Electronic cigarettes present a conundrum for public health officials. On the one hand, they contain fewer — or perhaps even none — of the cancer-causing substances found in tobacco products “which presents an opportunity for harm reduction if smokers use them as substitutes for cigarettes,” according to the American Heart Association in a new recommendation released on Monday.
The group recommended that doctors should counsel patients to use e-cigarettes when other smoking cessation approaches fail.
On the other hand, teens who would never dream of smoking regular cigarettes have been puffing away on vaporized nicotine from e-cigarette cartridges -- and some may eventually turn to regular cigarette use as a result.
The latter concern has tipped the balance against e-cigarette use for many of the nation’s health leaders who view them more as a toy for teens than as a legitimate smoking cessation tool on par with nicotine patches, gum, and lozenges, which are regulated by the US Food and Drug Administration as medical products.
In fact, more than a quarter of a million teens who had never smoked a cigarette used electronic cigarettes in 2013, according to national survey data that was published Monday by Centers for Disease Control and Prevention researchers. This compares to 79,000 non-smoking teens who reported using e-cigarettes in a 2011 National Youth Tobacco survey.
The CDC study published in the journal Nicotine and Tobacco Research also found that 44 percent of teens who reported trying e-cigarettes said they intended to smoke conventional cigarettes within the next year compared with 22 percent of those who had never used e-cigarettes.
For this reason, CDC officials have taken a firm stance against e-cigarette use in teens basically equating it with tobacco use. “We are very concerned about nicotine use among our youth, regardless of whether it comes from conventional cigarettes, e-cigarettes or other tobacco products. Not only is nicotine highly addictive, it can harm adolescent brain development,” Dr. Tim McAfee, director of the CDC’s Office on Smoking and Health, said in a statement.
CDC director Tom Frieden has gone further in media interviews saying that the products have not been demonstrated in solid clinical trials to be an effective quitting tool for smokers and that until those trials are done, e-cigarettes should be regulated like tobacco products with a ban on sales to minors, other sales restrictions, and hefty taxes to discourage their use.
The American Heart Association has taken a more nuanced approach in their new policy statement. While the group recommends that e-cigarettes be regulated by states similar to tobacco, they also think the products could work for some smokers trying desperately to quit.
Doctors should recommend “proven smoking-cessation strategies” as the first line of treatment for patients attempting to quit smoking such as behavioral counseling, prescription medications like Chantix (varenicline) and Zyban (bupropion), or FDA-approved nicotine replacement products, according to the AHA. But the association recommended that “clinicians should not discourage” the use of e-cigarettes by patients when those approaches don’t work.
Rather, they should inform patients that the products may be useful to help them quit but are “unregulated, may contain low levels of toxic chemicals, and have not been FDA-approved as cessation devices.”