Electronic cigarettes (e-cigarettes) can assist patients with smoking cessation, which is all they should be used for!
Mark Twain said, “Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.” Despite the current options, the rate of success in smoking cessation continues to be low.1–3 Smoking is known to harm nearly every organ in the body4 and quitting smoking can add years to a patient’s life. This article reviews why e-cigarettes can assist our patients in their journey.
Potential concerns
A Chinese company, Ruyan, is credited with the invention of the e-cigarette, released on the Asian market in 2004.5 “Vaping” (the act of using an e-cigarette) is healthier than smoking because the e-cigarette does not produce smoke or contain the toxic compounds present in a traditional cigarette, nor does it release second-hand smoke. However, there are potential concerns. In 2009, the US Food and Drug Administration conducted an analysis of 2 brands of e-cigarette cartridges. Trace levels of carcinogenic nitrosamines were present in more than half of the samples, and potentially harmful compounds, such as anabasine, myosmine, and β-nicotyrine, were present in most of the tested samples.6 These compounds are also present in tobacco smoke at concentrations that are 100 to 1000 times higher than in e-cigarettes! Propylene glycol, the main ingredient in most e-cigarette cartridges, has been approved for use in food products in Canada as a food preservative, in asthma inhalers and nebulizers, and in theatrical fog machines. Its effects on health are currently, at most, controversial.
Another concern is that public use of e-cigarettes could re-normalize the use of tobacco products.7 Flavoured nicotine cartridges appeal to youth, which could potentially serve as a gateway to developing a harmful nicotine addiction. That being said, all population-based studies of adults show the highest rate of e-cigarette use is among current smokers, followed by former smokers, with little use among non-smokers, although e-cigarette trial and use rose in all of these categories.8 In a sample of e-cigarette users recruited from websites dedicated to e-cigarettes and smoking cessation,9 most (72%) were former smokers at baseline.
In Canada, the only legal e-cigarettes have no nicotine added. We need to ensure that there is specific legislation to prevent smoking e-cigarettes in the same places regular cigarettes are prohibited. They also should not be flavoured or sold to minors.
Choice is needed
People smoke for various reasons and thus need a variety of choices to assist in cessation attempts. Nicotine addiction, habit, stress, and lifestyle are all factors that need to be dealt with. Reasons quoted for smoking include the following: “I light up when someone makes me angry,” “I am very aware of not smoking when I don’t have a cigarette in my hand,” and “I find a cigarette in my mouth and don’t remember putting it there.”10 Allowing patients to mimic smoking behaviour with an e-cigarette can be helpful. In the ECLAT (Efficiency and Safety of an Electronic Cigarette) study, 11% of the smokers who received e-cigarettes containing nicotine reported that they had abstained from smoking traditional cigarettes at the last follow-up visit.11 Polosa et al followed 23 subjects not currently planning to quit who were given e-cigarettes containing nicotine; at the 24-month visit 18 continued to smoke and 11 had reduced cigarette consumption by 50% or more, with a statistically significant reduction from an average of 24 to 4 cigarettes per day (P = .003).12 Five participants had quit tobacco cigarettes at 24 months.
Conclusion
Do not throw the baby out with the bath water. Electronic cigarettes are a harm-reduction strategy for current smokers. Electronic cigarettes can assist your patients in quitting smoking, which is one of the most important health changes they will ever make!
Notes
CLOSING ARGUMENTS — YES
Alan Kaplan md ccfp(em) fcfp
Current smoking cessation aids have limited utility and do not deal with the “habit” component of why people smoke. Electronic cigarettes (e-cigarettes) fill this void, but should not be used for any other purpose.
Smoking e-cigarettes is healthier than smoking regular cigarettes because e-cigarettes do not produce smoke or second-hand smoke, and do not contain toxic compounds at the same levels as traditional cigarettes.
Legislation is needed to ensure e-cigarettes are used properly. They should not include flavouring or nicotine, and they should not be sold to minors.
Footnotes
Cet article se trouve aussi en français à la page 502.
Competing interests
Dr Kaplan has served on advisory boards for and received honoraria for giving lectures from Pfizer and Johnson and Johnson.
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