This week, two articles have been published which review the current state of treatment for smoking cessation. Both articles conclude that electronic cigarettes show promise and that these innovative products should be considered as strategies to promote smoking cessation or reduction.
In an article appearing in this month's issue of Nicotine & Tobacco Research, Brent Caldwell, Dr.Walt Sumner, and Julian Crane provide a systematic review of inhaled nicotine as a tool for smoking cessation. First, they point out the dismal effectiveness rates for traditional nicotine replacement therapy (NRT) products, noting that their long-term success rates are low. Second, they review current evidence on the use of various inhaled nicotine devices, including nicotine inhalers and electronic cigarettes. They conclude that these devices are unlikely to cause serious health problems. They also conclude that electronic cigarettes, in particular, show promise. Their ultimate conclusion is that: "Investment in development of therapeutic pulmonary nicotine devices is likely to result in a major advance in smoking cessation treatment and prevent considerable mortality and morbidity."
In an article appearing online ahead of print in the journal Internal and Emergency Medicine, Dr. Pasquale Caponnetto, Elaine Keller. Dr. Cosimo M. Bruno, and Dr. Riccardo Polosa provide a review of strategies to handle relapse in smoking cessation. They present an algorithm for responding to relapse and their approach includes the consideration of using harm reduction approaches such as electronic cigarettes. They conclude that: "Recent research with electronic cigarettes, battery-operated products designed for the purpose of nicotine delivery has found them to be safe and effective in helping smokers remain abstinent. ... Thus, advising smokers who cannot (or do not want to) quit to switch to either low-nitrosamine snuff or electronic cigarette could be an equally effective way to help smokers to become abstinent. This new emphasis on tobacco harm reduction as an exit strategy for smokers unable (or unwilling) to quit is a key paradigm shift in the management of relapse, which could save millions of lives world-wide."
The Rest of the Story
I think that the persistence and perseverance of harm reduction advocates, especially electronic cigarette advocacy groups and users, is finally starting to have an effect on public and scientific opinion. It would have been unheard of two years ago for a pair of articles to come out on the same day, both supporting the use of electronic cigarettes as a potential smoking cessation strategy.
That harm reduction is now on the mainstream agenda is a testament to the efforts of researchers and advocates who will not give up, including but not limited to the work of Bill Godshall, Scott Ballin, Dr. Carl Phillips, Dr. Brad Rodu, Paul Bergen, Dr. David Sweanor, Dr. Murray Laugesen, Dr. Jonathan Foulds, Dr. Gil Ross, and many others, as well as the efforts of advocacy groups such as CASAA (The Consumer Advocates for Smoke-Free Alternatives Association).
But most importantly, it is due to the testimony and dedication of the actual users of these products - notably, the many electronic cigarette users who have been willing to share their experiences with the media, the public, policy makers, and the harm reduction community. Their message is starting to be heard. Despite the ideological and political/financial barriers posed by many leading groups in the tobacco control movement, the overwhelming experience of tens of thousands of electronic cigarette users cannot be suppressed or ignored forever.
I finally see the tide beginning to turn.