RANDOMIZED TRIAL FINDS E-CIGARETTES ARE MORE EFFECTIVE SMOKING CESSATION TOOL THAN NICOTINE REPLACEMENT THERAPY

February 11, 2019

KEY POINTS

  • A new study published in The New England Journal of Medicine finds the use of electronic cigarettes and vaping devices to be “twice as effective as nicotine replacement at helping smokers quit.”

  • Researchers analyzed 886 randomized participants to examine the effects of e-cigarettes and nicotine replacement therapy (NRT) on smoking cessation.

    • Participants were mostly “middle aged smokers,” were broken into an NRT group and an e-cigarette group.

    • More than 78 percent completed the 52-week follow up conducted by the researchers.

  • More than 100 participants reported abstinence during the 52-week follow up. Researchers found “80% … were using e-cigarettes at 52 weeks in the e-cigarette group and 9% were using” NRT products in the NRT group.

  • The researchers concluded a higher abstinence rate in the group of e-cigarette users, with 18.0 percent. Participants in the NRT group reported a 9.9 percent one-year abstinence rate.

  • In terms of smoking-related health issues, researchers found that “among participants who reported cough or phlegm at baseline, significantly more were symptom-free at the 52-week follow up in the e-cigarette group” compared to the NRT group.

  • These latest findings provide more valuable information on the public health role that e-cigarettes and vaping devices provide for the 38 million cigarette smokers in the United States.

A new study published in The New England Journal of Medicine finds the use of electronic cigarettes and vaping devices to be “twice as effective as nicotine replacement at helping smokers quit.”

In a “two group, pragmatic, multi-center, individually randomized, controlled trial,” researchers analyzed 886 randomized participants to examine the effects of e-cigarettes and nicotine replacement therapy (NRT) on smoking cessation. The participants, who were mostly “middle aged smokers,” were broken into an NRT group and an e-cigarette group. More than 78 percent completed the 52-week follow up conducted by the researchers.

More than100 participants reported abstinence during the 52-week follow up. Researchers found “80% … were using e-cigarettes at 52 weeks in the e-cigarette group and 9% were using” NRT products in the NRT group. Overall, the researchers concluded a higher abstinence rate in the group of e-cigarette users, with 18.0 percent. Participants in the NRT group reported a 9.9 percent one-year abstinence rate. E-cigarettes provided “greater satisfaction and were rated as more helpful to refrain from smoking” than NRT products.

In terms of smoking-related health issues, researchers found that “among participants who reported cough or phlegm at baseline, significantly more were symptom-free at the 52-week follow up in the e-cigarette group” compared to the NRT group. The researchers did run “an exploratory analysis that controlled for abstinence status at 52 weeks” and found no difference in results.

These latest findings provide more valuable information on the public health role that e-cigarettes and vaping devices provide for the 38 million cigarette smokers in the United States. Research increasingly indicates that the many tobacco products available to consumers today exist on a continuum of harm, with combustible cigarettes the most harmful.

In the past twenty years, researchers have examined the role of tobacco harm reduction products—including smokeless tobacco and snus, e-cigarettes and NRT products—and their role in helping smokers quit combustible cigarettes. Dr. Brad Rodu, a senior fellow at The Heartland Institute, has conducted extensive analyses on men in Sweden, who have the highest rate of smokeless tobacco use in Europe, and reports they also “have the lowest rates of lung cancer and other smoking-related disease in Europe.” It important to note that Swedish snus, a Swedish moist snuff tobacco product, is banned in all European Union countries except Sweden.

Other findings provide further evidence to the efficacy of e-cigarettes. Numerous leading public health groups have extensively studied these products and find them to be significantly less harmful than combustible cigarettes. Public Health England’s landmark report found e-cigarette use to be “95% less harmful” than combustible cigarettes. The Royal College of Physicians estimates e-cigarette use “unlikely to exceed 5% of the harm from smoking tobacco.” The National Academies of Sciences, Engineering, and Medicine found switching from combustible cigarettes to e-cigarettes “results in reduced short-term adverse health outcomes in several organ systems,” and the American Cancer Society has noted that “the exclusive use of e-cigarettes is preferable to continuing to smoke combustible cigarettes.”

Even more comforting to state lawmakers are the positive effects THR products can provide by reduction of health care costs associated with combustible cigarettes. One analysis found states would have saved $48 billion in Medicaid spending in 2012 if all then-currently smoking Medicaid recipients switched to e-cigarettes. Analysis on a smaller percentage of Medicaid recipients switching to e-cigarettes found that if one percent of the population switched to e-cigarettes, estimated Medicaid savings would “be approximately $2.8 billion per 1 percent of enrollees” over the next 25 years.

Policymakers should embrace evidence to the efficacy of THR products and provide a framework that moves to educate the public. Furthermore, policies and regulations aimed at THR products should reflect the relative harm of the products.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute or Tobacco Harm Reduction 101.

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