E-cigarettes are more effective for smoking cessation than conventional nicotine replacement therapy

Nicotine e-cigarettes are more effective at helping people quit smoking than conventional nicotine replacement therapy (NRT), according to the latest Cochrane review, led by a University of Massachusetts Amherst public health and policy researcher.

The review of studies published in Cochrane Database of Systematic Reviews found high-certainty evidence that e-cigarettes, which allow users to “vape” nicotine instead of smoking it, lead to a better chance of quitting than patches, gum, lozenges or other traditional NRTs.

In England, quite unlike the rest of the world, e-cigarettes have been adopted by public health services as a tool to help people reduce the harm of smoking.”

Jamie Hartmann-Boyce, assistant professor of health policy and promotion in the School of Public Health and Health Sciences

Globally, smoking is the leading cause of preventable disease and death, resulting in more than seven million deaths annually. “Most US adults who smoke want to quit, but many find it really hard to do so,” says Hartman-Boyce, who conducted research at the University of Oxford in England before joining UMass Amherst earlier this year. “We need a range of evidence-based options for people to use to quit smoking, as some people will try many different ways to quit before finding one that works for them.”

Cochrane editor Hartmann-Boyce is the senior author of the review, which included 88 studies and more than 27,235 participants – an addition of 10 studies since the last update in 2022. Most of the studies analyzed were conducted in the US, in United Kingdom or Italy.

E-cigarettes do not burn tobacco, but instead heat liquids with nicotine and flavorings, allowing users to inhale a nicotine-containing vapor instead of inhaling cigarette smoke. With conventional cigarettes, people who smoke are exposed to a complex mixture of chemicals known to cause disease.

“We have very clear evidence that, although not harmless, nicotine e-cigarettes are significantly less harmful than smoking,” says Hartmann-Boyce. “Some people who have not had success in the past with other smoking cessation aids have found that e-cigarettes have helped them.”

The analysis found that for every 100 people who use nicotine e-cigarettes to quit smoking, eight to 10 are expected to quit successfully, compared with six in 100 people who use traditional nicotine replacement therapy and four in 100 who try to quit smoking without support or only behavioral support.

Regular review of smoking cessation studies continues to provide strong evidence that can inform public health policies and strategies, giving smokers better tools to quit for good. Hartmann-Boyce stresses that the public health message is a complex one, especially in the US.

While non-smokers should avoid using e-cigarettes because of the potential negative health effects, Hartmann-Boyce says, some smokers can improve their health and reduce their risks by quitting with the help of e-cigarettes. . .

“Not everything is completely harmful or beneficial,” says Hartmann-Boyce. “Different things may have different effects on different populations. The evidence shows that nicotine e-cigarettes can help people quit smoking, and that people who don’t smoke should not use e-cigarettes.”

Compares the smoking versus e-cigarette scenario to treating a substance use disorder involving opioids. “We’re not going to prescribe methadone to people who aren’t addicted to opioids,” Hartmann-Boyce says. “But for people who are addicted to opioids, we recognize that methadone is a helpful thing.”

The US Food and Drug Administration (FDA), which regulates e-cigarettes, has approved seven different drugs that have been shown to help adults quit smoking. Electronic cigarettes are not one of them. Earlier this year, in a briefing on the FDA’s tobacco program, FDA Commissioner Dr. Robert Califf said: “While some e-cigarettes may help adult smokers transition away from or significantly reduce the use of more harmful combustible cigarettes, the Public Health Act balances this potential against the known and substantial risk of youth appeal, uptake and use of these highly addictive products’.