People trying to quit smoking tobacco were by using e-cigarettes were twice as successful as those who used traditional nicotine replacement (18% versus 9%). That is the conclusion of a British study just published in the New England Journal of Medicine. Both groups were provided with in-person behavioral support which appears to have improved the outcomes compared to previous studies for which such support was not provided. The e-cigarette users reported fewer cravings, as well as less irritability, restlessness and difficulty concentrating. Respiratory symptoms were also more improved. These results will be welcomed by those who believe that e-cigarettes can be used therapeutically.
On the other hand, of those in the study who abstained from tobacco, many more of the e-cigarette users were still using these devices after one year (80%) compared to the nicotine replacement group (9%). Most experts agree that nicotine, although a prime addicting component in tobacco, is not in fact the source of its primary medical danger and toxicity. The finding of continued use, however, would support the arguments of those who see e-cigarettes as vehicles that may actually increase rather than reduce tobacco addiction. The study did not continue long enough to determine if those still using e-cigarettes ultimately return to tobacco at a higher rate than those using traditional methods.
The e-cigarette opponents can point to the dramatic increase last year in the use of these devices by teenagers [Link to recent blog] and argue that they can be a gateway to tobacco use rather than an exit. One strategy to address this danger is to restrict the addition of flavors which can lead non-addicted young people to become addicted to nicotine. The FDA Commissioner Scott Gottleib has in fact taken steps to in this direction.
E-cigarettes appear to be another example of a proverbial double-edged sword, the impact of which will depend on the devilish details of how they are regulated. Compared to other addictions, tobacco addiction has been relatively neglected despite the fact that the morbidity and mortality that it causes is much greater than other addictions. Because e-cigarettes have only been available in this country since 2006, research addressing the controversies surrounding them is just beginning to become available. Hopefully, future clinical and public policy decisions will be guided not by the intensity of opinions or the reassurances of e-cigarette manufacturers, but rather by research studies such as this one.