Consumer News: E-cigarettes may have a bigger role in helping smokers quit

New guidance says doctors should include nicotine vapes in smoking-cessation conversations

• A new JAMA paper says nicotine e-cigarettes should be part of conversations about quitting cigarettes.

• Researchers reviewed existing evidence on e-cigarettes and smoking cessation and developed guidance for clinicians.

• The authors say e-cigarettes can be less harmful than cigarettes and more effective for quitting than FDA-approved nicotine replacement therapies.

For people trying to quit smoking, there are plenty of options to consider from nicotine patches and gum to prescription medications. Now, a group of tobacco researchers says nicotine e-cigarettes deserve a more prominent place in those conversations.

A new special communication published in JAMA recommends that clinicians discuss nicotine e-cigarettes alongside other evidence-based treatments for adults who currently smoke cigarettes. The authors say existing evidence indicates that e-cigarettes with nicotine are less harmful than traditional cigarettes and have been more effective for smoking cessation than FDA-approved nicotine replacement therapies.

The recommendation doesn't mean e-cigarettes are risk-free. Instead, the authors argue that conversations about quitting should give smokers a clearer picture of the potential benefits and risks of each available treatment.

Cigarette smoking causes about 30% of all cancer deaths in the United States and most people want to quit but struggle to do so, researcher Eleanor Leavens, Ph.D., said in a news release. Adding clear guidance on ecigarettes gives clinicians a practical tool that can help people move away from combustible tobacco and toward better health.

How researchers developed the guidance

This wasn't a clinical trial in which smokers were assigned to different treatments. Instead, the paper was developed by a working group within the Treatment Research Network of the international Society for Research on Nicotine and Tobacco.

The researchers' goal was to summarize the existing evidence surrounding nicotine e-cigarettes and smoking cessation and use that evidence to develop practical recommendations for clinicians. They focused on two areas: how doctors can discuss e-cigarettes as part of shared decision-making about smoking-cessation treatments and how e-cigarettes can be used in practice to help people quit.

The group also addressed what it describes as misconceptions about the risks of e-cigarettes and offered questions clinicians can use when talking with patients about their options.

What this means for smokers

The paper's main recommendation is straightforward: Doctors should include nicotine e-cigarettes when discussing evidence-based ways to quit smoking.

The authors point to evidence that nicotine e-cigarettes can help people stop smoking and say they can reduce the harms associated with cigarette smoking when used as a quitting tool. At the same time, the guidance is intended for adults who currently smoke cigarettes not as a recommendation for people who don't smoke to start vaping.

For consumers who are trying to quit, the takeaway is that e-cigarettes may be worth discussing with a healthcare professional alongside other smoking-cessation options. The authors emphasize patient-centered conversations, meaning the choice of treatment should take into account the individual smoker's circumstances, preferences, and needs.

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, Dr. Leavens said. 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, providers will ensure patients have a better chance of quitting for good and improving their overall health.