We have seen a number of individual testimonials about e-cigarettes helping people quit traditional cigarettes, many using the hashtag #vapingsavedmylife. The California Department of Public Health supports any and all efforts to quit traditional cigarettes. We know the vast majority of people want to stop smoking, but have a hard time quitting. Knowing how hard it is, any time a person is able to quit traditional cigarettes completely, we applaud them.
Because of this we get asked a lot about why we don’t promote e-cigarettes as a way to quit smoking. There are a few reasons we don’t endorse e-cigarettes as quit smoking aids or devices:
- E-cigarettes are not FDA-approved quit smoking devices. FDA-approved nicotine replacement therapies (NRTs) undergo a rigorous approval process and are subjected to animal and human clinical trials before being made available to the public. In addition, there are regulations governing manufacturing, labeling, packaging, and warning requirements. The purpose of this process is to ensure that these products are safe and effective. This is not true for e-cigarettes and other devices that heat up liquids that include nicotine and are inhaled into the lungs. E-cigarette companies could go through the process of having their products FDA-approved as cessation devices. However, as of today, it is not evident that any of the hundreds of e-cigarette companies out there have submitted applications to do so. 1 2
- Studies show that using both e-cigarettes and traditional cigarettes during the quitting process is problematic. Though smokers may reduce the number of cigarettes they smoke, many end up using both products at the same time, and never actually quit altogether. This means that any potential health benefits are reduced and the cardiovascular risks associated with smoking stay essentially the same and continue to cause significant health problems for the individual. Additionally, e-cigarettes may prevent people from successfully beating their addiction to nicotine. 3 4 5 6
- There is no conclusive scientific evidence showing that e-cigarettes are a safe and effective method to reduce traditional cigarette use at the population level. In a recent review of effective cessation treatments, the United States Preventive Services Task Force determined that there is insufficient evidence to recommend the use of e-cigarettes as a smoking cessation tool. Additional research is being done, with the latest analyzing multiple published studies (called a “meta-analysis”). It determined that adult smokers who use e-cigarettes are 28% less likely to stop smoking cigarettes. There are still doubts and concerns about whether these products help people to completely quit smoking, or if they increase the adverse impact of smoking combustible products by discouraging cessation, encouraging long-term dual use, and if they increase tobacco use and nicotine addiction among non-users. 7 8 9 10 11 12
Addiction has 3 components: physical, psychological, and behavioral. Nicotine replacement therapies (NRTs) were designed to help people with the physical part of addiction. Quit smoking programs that address the psychological and behavioral parts of addiction, combined with NRTs or other quit smoking medications, are very effective in helping people quit. In fact, the American Lung Association’s Freedom From Smoking program has a 60% success rate when combined with quit smoking medication. NRTs were not designed for long-term use, which is different than how many people view switching to e-cigarettes. Many people may switch to e-cigarettes with no plan to quit using them. The long-term health risks of regular use of e-cigarettes as a substitute for traditional cigarettes are still unknown. Additionally, the people who simply switch may still continue the psychological and behavioral parts of traditional cigarette addiction, even if they are decreasing their nicotine consumption. 13
Much of the e-cigarette debate centers on what’s referred to as “harm reduction.” Harm reduction is the idea that, even though e-cigarettes have known health risks, those risks are less than traditional cigarettes’ health risks, and because of this, it reduces overall harm. However, looking at a larger “public health” picture that goes beyond helping current people quit traditional cigarettes; there is a real concern about teens and young adults starting a lifelong tobacco addiction through e-cigarettes, especially since the long-term health risks are still unknown. Mounting evidence from longitudinal studies shows that teens and young adults who use e-cigarettes are far more likely to end up smoking traditional cigarettes one year later. Looking at this larger picture then, the question is whether harm is really being reduced if a new generation is becoming addicted to nicotine, a highly addictive neurotoxin with known health risks, and if these youth end up using traditional cigarettes. 14 15 16 17 18 19 20