Evidence Regarding E‐Cigarettes as a Harm Reduction Strategy and Treatment for E‐Cigarette Cessation: An Overview and Guide for Clinicians

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Abstract
Since their emergence on the United States market in the early 2000s, e‐cigarette accessibility and use have grown considerably. Electronic cigarettes (e‐cigarettes), also referred to as vapes or electronic nicotine delivery systems, deliver their contents by heating and aerosolizing an “e‐liquid” that is then inhaled. This differs from traditional tobacco cigarettes (TC), which rely on combustion, a process that is responsible for many of the deleterious effects of smoking. As a result, e‐cigarettes are viewed by some as a potential harm reduction tool for those interested in quitting smoking TC. However, others are concerned that increasing use, particularly among adolescents and young adults, may reverse decades of progress toward a tobacco‐free society and lead to greater harms. As e‐cigarette accessibility and use grow, clinicians will continue to encounter more patients using e‐cigarettes who may be seeking assistance in quitting; therefore, it is crucial that clinicians remain aware of the literature to provide complete and accurate information to patients. Current evidence suggests e‐cigarettes may be efficacious as a harm reduction tool for those not yet ready to completely abstain from nicotine. However, their relative addiction potential, lack of long‐term safety data, and known or suspected cardiovascular, pulmonary, and carcinogenic risks suggest that for most patients who are ready to stop using nicotine completely, the US Food and Drug Administration‐approved pharmacotherapy options should still be the recommended first‐line options. Ultimately, if e‐cigarettes are used as a tobacco cessation tool, patients should be advised that the end goal should be to quit using these products entirely. While there remains an unmet need for additional research into e‐cigarette cessation interventions, the existing evidence to date supports the use of partial nicotine receptor agonists such as varenicline to assist with cessation.

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