Rebuttal: Can electronic cigarettes assist patients with smoking cessation?

Electronic cigarettes (e-cigarettes) should allegedly not be used owing to lack of evidence of safety; because they are being produced and marketed by tobacco companies; and because they are potentially a gateway to smoking.¹ All plausible concerns, but what about that smoking patient (15% of our population) in front of you?²

If smoking cessation were easy, this would be moot. A substantial barrier to cessation is the sensation of smoking and having something to do with the hands. It is not solved by pharmacotherapy, gum, or eating (which is a common issue and leads to weight gain—another health issue). Electronic cigarettes seem to have had some success, even in the absence of nicotine, because they deal with the habit! The increasing popularity of e-cigarettes has led to a decrease in tobacco sales in the United States.³ In addition, e-cigarettes have been shown to be as efficient as nicotine patches in assisting with cessation efforts.⁴ There is no evidence that they are a gateway product; in fact, the opposite is true, as they assist cessation.

The levels of carcinogens in e-cigarettes are thousands of times lower than in cigarettes, so we are talking about using them for harm reduction initially and hopefully cessation after that. As for safety, what about second-hand smoke exposure? This is a hazard for non-smokers with cigarette smoke, but not with e-cigarette vapour!

Legislate safety and remove nicotine, fancy flavours, and marketing, but use e-cigarettes to help your patients quit smoking. That is what is important; smoking tobacco kills.

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