Are e-Cigarettes Effective for Smoking Cessation?

Peter M. Yellowlees, MBBS, MD


December 08, 2016

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This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

Electronic cigarettes (ECs) are electronic devices that heat a liquid such as glycerol, with or without nicotine and other flavoring, into an aerosol for inhalation. Since ECs appeared on the market in 2006, there has been a steady growth in their sales. While some report using ECs to reduce the risks of smoking, healthcare organizations, tobacco-control advocacy groups, and policy makers have been reluctant to encourage smokers to switch to ECs, citing lack of efficacy and safety evidence.

Now a team of investigators[1] from the University of Oxford, England, have undertaken a Cochrane review to evaluate the safety and effect of using ECs to help people who smoke achieve long-term smoking abstinence. They found only two randomized controlled trials that measured abstinence rates at 6 months or later, and 21 cohort follow-up studies with at least 6 months of follow up.

The authors concluded that there is some evidence from two trials that ECs help smokers to stop smoking in the long term compared with placebo ECs. They also noted that in another trial, there was a lack of difference in the effect of ECs compared with nicotine patches. However, they had low confidence in all of these conclusions, and none of the included studies detected serious adverse events related to EC use beyond irritation of the mouth and throat. They noted that the long-term safety of ECs remains unknown.

So, what should we do when our patients, smokers and nonsmokers, ask us about the use of ECs? From a scientific perspective, the jury is still out and more research is needed, but there is some evidence available to support the use of ECs as a tool to help our current smoking patients quit. The more important clinical issue is the potential for current nonsmokers to use ECs as a gateway drug to start smoking real cigarettes, so we should strongly advise nonsmokers not to start using ECs.

Thank you for listening to this Medscape Psychiatry Minute. Do enjoy your practice.


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