The efficacy of e-cigarettes in smoking cessation

Morgan Liotta

30/01/2020 1:54:02 PM

Limited evidence means e-cigarettes are only recommended as second-line treatment in the new RACGP  guidelines.

Using an e-cigarette
Nicotine-containing e-cigarettes are not considered a first-line treatment for smoking cessation.

The RACGP is clear that a precautionary approach be taken for nicotine-containing e-cigarettes as a potential second-line treatment to support cessation. But ongoing debate remains about a potential role for e-cigarettes in harm reduction for people who do not want to give up tobacco or nicotine use completely.
‘Nicotine-containing e-cigarettes are not first-line treatment for smoking cessation and there are no products that have been evaluated and approved for therapeutic use,’ Professor Nick Zwar, Chair of the Expert Advisory Group for the RACGP’s Supporting smoking cessation: A guide for health professionals previously told newsGP.
The newly updated guidelines stress that practitioners should exercise caution when deciding whether to prescribe nicotine-containing e-cigarettes as the best option for their patients intending to quit.
A lack of current evidence regarding short- and long-term health effects and social implications shrouds the e-cigarette market with controversy, creating some uncertainty in the primary care setting, given the evolving safety profile and efficacy of the products.
The RACGP guidelines recommend that nicotine containing e-cigarettes may be a ‘reasonable intervention’ to consider for people who have tried to achieve smoking cessation with approved pharmacotherapies and failed, but who are still motivated to quit smoking and have brought up e-cigarette usage with their healthcare practitioner.
However, this needs to be preceded by an evidence-informed shared decision-making process, whereby the patient is aware that:

  • long-term health effects are unknown
  • no tested and approved e-cigarette products are currently available
  • possession of nicotine-containing e-liquid without a prescription is illegal
  • only short-term use should be recommended
  • dual use – ie with continued tobacco smoking – should be avoided.
Professor Zwar confirmed that recommendations of considering e-cigarettes as a smoking cessation aid come with a warning, as no products have undergone suitable therapeutic assessment.
‘If you are a health practitioner, the problem is you do not know exactly what’s going to be in any e-cigarette product – it’s not standardised,’ he said.
The guidelines also refer to another concern surrounding the use of e-cigarettes having a potential gateway effect that leads to cigarette smoking and normalising nicotine use, particularly among young people.
Therapeutic Goods Administration (TGA)-approved pharmacological options – nicotine replacement therapy (NRT), varencicline and bupropion – combined with appropriate behavioural support, offer the strongest evidence base for efficacy and safety in smoking cessation. The RACGP’s smoking cessation guidelines also support these options as first-line treatment.
The use of e-cigarette products is currently not approved by the TGA in Australia, and each state and territory has its own regulations regarding the sale and supply of nicotine-containing e-cigarettes.
The second edition of the RACGP’s Supporting smoking cessation: A guide for health professionals is now available.
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