With public service announcements declaring that “Vaping is as safe as skydiving without a parachute!”
It is understandable that a generally anti-e-cigarette climate has developed among the public and within the healthcare community in the United States (US).
While e-cigarettes (EC) are undeniably harmful when used by adolescents and nonsmokers, the increasing negative perceptions of EC and widespread false belief that EC are equal or more harmful than combustible cigarettes (CC) represent a significant missed public health opportunity. Calls have been made to balance the risks and benefits of EC rather than solely focusing on the harms as many among the health community, media, and policymakers are wont to do. Smoking remains the leading preventable cause of death and disease in the US and EC have a great potential to serve as a mechanism for smoking harm reduction among hard-to-treat populations of smokers who have failed to quit with currently available treatments. In this paper, we outline why we need to overcome the hostile EC research environment to explore the potential use of EC as a harm-reduction strategy in hard-to-treat populations.
More research needed
Despite 40 years of availability, smokers often have very limited enthusiasm for available nicotine replacement therapies (NRT), and decades of interventions have not had a large impact on that. When compared to other NRT, EC in conjunction with behavioral therapy were shown to be nearly twice as effective in helping people quit smoking (18.0% vs. 9.9%), and have been associated with more persistent CC abstinence than approved pharmaceutical aids. There are indications that many smokers find EC more appealing than other smoking cessation aids suggesting the reach and impact of EC could prove greater than traditional pharmacotherapies. However, there are few randomized controlled trials (RCT) examining the use of EC to reduce smoking, and more evidence is needed to inform EC regulations and medical use.
Hostile research environment
Despite the need for further investigation, the negative climate around EC has made this promising research difficult to perform. In the US, research of EC as a smoking cessation aid is not permitted because EC are regulated by the Food and Drug Administration (FDA) as consumer tobacco products and not as a medical device. As a result, only harm-reduction studies are currently permitted and not cessation studies. Additionally, due to misconceptions about safety and to avoid controversy by appealing to popular opinion, leadership at potential study sites has shown hesitancy in allowing EC intervention research to occur within their patient populations.
Stevens ER, Sherman SE – American Journal of Drug and Alcohol Abuse – 2022-03-04.
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