Smoking cessation and e-cigarettes

Abstract

Background: Electronic cigarettes (e-cigarettes) are often promoted as aids to tobacco smoking cessation. Australia has a unique regulatory position internationally, with e-cigarettes legal only on prescription for smoking cessation, as unregistered therapeutic products. Use of any product in the therapeutic context requires appropriate levels of safety, efficacy and quality. Objectives: To summarise the current evidence, the efficacy of e-cigarettes for smoking cessation and their likely health impacts. Methods: Evidence from major national and international reports, published peer-reviewed studies and nationally relevant survey data was reviewed systematically and summarised. Findings: Evidence was very limited. From >6500 identified titles, 189 studies were included. The commonest exposure pattern is smoking combined with e-cigarette use. There is limited evidence that free-base nicotine e-cigarettes with nicotine concentration ≤20 mg/mL are efficacious in the clinical setting for smoking cessation vs no intervention, placebo or NRT. E-cigarettes may lead to greater ongoing nicotine exposure than other cessation methods. Use of nicotine e-cigarettes increases the risk of a range of adverse health outcomes, including poisoning, toxicity from inhalation (such as seizures), addiction, trauma and burns, lung injury and smoking uptake, particularly in youth. Their effects on most other clinical outcomes, including cancer, cardiovascular disease and development in children and adolescents, are unknown. Conclusion: There is limited evidence that nicotine e-cigarettes may be efficacious for smoking cessation in the clinical setting, strong evidence of certain harmful effects and uncertainty regarding major health outcomes. There is uncertainty regarding the overall balance of risks and benefits of e-cigarettes for smoking cessation.