Current advances in research in treatment and recovery: Nicotine addiction

Resource Notes:

From “Discussion”: The overall impact of e-cigarettes on public health remains a question of debate. While e-cigarettes may have adverse effects on respiratory health and possibly other diseases, the harm is generally accepted to be much less than that of cigarette smoking (24). Thus, if smokers were to switch completely to e-cigarettes, then smoking-related disease is predicted to decrease substantially. Population-based models of the impact of e-cigarette use predict an overall health benefit, because many smokers will quit, while those who continue vaping or take up e-cigarettes anew experience much less harm (234). On the other hand, many parents, pediatricians, public health officials, and others are extremely concerned about youth uptake of e-cigarettes and are encouraging local communities to ban e-cigarette sales. E-cigarette use in youth shows exposure to toxins with concern about the long-term health effects from sustained use (235). The overall benefit versus risk for a community is likely to depend on the prevalence of cigarette smoking in the community. Where smoking prevalence is high, the potential benefits of e-cigarettes in reducing smoking are high. Where smoking prevalence is low, the benefit is low and the potential risk of e-cigarettes to youth becomes the major community concern.

Another consideration regarding e-cigarettes is a role that it may play in a broader public health regulatory intervention. Reducing the nicotine content of combustible tobacco would make the products less satisfying to smokers. The availability of less harmful noncombusted sources of nicotine, such as e-cigarettes, could help a smoker transfer their nicotine addiction from combustibles to e-cigarettes. Presumably, many, if not most, people would stop smoking, and the result would be prevention of most tobacco-related disease. In time, a former smoker who switched to e-cigarettes could quit nicotine use or remain a long-term e-cigarette user but with much less harm than from smoking cigarettes.

In closing, with the evolving nicotine product market, critically important is the need for evidence to inform innovations in tobacco control policies and tobacco treatment approaches (behavioral, pharmacologic, and technology based), with consideration of the risks and benefits for all populations affected.