E-Cigarettes: Quitting Aid or Gateway Device?

“I Don’t Smoke Anymore, I Vape.”

Have any of your patients who smoke cigarettes told you recently that they’ve traded conventional smoking tobacco for the vaporized nicotine delivered by an electronic cigarette?  The controversy surrounding the so-called cigarette “replacements” is hard to avoid as claims that support use of the devices and counter claims that vilify them swap headlines every week in the lay and scientific press.

Whether the combination of gaseous nicotine plus chemicals and flavorings (ie, chocolate, bubble gum, mint) will one day be found as ruinous to health as the tar and other carcinogens that come conveniently rolled in paper, there is an equal fear that e-cigarettes have the potential to hook another entire generation on a new habit-or introduce them to an old one.  First, a few facts, then questions for you.  

Initiation 

Data from the 2011 and 2012 National Youth Tobacco Survey revealed e-cigarette smoking among US youth doubled among adolescents in one year:  

   o In 2012, 2.7% of middle school students reported ever using an e-cigarette compared with 1.4% in 2011 (P <.05).

   o In 2012, 10% of high school students reported ever using e-cigarettes, up from 4.7% the year before

   o An estimated 160 000 students who reported ever using an e-cigarette also reported they had never smoked a conventional cigarette.

Established users

 A new analysis published in JAMA Internal Medicine casts doubt on marketing campaigns that suggest e-cigarettes help smokers quit

   o In a study of e-cigarette use and smoking cessation baseline e-cigarette use was not associated with a change in cigarette consumption at 1 year

   o The analysis reviewed another study that showed that e-cig use was not followed by greater rates of quitting or by reduction in cig consumption at 1 year

In a randomized placebo-controlled trial published in The Lancet, there was no difference found in quit rates between participants who used nicotine patches versus those who used e-cigarettes.

 What do you think?