Electronic cigarettes, or e-cigarettes, have gained popularity in recent years as a potential alternative to traditional smoking. Vaping involves inhaling an aerosol containing nicotine, flavorings, and various chemicals, including carcinogens, toxic substances, and metals. While often perceived as a safer option, vaping carries significant health risks similar to those associated with traditional cigarettes. In this article, we will delve into the history of e-cigarettes, examine their effectiveness as a smoking cessation aid, and explore the crucial role pharmacists can play in educating patients about the dangers of vaping and providing guidance on safe and effective methods to quit smoking.
The Origins of E-Cigarettes: A Brief History
The concept of e-cigarettes can be traced back to the 1960s when British American Tobacco developed a smoking device under the codename Ariel. At the time, researchers were already aware of nicotine's addictive properties, but new evidence linking smoking to lung cancer prompted cigarette companies to explore alternative products with reduced risks. The goal was to create an inhalation device with filters to minimize carcinogens and tar. However, it was discovered that filtered cigarettes were not a healthier alternative, as all components of cigarette smoke proved to be harmful.
To avoid the strict regulations and extensive clinical trials required for drug delivery systems, the company aimed to produce a product with a high nicotine concentration while bypassing the classification as a drug-delivery system. This allowed them to reduce manufacturing costs, speed up production, and bring the device to market more quickly. Despite creating a product with a nicotine concentration six times higher than traditional cigarettes, Ariel was ultimately discontinued to protect the company's profitable cigarette market. This marked the first instance of companies exploring the manipulative potential of nicotine.
The Rise of E-Cigarettes and the Juul Phenomenon
In 2007, the FDA officially authorized the sale of e-cigarettes, leading to the emergence of over 460 brands. Among them, Juul became the most popular, accounting for nearly 75% of the e-cigarette market. However, in 2022, the FDA banned the sale of Juul products due to conflicting evidence regarding their associated risks, including the potential to cause strokes, respiratory failure, seizures, and cases of e-cigarette or vaping-use-associated lung injury (EVALI). EVALI is a condition in which the lungs become severely damaged, often resulting in admission to the intensive care unit (ICU) and the need for mechanical ventilation.
The Efficacy of E-Cigarettes as a Smoking Cessation Aid
Despite being marketed as a healthier alternative to cigarettes, e-cigarettes have not demonstrated clear efficacy as a smoking cessation aid. While a few studies suggest that vaping may help in quitting tobacco, it has not proven effective in quitting nicotine use altogether. One study found that individuals who used e-cigarettes in combination with nicotine replacement therapy (NRT) and counseling were 24.3% less likely to quit smoking compared to those who used only NRT and counseling. Furthermore, e-cigarette users were 15.1% more likely to become dual users, utilizing both tobacco and vaping products, which increases the risk of health complications, including myocardial infarction and a four-fold increase in the likelihood of developing lung cancer.
In a survey of 800 people who used vaping as a smoking cessation agent, only 9% successfully quit when asked one year later, compared to 19.8% who utilized NRT. These findings highlight that vaping is not a reliable method for eliminating nicotine use entirely and can even lead to the simultaneous use of both traditional and electronic cigarette products.
The Youth Vaping Epidemic
Vaping has become the most commonly used form of nicotine consumption among adolescents. A study showed that high school students who had used e-cigarettes were 16.7% more likely to start smoking cigarettes within the next year. Nicotine's impact on the developing brain can lead to mood disorders, affect attention and learning, and amplify the desire for other mood-enhancing drugs such as cocaine or methamphetamine. In 2018, e-cigarette use among high school students increased by 78%, prompting the FDA to enforce stricter regulations on the sale of nicotine products. Despite these efforts, vaping remains a significant challenge for teens who have already fallen victim to nicotine addiction.
The Role of Pharmacists in Smoking Cessation
Pharmacists play a vital role in smoking cessation by educating patients about the dangers of vaping and providing guidance on safe and effective methods to quit smoking. The FDA currently lists seven approved quit aids that are safe and effective for smoking cessation, including several forms of NRT and pharmacologic therapy with bupropion and varenicline. Some of these agents, such as NRT gum, patches, and lozenges, are available over-the-counter (OTC), making pharmacists crucial in helping patients who lack access to a primary care provider.
When guiding patients towards smoking cessation, pharmacists should prioritize FDA-approved agents, either prescription medications through a provider or OTC therapies available in the pharmacy, rather than recommending e-cigarettes due to the lack of supportive data and increased risk of adverse health events. The selection of an appropriate FDA-approved agent should be individualized based on the patient's specific factors, contraindications, and goals of therapy. Pharmacists should educate patients extensively on the available options for smoking cessation and refrain from recommending e-cigarettes.
However, if a patient decides to use e-cigarettes, pharmacists should still serve as a support system by being the primary educator and providing extensive counseling on the associated risks of vaping. Patients should be made aware of both the known and unknown adverse reactions associated with electronic cigarettes, emphasizing that the goal of vaping should be to achieve complete smoking cessation.
Conclusion
Vaping e-cigarettes has emerged as a popular alternative to traditional cigarettes, but its efficacy and safety as a smoking cessation aid remain uncertain. Pharmacists, as the most widely accessible healthcare professionals, have the power and knowledge to be the most influential providers in advising patients on the correct paths to smoking cessation. By staying up-to-date on the latest literature and following the FDA's suggestions on smoking cessation methods, pharmacists can offer education and support to help patients live healthier lives and take steps towards reversing the youth smoking epidemic one education at a time.
