We discussed nicotine replacement for smoking cessation today at morning report. A question came up:
Q: Are e-cigarettes an acceptable form of nicotine replacement to prescribe for our patients?
A: Smokeless cigarettes are the “new thing”. The devices retail for $100 to $200 + refills. They are composed of lithium battery, electronic components, an atomizer, a cartridge of water, propylene glycol, flavoring and nicotine. There is a heater that vaporizes liquid nicotine in a small cartridge. The heater also vaporizes propylene glycol (PEG) in the cartridge. PEG is the stuff of which theatrical smoke is made. The user gets a puff of hot gas that feels a lot like tobacco smoke. When the user exhales, there’s a cloud of PEG vapor that looks like smoke.
Early studies show it may help smoking cessation as a nicotine replacement therapy. Toxicology reports of different brands reveal that some may contain small amounts of toxins and carcinogens like diethylene glycol (stuff found in antifreeze) and tobacco-specific nitrosamine but at levels much lower than in cigarette smoke (reference).
Most smoking cessation organizations and standard of care is to still advocate a combination of counseling/behavior therapy and nicotine replacement therapy other than smokeless cigarettes. According to a recent review of AMA policy:
Whether e-cigarettes can safely help people quit smoking also is unknown, but with their fruit and candy flavors, they have a clear potential to entice new smokers.
In a recent press release, the CDC maintained a skeptical view:
…the impact of e-cigarettes on long-term health must be studied. Research is needed to assess how e-cigarette marketing could impact initiation and use of traditional cigarettes, particularly among young people.
Oh, and “vaping” is the new slang word of the day.