for me.
Posted @ Saturday, December 01, 2012 10:05 AM by Darlene
I tried the gum to quit last June and didnt like it at all. Then I tried the e-cig and it worked. I didn't use it like a replacement for a cigarette, I just took a couple puffs when I needed the nicotine. It took about a month and a half but I was able to taper off and by the end of two months I wasn't using it at all anymore.
Posted @ Tuesday, February 05, 2013 4:49 PM by Aggie
I guess I’m like the other posters who are e-cigarette users. I've smoked for over 50 years and have tried quitting a number of times without success. Then one day I decided to try an e-cig. I didn’t like it all that much at first, but decided to stay with it to see if I could wean my way off real cigarettes. I went about a week smoking real cigs and alternating with the e-cigs. Then I tried dropping the real cigs for a day, then two days, then the next thing I knew I had gone a week without a real cig. All this happened within the span of a few weeks. 
 
Now I occasionally “try” a couple of puffs from a real cig and find that it tastes horrible. I am currently in the process of working my way off the e-cigs. It’s really easy to cut down the use of the e-cigs since you don’t have to light it and smoke the whole thing or throw it away after smoking a little of it. With an e-cig you can pull it out, take 1-2 puffs and just put it back in your pocket. I’m now at the point to where I’m using “low nicotine” cartridges and I only take 2-3 puffs something like 8-10 times a day. 
 
Perhaps the clue to using the e-cigs to quit is to use a flavor that is more pleasant than real cigarettes. At least that is what seemed to work for me. 
Posted @ Wednesday, February 06, 2013 11:48 AM by hippie51yrs
I tried every method there is, even reading Allen Carrs EasyWay. 
 
I made the switch in just 2 days on a good e-cig (not cheap cigarette looking ones). It was unrealistically easy, I felt like I cheated somehow. And I'm dropping nicotine levels without any symptoms of withdrawal or any want for a normal cigarettes. 
 
Don't say it has no scientific backing, it does, there's many studies out on its effectiveness.
Posted @ Thursday, April 04, 2013 2:15 PM by Alex
People need to use whatever aid helps them kick the cigarette habit forever.  
 
With that being said, I find it interesting that the FDA has only managed to 'approve' quit smoking treatments that financially benefit Big Pharma (Zyban, Nicotine gum, Nictoderm patches, Chantix, etc.). 
 
Seems to me there is more than meets the eye in the e-cig debate.
Posted @ Tuesday, May 14, 2013 10:38 AM by Charlene Karedes
So, Nancy, over 1000 published, peer-reviewed studies about the effectiveness of quit aids, and the FDA, are all fake because the manufacturers make money by selling them?  
 
And e-cigs, which have zero published, peer-reviewed studies proving they work to get people nicotine free, are real because you say so--even though manufacturers make money from you advertising for them? 
 
More than meets the eye, indeed. 
 
Posted @ Tuesday, May 14, 2013 11:11 AM by Todd Lakoff
Todd, your thoughts successfully urge critical thinkers to explore why e-cigs have "zero ... peer-reviewed studies"; yet, pharmaceutical quit aids have "over 1000."  
You also open the door to a relevant discussion of alleged flaws in the peer-review process which has prompted, ironically, some engrossing peer-reviewed articles that force us to question if the "peer-reviewed" label is really all its cracked up to be merely because it is the only show in town. 
 
Finally, I don't think pointing out facts is really "advertising" e-cigs as I opened my post by urging people to use whatever aids prove most successful to ditching their cigarettes for good. However, I do believe in educated consumers and the fact that the FDA receives over 60% of its funding from the very companies whose drugs they review is concerning.  
 
Thank you for your response to my original comments. By the way, my name is not Nancy.  
 
 
Posted @ Saturday, May 18, 2013 10:53 AM by Charlene Karedes
 
Sorry about the name and advertising bits, Charlene, looks like I got those from other misinformed comments. For example, Alex is wrong or dishonest when he says there are many studies on e-cig effectiveness. There aren't. XCEPT THOSE BY E-CIG MANUFACTURERS THEMSELVES. And those don't pass the smell test. 
 
Which is the same conflict of interest you accuse the FDA of on other quit-aids, only much worse. 
 
About the FDA...You point out that the agency is funded by manufacturers with products they want reviewed. You don't mention that those funds are 'user fees'. The government doesn't just start reviewing any product that comes on the market, you have to pay for the approval process.  
 
Like if you want a driver's license, you pay your state for your driving test--it doesn't automatically drive-test every 16 year old for free. Are you bribing the state because you're paying them to test you? Do you believe you don't deserve your driver's license just because you paid the state for it? 
 
I don't understand your comments about flaws in the 'peer review process'. Not sure what you think that means, but peer review is what happens after you publish your study and your methodology in a prominent place, so it can be seen by as many as possible. Other researchers examine your methods and results and either replicate or refute them. There's nothing inherently flawed about that process. It's the LACK of peer review, which is the current problem with e-cig 'studies'. They haven't even been on the market long enough to have any credible testing to validate or debunk their claims. And I should note that a federal court, NOT THE FDA, ordered e-cig sellers to stop claiming they're quit-smoking tools, because there's no evidence that they are. 
 
In the interest of educated consumers, Todd L
Posted @ Thursday, May 23, 2013 11:21 AM by Todd L
I don't believe anything the FDA, or any other govt. agency says.I do know this for a FACT, I quit smoking cigs more than 6 mos ago using an e-cig,ones I fill myself. I could have never quit cold turkey ,gum , patch or pills,as I tried them all and never succeeded. 
I am MUCH healthier with the e-cigs. I used a very dose of nicotine,and once I started the e-cig ,never touched another real cigs. As for the health of the e-cig, anything is better than the thousands of chemicals in a cig .
Posted @ Monday, August 05, 2013 9:44 AM by Chris
More recent research has show that ecigs are effective and pose no real harm to the user or bystander. Time to update your science.
Posted @ Friday, August 30, 2013 10:26 PM by Fr. Jack Kearney
I quit smoking 8 months ago by using e-cigs. I had failed in my previous six attempts to quit, but the e-cigs made it quite easy. Yes, I'm still inhaling nicotine, but I'm not inhaling thousands of chemicals, many of which are carcinogenic, from cigarettes. 
 
It's not a perfect solution, but I'm convinced (after many hours of my own research) that my risk of lung cancer has fallen dramatically. And while nicotine is bad for the heart, smoking real cigarettes presents much greater risk of heart disease. 
 
I smoked for 35 years and thought I might never be able to quit. E-cigs changed my reality. I believe I am extending my life span by ingesting nicotine-laced steam instead of cancer-causing smoke. 
 
Yes, it is time to look into the latest research, which indicates that e-cigs may not be an effective quitting therapy for everyone, but they are a far healthier alternative than smoking cigarettes.
Posted @ Tuesday, February 18, 2014 12:05 PM by Mark Fox
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