E-Cigarettes May Aid Quit-Smoking Efforts

September 27, 2013

News Review From Harvard Medical School -- E-Cigarettes May Aid Quit-Smoking Efforts

E-cigarettes may help people quit smoking, a small study suggests. The study included 657 adults who wanted to quit smoking. They were randomly divided into 3 groups. One group received nicotine patches. The others received either real or fake (placebo) e-cigarettes. E-cigarettes produce a vapor that contains nicotine. They do not burn tobacco. The placebo e-cigarettes did not contain nicotine. After 6 months, 7.3% of those using the e-cigarettes had quit smoking. That was slightly better than the 5.8% who quit with the patch, an established quit-smoking aid. About 4.1% quit with only the fake e-cigarettes. Researchers said more study is needed to establish the benefits and long-term harms of e-cigarettes. The journal Lancet published the study. CNN.com and HealthDay News wrote about it.

By Mary Pickett, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Electronic or e-cigarettes are battery-operated devices shaped like cigarettes.  They give off a flavored vapor that contains nicotine. They give the illusion and feel of smoking a cigarette without burning tobacco. Some e-cigarette users say that they are "smoking." Others call it "vaping," to distinguish the vapor from smoke.

Doctors have paid little attention to e-cigarettes since they arrived on the scene about four years ago. Why? E-cigarettes are not regulated by the Food and Drug Administration, so safety has been uncertain. I have told patients, "I don't know much about those, but I can't vouch for their safety so I would avoid them."

But now doctors -- and patients, too -- are taking interest in a study that was published earlier in the month. This study suggests that e-cigarettes might help smokers who want to cut down or quit.

The study enrolled 657 smokers who were interested in quitting. Of these patients, 292 were given e-cigarettes to use during their quit attempts. Another 292 patients were given nicotine patches. Patches have proven benefit in helping people quit smoking. The remaining patients were given a placebo e-cigarette, which did not release any nicotine.

During the next 13 weeks, 7.3% of people in the e-cigarettes group quit smoking. This does not sound like much of a success. It is only one quitter out of 15 people who tried. But this was close to the quit rates of people who used nicotine patches. By comparison, only 4.1% of those who got the placebo e-cigarettes were able to quit.

Besides those who quit, many people in the nicotine e-cigarette group cut down their (regular) cigarette smoking. About 57% cut their smoking by at least half in the 6 months after they started e-cigarettes.

If you already "vape," maybe you have found it can help you to smoke less. Maybe it has helped you to quit. Quite honestly, I am still not going to recommend e-cigarettes to my patients. But if they do become a regulated product, so that their ingredients can be guaranteed and their safety can be tracked, I may begin to take some interest. 

What Changes Can I Make Now?

If you want to quit smoking, there has never been a better time. Most quitters need to quit several times. The average is about five, because it is common for early quit attempts to "not stick." If you are willing to repeat your efforts to quit, you have an excellent chance of succeeding.

The first step is to set a quit date. Make this a public plan that you share with your family, friends and doctor.

There are several ways to improve your chance for success as you quit. Most medicines that help with quitting are used for several months. Each of these treatments comes close to doubling the "cold turkey" quit-smoking success rate:

• The nicotine patch provides you with a continuous trickle of nicotine into your bloodstream. This allows you to change your daily routine. You can skip cigarette breaks and get used to having your hands free. And you won't have the physical withdrawal symptoms that can result if you abruptly stop nicotine.
• Bupropion (Zyban or Wellbutrin) reduces the number of cravings you get and makes them less intense. This medicine can be combined with the nicotine patch or used alone.
• Nortriptyline (Aventyl, Pamelor) is an old-fashioned, low-cost  medicine that helps to reduce cravings. It has been helpful when used along with the nicotine patch. It has not been studied in combination with bupropion.
• Varenicline (Chantix) has been available for several years. This medicine reduces withdrawal symptoms and also reduces the amount of pleasure that you might feel from smoking if you relapse. It may be slightly more effective than other current treatments. A small number of people develop mood changes, such as depression, while taking this medicine. For this reason, it is not recommended for people who have a history of serious mental health issues. People with advanced heart disease also are advised to avoid this drug. Possible side effects are nausea, headache, insomnia or changes in dreaming patterns. 

What Can I Expect Looking to the Future?

I think we will hear more about e-cigarettes. According to surveys by the Centers for Disease Control and Prevention, about 1 in 5 Americans has tried smoking an e-cigarette. This is roughly 6% of smokers. I suspect the recent study about e-cigarettes as a stop-smoking aide will increase their popularity.

In the past few years, many people have been hopeful about another product being developed for quitters. This was a "stop-smoking vaccine" called NicVAX. It was designed to work by stimulating the immune system to make antibodies against nicotine. Early study results looked good. But unfortunately, this is one treatment we probably will not hear very much about in the future. The vaccine has been studied in larger trials, and it simply doesn't work. This year, the manufacturers announced that they could not prove it worked any better than a placebo.