What about those Electronic Cigarettes?

Kelly J. Wright, PharmD, BCACP,
Tobacco Treatment Specialist (TTS) and
Steve Burson, R.Ph.

“What about those electronic cigarettes?” is a question that more and more patients will be asking their pharmacists as they seek to fend off the harmful effects of their nicotine addictions. The use of these battery-powered vaporizers, also known as “e-cigarettes,” has been growing rapidly in the U.S. over the past few years as advertising for the products has increased.^1-3 Cartridges, usually containing nicotine and flavors, are placed into the device, and the vapor is inhaled in a manner very similar to cigarette smoke.

This article will briefly address the two main questions that pharmacists should be able to answer about e-cigarettes: 1) Are they safe? and 2) Are they an effective tobacco cessation tool?

Are they safe? E-cigarettes are largely unregulated at this point in time. There are concerns that the nicotine, propylene glycol, and other vapor constituents in e-cigarettes may cause lung damage and other health problems, environmental pollution, and second-hand harm.⁴ However, these products have not been around long enough for there to be any evidence on their long-term risks. Manufacturers of e-cigarettes are touting them as healthier than smoking. There is some preliminary evidence supporting this claim, but it is important to note that cigarettes kill up to 50 percent of people who use them, so just because e-cigarettes are safer than cigarettes, doesn’t mean they are safe.⁵ The nicotine obtained through e-cigarettes is still addictive since it is inhaled, putting the user at risk for continuing their cycle of addiction. Overall, it is safe to say that e-cigarettes should be avoided by people who do not already have a nicotine addiction. They are likely safer than cigarettes for current smokers, but the long-term risks of these products are not known.

Are they an effective tobacco cessation tool? One recent study did find that e-cigarettes may have similar efficacy as nicotine patches, but overall there is still very little research to give health professionals insight into this question.⁶ Pharmacists should recommend FDA-approved first-line treatments to patients who wish to stop using tobacco, per the Treating Tobacco Use and Dependence guidelines, preferentially to e-cigarettes at this time. These treatments include bupropion SR, varenicline, and various nicotine replacement therapies, all of which can be very effective in motivated patients who are also receiving education and counseling from a healthcare provider. Pharmacists have the knowledge, skill set, and access to patients who make them great candidates to provide these services.

Great American Smokeout. A great time to engage patients about e-cigarettes is during the Great American Smokeout, which is held on the third Thursday of November and is sponsored by the American Cancer Society. This event is a great opportunity for pharmacists to help encourage smokers to quit. Smokers are more likely to quit when there is support and advice readily available. 

Resources. Pharmacists can offer support and provide easy access to information on nicotine replacement products, quitting tips, and the effect that smoking cessation has on health. We need to take this opportunity to inform our patients about the benefits of quitting. We can accomplish this with displays throughout the pharmacy and handouts made available to patients. You can find these at www.cancer.org, www.smokefree.gov or the CDC’s new smoking cessation resource for pharmacists: http://www.cdc.gov/tobacco/campaign/tips/partners/health/pharmacist/.

You can find even more resources on the OPA’s website. Just click on the Resource Center link! You will find helpful tools as well as a great Media Press Kit, which can help you develop a press release, contact local media and help educate the public on the importance of smoking cessation. We’d love to hear about your outreach and media efforts.  Just send us a note at info@ohiopharmacists.org.

References

1. Dutra LM, Glantz SA. Electronic cigarettes and conventional cigarette use among U.S. adolescents: A cross-sectional study. JAMA Pediatr. 2014;168(7):610-617.

2. Pearson JL, Richardson A, Niaura RS, Vallone DM, Abrams DB. E-cigarette awareness, use, and harm perceptions in U.S. adults. Am J Public Health. 2012;102(9):1758-1766.

3. Duke JC, Lee YO, Kim AE, et al. Exposure to electronic cigarette television advertisements among youth and young adults. Pediatrics. 2014;134(1):e29-e36.

4. Britton J, Bogdanovica I, Ashcroft R, McNeill A. Electronic cigarettes, smoking and population health. Clinical Medicine. 2014;14(4):334-337.

5.  World Health Organization. Tobacco Fact Sheet: Updated May 2014. Available at: http://www.who.int/mediacentre/factsheets/fs339/en/. Accessed on September 11, 2014.

6. Bullen C, Howe C, Laugesen M, et al. Electronic cigarettes for smoking cessation: A randomised controlled trial. Lancet. 2013;382(9905):1629-1637.