For the first time, a panel of experts has released clinical guidelines outlining how e-cigarettes can be used as a tool to help adult cigarette smokers quit.
The recommendations from a Society for Research on Nicotine and Tobacco panel say e-cigarettes should be considered alongside established smoking-cessation options, including nicotine replacement products and medications such as varenicline and bupropion. The guidance was recently published in the Journal of the American Medical Association.
While emphasizing that e-cigarettes carry health risks of their own, the authors concluded that vaping is less harmful than cigarette smoking and may be more effective at helping smokers quit than conventional nicotine replacement treatments.
“This work is about correcting misperceptions that act as barriers to evidence-based care for smokers and expanding the tools clinicians can use to support smoking cessation among their patients,” lead researcher Eleanor Leavens said in a news release. She is an assistant professor of population health at the University of Kansas.
“There is no single approach that will help all smokers quit, but by providing patients with a menu of options and engaging in a risk-benefit conversation, they have a better chance of quitting for good and improving their overall health,” Leavens said.
In their review of the available evidence, the researchers said smokers who switch to vaping can substantially reduce their exposure to dangerous chemicals and cancer-causing substances, with reductions reaching as high as 90% in some cases.
Although the U.S. Food and Drug Administration has not approved e-cigarettes as a smoking-cessation treatment, the researchers said there is high-certainty evidence linking their use with higher quit rates than nicotine replacement options such as patches, gum and nasal sprays.
“Unlike NRT (nicotine replacement therapy), e-cigarettes typically deliver nicotine rapidly and similarly to cigarettes,” the panel wrote in its paper. “Although such delivery poses a risk of greater dependence and long-term use relative to NRT, it may also contribute to e-cigarettes’ being more satisfying and a more effective substitute for cigarettes relative to NRT and contribute to a reduced risk of relapse.”
The panel said physicians counseling smokers should work with their patients to weigh the benefits and risks of the available approaches and determine which cessation method is most appropriate for each individual.
For patients who choose e-cigarettes as their method for quitting, the guidelines advise doctors to steer them toward FDA-authorized vaping products whose benefits have been determined to outweigh their risks. Patients should be encouraged to vape whenever they ordinarily would have smoked, transition completely away from cigarettes as rapidly as possible, and combine the effort with behavioral counseling to increase the likelihood of success.
“Behavioral support should focus on complete cessation of cigarettes and should include setting a quit date for cigarette use,” researchers wrote.
Once a smoker has completely stopped using cigarettes, the guidelines say physicians can consider advising the patient to gradually reduce nicotine exposure from vaping.
“The most important goal to keep in mind is maintaining complete abstinence from cigarettes,” the team wrote.
The recommendations were developed by the Harm Reduction Workgroup of the Society for Research on Nicotine and Tobacco, an international nonprofit organization that does not accept tobacco-industry funding.
“Cigarette smoking causes about 30% of all cancer deaths in the United States and most people want to quit but struggle to do so,” Leavens said. “Adding clear guidance on e-cigarettes gives clinicians a practical tool that can help people move away from combustible tobacco and toward better health.”
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