Are e-cigarettes a safe way to quit smoking?

E-cigarettes became a hot topic when the Food and Drug Administration (FDA) announced in May that it would be extending its authority to all tobacco products, including e-cigarettes.

The FDA announcement came after the Royal College of Physicians (RCP) recommended the use of e-cigarettes as a smoking cessation tool in the UK. The RCP recommendation states: “E-cigarettes are not currently made to medicine’s standards and are probably more hazardous than NRT [nicotine replacement therapy]. However, the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed five percent of the harm from smoking tobacco.”

Currently, the only FDA-approved treatments to help patients in the U.S. quit smoking are NRT (patches, lozenges, gum, inhalers, or nasal spray) and the oral medications bupropion (Wellbutrin) and varenicline (Chantix). There are no medical guidelines in the U.S. that currently support using e-cigarettes as a smoking cessation tool, and there is a lack of consensus by U.S. physicians on the safety of e-cigarettes. This leaves both doctors and patients with a dilemma on their hands: are e-cigarettes a safe tool for quitting smoking?

Some might say: sure, anything is better than smoking cigarettes, right? Well, I would caution you to think before you vape. What do we actually know about e-cigarettes? Very little compared to the extensive research on cigarette smoking. Yes, e-cigarettes contain fewer hazardous ingredients than traditional cigarettes, but they still contain nicotine and chemicals like propylene glycol and glycerol.

Besides being incredibly addictive, nicotine can cause dizziness, nausea, vomiting, and adverse effects on adolescent brain development. Glycerol is a known upper airway irritant and can cause dry mouth, dry eyes, and dry cough. When vaporized, glycerol and propylene glycol can produce byproducts like formaldehyde, acetaldehyde, acrolein, nitrosamines, and diethyl glycol, which are toxins and carcinogens. Even the RCP’s recommendation concedes that the long-term effects of vaping are unknown and likely do carry some risk of lung cancer, COPD (Chronic Obstructive Pulmonary Disease), and cardiovascular disease.

Because the FDA did not previously regulate e-cigarettes, ingredients and their concentrations have varied widely because companies were not required to list them on labels. Cartridges can be purchased with or without nicotine, but levels vary considerably within the same brand and can even vary from puff to puff. Even when nicotine doses are listed on packaging, they have been found to be inaccurate during lab testing.

There is some evidence that e-cigarettes can help smokers quit smoking in the short-term, alleviate withdrawal symptoms, and help with cravings, but the studies are lower quality and even conflicting in some cases. However, we know that FDA-approved NRT, in combination with behavioral support, can double the rate of smoking cessation compared to quitting cold turkey. Only one clinical trial has been published comparing the results of NRT to e-cigarettes, and it showed no difference in smoking cessation.

Bottom line: New FDA regulations will provide physicians with more information on the ingredients of e-cigarettes and lead to more long-term research, but for now, we are left struggling to find the right answer for patients. For smokers who cannot tolerate, or have poor results with, the FDA-approved NRT and medications, e-cigarettes may be an acceptable option to reduce the harm from smoking cigarettes. Talk to your doctor about appropriate options for you.

 

— Maddie is the Chief Resident at Harpers Ferry Family Medicine Residency Program. She plans on practicing family medicine in the area when her training is done.

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