More on Electronic Cigarettes or E-cigs

I continue to receive multiple comments on my original post Electronic Cigarettes and appreciate them all. There is an avid group of e-cig users that does not appreciate my opinion on this topic. Rather than respond to several recent comments on the original post, I thought it would be more effective to just generate a brand new post. Here are my responses to some general concerns/criticisms.

If electronic cigarettes are a safer alternative to tobacco cigarettes, why do you oppose them?
I think most people, even tobacco cigarette smokers, will agree that tobacco cigarettes are harmful in many ways. E-cigarettes may be safer than tobacco cigarettes. However, I have no way of knowing this. There is simply no published studies in the medical literature (and the few in existence are from the manufacturers). Yes, e-cigs don't have the carcinogens that tobacco cigarettes contain, and it is most likely that they pose no more dangers than those we already know to be attributed to nicotine. However, without regulation and research, I can not recommend these to patients. My opposition is more with the regulators than the electronic cigarettes. First, e-cigs are drugs by definition. Therefore, the fall within the jurisdiction of the FDA, who has turned a deaf ear to this issue. Many users buy these products online from China, and there have been several recent health related risks with products from China. In addition, many of the e-cigs sold in the US are sold in retail shopping malls. Since the FDA has chosen to ignore e-cigarettes, there is nothing really stopping vendors from selling these to minors. I strongly believe that the FDA should regulate these products as the drugs they are, which would include ensuring that they are safe. If patients choose to use e-cigarettes as tobacco cigarette alternatives, I would rather them purchase this from behind the counter of a CVS then from a questionable online site selling non-US made products.


There are plenty of nicotine replacement products out there. These are safe, so why do you think electronic cigarettes post a threat?
First, all nicotine replacement products (patch, gum, etc.) are regulated by the FDA and have been proven to be safe. E-cigarettes have not been proven safe. Secondly, nicotine has risks associated with it. These risks are clearly labeled on all nicotine replacement products. Every medicine we dispense has risks and benefits. With nicotine replacement products, the risk of short term nicotine use is outweighed by the benefits of stopping (hopefully permanently) tobacco cigarette smoke. No nicotine replacement product is intended for long term use. Caffeine also has side effects. Though I think it is OK for patients (without certain health conditions) to drink a cup or two a day, I would not recommend six or seven cups of coffee a day because of adverse effects. Thus, even if e-cigarettes are proven as safe as nicotine replacement products, I still would not recommend their regular use (though if studies were done, I would agree that this would be preferred to tobacco smoke).

I have tried everything to stop smoking. Electronic cigarettes were the only thing that worked for me. Why do you oppose e-cigs when current methods don't work and some, especially Chantix, might even be dangerous.
Current methods do work and about double your chance of successfully quitting. E-cigarettes may be effective smoking cessation devices, but they have not yet proven to be effective. Also, there is a difference between quitting tobacco cigarettes and quitting nicotine products. Nicotine replacement products like the patch are not intended for permanent use. E-cigarettes were designed to be tobacco cigarette replacement products, not smoking cessation aides. It is also possible that smokers will use e-cigarettes in place of SOME of their tobacco cigarettes. Although this does decrease exposure to known dangerous products, e-cigarettes might therefore actually prolong tobacco cigarette smoking.
Lastly, Chantix has gotten a bad rap. have posted several times about Chantix here, here, here, and here and most recently in the post Prescription Drugs: Risk vs. Benefit vs Cost- The Chantix Example . Chantix is the most effective smoking cessation agent available. Though post-marketing safety data suggest that Chantix may be associated with depressed mood, agitation, and suicidal behaviour or ideation; these also occur with smoking cessation alone. Thus, it is unclear if some these reports are due to taking Chantix or stopping smoking. Since there was at least one report of these side effects with a patient who was taking Chantix, but still smoking, the FDA appropriately decided to add this to the warnings section on Chantix' label and is currently conducting an extensive safety review. Again, all medications have risks and benefits. Being the most effective agent, these potential and rare risks are likely worth the benefit. E-cigarettes have not been tested so the risk is not known, and it is unclear whether they are effective in smoking and nicotine cessation.