The Case in Favor of E-Cigarettes for Tobacco Harm Reduction

Abstract

A carefully structured Tobacco Harm Reduction (THR) initiative, with e-cigarettes as a prominent THR modality, added to current tobacco control programming, is the most feasible policy option likely to substantially reduce tobacco-attributable illness and death in the United States over the next 20 years. E-cigarettes and related vapor products are the most promising harm reduction modalities because of their acceptability to smokers. There are about 46 million smokers in the United States, and an estimated 480,000 deaths per year attributed to cigarette smoking. These numbers have been essentially stable since 2004. Currently recommended pharmaceutical smoking cessation protocols fail in about 90% of smokers who use them as directed, even under the best of study conditions, when results are measured at six to twelve months. E-cigarettes have not been attractive to non-smoking teens or adults. Limited numbers non-smokers have experimented with them, but hardly any have continued their use. The vast majority of e-cigarette use is by current smokers using them to cut down or quit cigarettes. E-cigarettes, even when used in no-smoking areas, pose no discernable risk to bystanders. Finally, addition of a THR component to current tobacco control programming will likely reduce costs by reducing the need for counseling and drugs.

The smoking population in the USA and EU is softening not hardening

“…Smokeless tobacco and, more recently, e-cigarettes have been promoted as a harm reduction strategy for smokers who are unable or unwilling to quit1 2 3 4 on the assumption that as those who are able and willing to quit do so, a group of hardcore smokers will be left behind. The concept of harm reduction was first proposed by Russell5 6 when he suggested offering smokers a less harmful source of nicotine than combusted cigarettes.…”

Exposure to Nicotine and Selected Toxicants in Cigarette Smokers Who Switched to Electronic Cigarettes: A Longitudinal Within-Subjects Observational Study

“…3 Electronic cigarettes (e-cigarettes) represent a new prospect in harm reduction from tobacco use. 4,5 However, studies demonstrating the efficacy of e-cigarettes as harm reduction devices are lacking. 6,7 While several laboratory studies have shown that e-cigarette aerosol contains significant amounts of nicotine and reduced levels of toxicants compared to tobacco smoke, [8][9][10] laboratory machine yields do not necessarily reflect toxicant exposure in an individual smoker.…”

E-Cig Tipping Points vs. FDA Deeming Regulations

“…Except for American Cancer Society studies on light and low tar cigarettes [14] we have no population-based studies that allege differences in either addiction or risk of potentially fatal tobacco-related illness by chemical or component of the tobacco smoke within a given class of tobaccorelated products. By disregarding the studies by class of product, FDA ignores the large and growing body of evidence that e-cigs, as a class, are likely to be far less hazardous and less addictive than cigarettes [5,6,15].…”

“…British authorities came out with the Public Health England report endorsing tobacco harm reduction using e-cig products to reduce tobacco-related illness and death [4]. We now have American, Canadian, and British reports showing that e-cigs are effective in helping smokers cut down and quit [4][5][6][7][8] and doing so without recruiting significant numbers of nonsmoking teens to nicotine addiction. This tips e-cigs from a product seen as dangerous and highly addictive to a product that should be seen as having potential public health benefits well in excess of any potential harms; benefits not likely achievable by any other means.…”

“…They do claim that the potential benefits to smokers far outweigh the theoretical risks, and that the risk to nonusers is minimal [4][5][6][7].…”