For the first time, a US expert group has drawn up clinical recommendations on how doctors can use e-cigarettes as a tool to help people quit smoking. According to the researchers, e-cigarettes containing nicotine should be discussed alongside nicotine replacement therapy and other established treatments when adult smokers wish to quit.
The recommendations have been published in the medical journal JAMA and were drawn up by 24 researchers and experts within the Society for Research on Nicotine and Tobacco (SRNT)’s network for the treatment of tobacco dependence.
E-cigarettes are still not officially approved as smoking cessation aids by the US Food and Drug Administration (FDA). However, the researchers describe their recommendations as a way of translating the growing body of scientific evidence into practical healthcare.
”Should be included among the options”
The main recommendation is that doctors should include e-cigarettes when discussing the risks and benefits of various evidence-based methods for quitting smoking.
The researchers refer, amongst other things, to Cochrane’s regular reviews of randomised trials. According to these, there is now high-certainty evidence that nicotine e-cigarettes help more smokers to quit than traditional nicotine replacement therapies such as patches and chewing gum.
“The key message is that healthcare professionals should include e-cigarettes in their toolbox for smoking cessation,” says Tracy Smith, an addiction researcher at the Medical University of South Carolina and one of the report’s authors.
If the patient has no particular preference, the doctor may still, as a first step, suggest already approved medicines, such as varenicline, bupropion or nicotine replacement therapy. However, if an adult smoker prefers to try e-cigarettes, healthcare services should, according to the recommendations, support that choice – without requiring the person to have first failed with other treatments.
A complete change is the aim
The researchers also provide practical advice on how e-cigarettes should be used when trying to give up smoking.
Anyone choosing this method should use a product authorised for sale by the FDA and use the e-cigarette when they would otherwise have smoked or when they feel the urge to smoke. The aim should be to replace cigarettes entirely as quickly as possible, rather than continuing to use both products for an extended period.
The researchers also recommend behavioural support and follow-up from healthcare services.
E-cigarettes are not risk-free, the group notes. However, according to the researchers, the relevant comparison for a smoker is, above all, continuing to smoke cigarettes.
””The significant burden of disease caused by cigarette smoking, together with the scientific evidence regarding the use of e-cigarettes to help people quit smoking, clearly demonstrates that it is appropriate to include e-cigarettes in discussions about evidence-based treatment for smoking cessation,” the researchers write in their conclusion.
Wants to correct misconceptions
Some of the recommendations also relate to risk communication.
The researchers note that misconceptions about nicotine and e-cigarettes are common even amongst American healthcare professionals. Among other things, nicotine is often perceived as the main cause of cancer and other smoking-related diseases.
According to the report, doctors need to explain more clearly the difference between nicotine addiction and the harm caused primarily by the substances produced when tobacco is burnt.
– “This is not about encouraging nicotine use amongst people who do not smoke. It is about ensuring that doctors have accurate, evidence-based information so that they can discuss all available options with adult patients who still smoke,” says co-author Bethea Kleykamp of the University of Maryland.
A shift in the American view of giving up smoking
The recommendations mark a clear shift from previous US guidelines. As recently as 2021, the US Preventive Services Task Force, a federal expert group, concluded that there was insufficient evidence to assess e-cigarettes as a method for quitting smoking.
Since then, a considerably larger number of randomised studies have been published. The research group behind the new recommendations refers, amongst other things, to the Cochrane reviews of over 100 studies involving tens of thousands of participants.
At the same time, the use of cigarettes and e-cigarettes has changed significantly in the US.
As Vejpkollen recently reported, US population data from 2014 to 2024 show a clear shift from cigarette smoking to exclusive vejp use. Among Americans who either smoked or vaped, the proportion who smoked exclusively fell from around 80 per cent to 50 per cent, whilst the proportion who used e-cigarettes exclusively rose from around 5 per cent to 40 per cent.
Another US study reported by Vejpkollen also shows how some smokers gradually give up cigarettes after taking up vejpa – without necessarily having planned to quit smoking from the outset.
The UK took the lead
In the UK, e-cigarettes have been used in public smoking cessation programmes for considerably longer.
In 2023, the UK government launched the ”Swap to Stop” programme, under which up to one million smokers would be offered free e-cigarettes alongside support to help them give up smoking.
Last year, Vejpkollen reported on the results from Dorset in southern England. There, nearly 15,000 starter packs had been handed out and over 3,500 participants were reported to be smoke-free after four weeks.
