Nicotine e-cigarettes for smoking cessation: a clinical pharmacology perspective

Introduction Smoking cessation improves quality of life and increases life expectancy by up to a decade. Though two-thirds of people who smoke report a desire to quit, less than a quarter plan to quit within the coming month. The relative risks and benefits of e-cigarettes, proposed as a novel tool to support smoking cessation, are critical to monitor as the evidence evolves. Areas covered This review summarizes the evidence for smoking cessation treatment, characteristics and pharmacology of e-cigarettes, support for e-cigarettes for smoking cessation, and relevant harm reduction principles. Populations at the highest risk for continued cigarette smoking (e.g. individuals with co-occurring substance use and mental health conditions) and those who are vulnerable to initiating nicotine use through access to e-cigarettes (e.g. adolescents), are also discussed. Expert opinion Evidence indicating that e-cigarettes are comparable to nicotine replacement therapy points to their promise as a smoking cessation and harm reduction option for individuals who decline other treatment options. Future work should evaluate the comparative efficacy of e-cigarettes for historically excluded groups and the relative effects of specific products and monitor for any long-term effects. Evidence-based clinical guidelines are also needed to inform clinical practice in this rapidly evolving area.