A new study, published in the April issue of Tobacco Control, demonstrates that electronic cigarettes are effective in suppressing the desire to smoke, have similar efficacy to nicotine inhalers, and are more pleasant to use than the nicotine inhaler (see: Bullen C, McRobbie H, Thornley S, Glover M, Lin R, Laugesen M. Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tobacco Control 2010; 19:98-103).
The study was conducted among 40 smokers who refrained from smoking overnight and then were given either cigarettes, a nicotine inhaler, or electronic cigarettes. The electronic cigarette produced a significant decline in the desire to smoke, an effect equivalent to that observed with the nicotine inhaler. However, the electronic cigarette was found to be more pleasurable and to have fewer side effects than the nicotine inhaler.
Of note, the 0 mg electronic cigarette also significantly reduced the desire to smoke after overnight abstinence, although its effects were shorter-lived than those of the 16 mg electronic cigarette.
The 16 mg electronic cigarette produced a modest increase in blood nicotine levels, similar to those observed with the nicotine inhaler.
The study concludes: "The 16 mg Ruyan V8 ENDD [electronic nicotine delivery device] alleviated desire to smoke after overnight abstinence, was well tolerated and had a pharmacokinetic profile more like the Nicorette inhalator than a tobacco cigarette. Evaluation of the ENDD for longer-term safety, potential for long-term use and efficacy as a cessation aid is needed."
The Rest of the Story
This study demonstrates that the electronic cigarette is effective in suppressing the desire to smoke and suppressing withdrawal symptoms among dependent smokers, even though they deliver only modest amounts of nicotine to the user. The efficacy and acute adverse effect profile of the product was found to be similar to that of the nicotine inhaler, but the electronic cigarette was generally preferred to the inhaler. Most interestingly, even use of the 0 mg product resulted in a significant suppression of the desire to smoke.
That even the 0 mg cartridge was effective in suppressing the desire to smoke suggests that a substantial reason for the electronic cigarette's effectiveness is its simulation of smoking behavior. It appears that the behavioral aspect of the addiction to smoking, and not just the pharmacologic aspect of the addiction, needs to be addressed for a smoking cessation product to be effective. This may help explain why the electronic cigarette has anecdotally been widely reported as being effective in helping smokers quit.
Anti-smoking groups and advocates can no longer argue that there is no published evidence that electronic cigarettes are effective in suppressing the desire to smoke. The results of this study suggest that these devices may have the potential to be an effective strategy for smoking cessation, making them a potentially life-saving innovation.
This research should lead to the FDA making the study of electronic cigarettes a priority. Rather than ban the product, as many anti-smoking groups are urging, the FDA should embrace the potential of this approach to smoking cessation, and should work with manufacturers and distributors to help craft a research agenda that will answer questions about effectiveness in smoking cessation and long-term safety.
Meanwhile, states considering legislation to ban the electronic cigarette should reject such legislation, because enacting these laws will certainly lead to thousands of ex-smokers returning to smoking, which would substantially harm the public's health.