Current Evidence of Efficacy and Safety Profile of e-Cigarettes as a Pathway Option to Smoking Cessation

Behaviour | May 23, 2014 | Author: The Super Pharmacist

smoking, quit, e-cigarette, ecigarette, cessation, ENDS, eJuice, eLiquid

Current Evidence of Efficacy and Safety Profile of e-Cigarettes as a Pathway Option to Smoking Cessation

Smoking is one of the most difficult additions to break, regardless of how strong the desire is to stop. About 80% of smokers who attempt to quit unaided will relapse back into the habit in as little as a month. Only around 5% are able to achieve the goal of long-term cessation without any quitting strategy. Opinion remains sceptical toward the efficacy of the available smoking cessation programs. The use of behaviour support and pharmaceutical cessation aids have proven to have limited success rates, with the most effective option available demonstrating 32% success rates following 12 month follow-up. Evidence indicates that without an acceptable alternative to tobacco cigarettes, most current smokers will continue to suffer from their addiction. E-Cigarettes may be one of the most favourable and popular products currently available to aid smoking cessation. In addition to providing a nicotine vapour that does not contain all of the harmful combustion products, they also provide an effective replacement for some of the ritualistic behavioural components that accompany smoking cigarettes.

Understanding the Health Consequences of Nicotine

Nicotine promotes compulsive use, physical dependence and psychoactive effects, meeting the criteria of an addictive substance. It stimulates the receptors in the brain to produce sedative and euphoric effects. Nicotine alone has not been proven to be a carcinogen, nor does it present any cardiovascular risk. Although, nicotine is actually a potential toxin, tolerance is high in regards to long-term use. Studies have found that conventional cigarettes are by far the most harmful form of nicotine delivery. However, e-cigarettes are ranked about the same as transdermal nicotine patches. When you eliminate the inhalation of smoke, nicotine alone does not pose as great a risk on a person’s health.

Quickly Gaining Popularity

e-cigarrete useControlled trials have found that only about a quarter of the people who switched to e-cigarettes were still using the product at the end of a fifty-two week test period. Almost all of the participants had not only stopped smoking, but had also stopped vaping as well. Because these people were able to become free of the behaviour component that the e-cigarette reproduced, it is an indication that vaping is not a great risk for users becoming addicted. One of the things that makes electronic cigarettes so attractive to smokers is their similarity to conventional cigarettes. Users get the behaviour satisfaction of repetitive hand-to-mouth motion as well as a visual cue of vapour that is similar to smoke. The use of e-cigarettes is competitively priced, less harmful to health and more acceptable in public places where smoking is banned. The World Health Organization categorizes e-cigarettes as an electronic nicotine delivery system, or ENDS. These devices are designed to specifically deliver nicotine to the respiratory system without the need of tobacco use. Recently, the use of electronic cigarettes has increased exponentially. A number of different companies manufacture and sale these devices, which are made up of a lithium battery, atomizer, electronic components and a cartridge that contains a liquid solution. The liquid solution, which is known as eJuice or eLiquid, is made up of nicotine, flavouring, water and propylene glycol. Electronic cigarettes can be used as an additional tool for reducing tobacco use in smokers that are only experiencing limited or no level of success from smoking cessations programmes. Smokers who consider their use of cigarettes to be nothing more than a recreational habit rather than a medical condition will find e-cigarettes as an attractive option.

Toxicology of e-Cigarettes

Several studies have been conducted on the potential health risks of e-cigarettes. However, evidence indicates that serious health concerns are not an issue with electronic cigarettes. This means that they may be considered a safe alternative to conventional tobacco smoking. The liquid that is used with e-cigarettes has been tested for more than fifty of the same toxins that are found in cigarette smoke. Conventional cigarettes contain acetaldehyde, formaldehyde and acroleine, which are all potentially toxic compounds. These toxins have also been found in twelve different brands of electronic cigarettes. The level of toxins found in e-cigarettes is much lower than those that are found in cigarette smoke. It is believed that these compounds are the result of the oxidation of the glycerol or propylene glycol when it comes in contact with the e-cigarette heating coil. Laboratory tests of the eLiquid used in e-cigarettes revealed that only trace levels of the toxic compounds were present. This is similar to the amount found in transdermal nicotine patches. The level of these compounds in e-cigarette liquid is five hundred to over a thousand times lower than the levels that are found in conventional cigarettes. Manufacturers of electronic cigarettes are in the process of developing improved standards from manufacture. The eLiquids that were produced prior to 2013 were imprecise. The newest products available on the market have been improved significantly. The newer eLiquids have higher levels of purity, provide a more consistent vapour and contain a more accurate amount of nicotine. More rigorous studies are needed to determine the long term safety and potential cessation assistance for electronic cigarettes. Current evidence suggests that these products are proving to be helpful to those who have the desire to stop smoking with promising short term results.

References:

  1. Hughes JR, Keely J, Naud S: Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004, 99:29-38
  2. Polosa R, Benowitz NL: Treatment of nicotine addiction: present therapeutic options and pipeline developments. Trends Pharmacol Sci May 2011, 32(5):281-289.
  3. Mottillo S, Filion KB, Bélisle P, Joseph L, et al.: Behavioural interventions for smoking cessation: a meta-analysis of randomized controlled trials. Eur Heart J 2009, 30(6):718-730.
  4. Vogt Florian, Hall Sue, Marteau Theresa M: General practitioners’ beliefs about effectiveness and intentions to prescribe smoking cessation medications: qualitative and quantitative studies BMC Public Health
  5. Kozlowski LT, Wilkinson DA, Skinner W, Kent C, Franklin T, Pope M.Comparing tobacco cigarette dependence with other drug dependencies. Greater or equal 'difficulty quitting' and 'urges to use,' but less 'pleasure' from cigarettes. 1989 Feb 10;261(6):898-901
  6. Benowitz N: Nicotine Safety and Toxicity. Oxford (UK): Oxford University Press; 1998.
  7. Tobacco Advisory Group of the Royal College of Physicians: Harm reduction in nicotine addiction: Helping people who can’t quit. London: Royal College of Physicians
  8. Drug Science: Multi-criteria Decision Analysis: A new approach to evaluating the harm caused by nicotine delivery products
  9. Food and Drug Administration: Brief in Opposition to Motion for Preliminary Injunction
  10. Cahn Z, Siegel M: Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes?
  11. Laugesen M: Ruyan e-cigarette bench-top tests.
backBack to Blog Home