E-cigarettes helped more people quit smoking than traditional nicotine replacement therapy did, a new study says — but vapes aren’t a miracle cure for nicotine addiction. Most of the smokers who tried vaping were still smoking cigarettes by the end of the trial, and most of the vapers who did manage to quit smoking continued to vape a year later.
The new study, published Wednesday in the New England Journal of Medicine, reports that 18 percent of smokers who switched to e-cigarettes had given up cigarettes after a year. That’s more than the 9.9 percent of people who stopped smoking using conventional quitting aids like the patch, gum, lozenges, or inhalers. The results add weight to the claims that e-cigarettes could help some people quit cigarettes, but there’s still a lot we don’t know about the long term health effects of e-cigarettes, or how to keep millions of teens from using them.
E-cigarette companies market themselves as a less risky alternative for people looking to stop smoking cigarettes. But being less risky than cigarettes is a low bar, according to the CDC: “Burned cigarettes are extraordinarily dangerous, killing half of all people who smoke long-term.” And the jury’s been out about whether e-cigarettes can help people quit, Vox reports: few rigorous trials have compared vaping to other quitting aids, like the patch, or gum.
“This sort of study, a systematic, well-done randomized controlled trial, was what was severely lacking in the decade-long debate of the potential benefits and harms of e-cigarettes,” Gideon St. Helen, a tobacco researcher at the University of California, San Francisco who was not involved in the research, says in an email to The Verge. “The findings are really important and perhaps game-changing.”
There are still some key limitations to the study: it was conducted in the UK, for example, which has a different health care system than the US; the study didn’t assess more popular kinds of e-cigarettes like Juul; and it didn’t include drugs approved to help people quit, like Chantix. “It’s one study. It’s a step in the right direction, but I don’t know if it should change the standard for evidence-based practice recommendations either,” says Belinda Borrelli, a professor at the Boston University Henry M. Goldman School of Dental Medicine. Borrelli was not involved in the study, and wrote an editorial about the paper.
Researchers led by Peter Hajek, a professor of clinical psychology at the Wolfson Institute Of Preventive Medicine, found 886 people who wanted to quit smoking, and didn’t care how. For the first month, all of them received weekly one-on-one meetings with a clinician. Half also received their favorite nicotine replacement therapies, and half were given a starter kit for a refillable vape, including a bottle of Tobacco Royale flavored vape juice. Participants could swap out the device or the liquid if they wanted to.
The researchers checked in with the study participants periodically, assessing things like their sleep, whether they felt nauseated, if their throat or mouth hurt, and how much phlegm they coughed up. The big question was whether the participants could stay off cigarettes a year out. The researchers checked by measuring the carbon monoxide that the study participants exhaled – a marker for cigarette smoking. After a year, 18 percent of the e-cigarette users had quit smoking cigarettes, as had 10 percent of the nicotine replacement group. The e-cigarette users liked their vapes more than the other group liked their nicotine replacement therapies, and they had less severe withdrawal symptoms.
There are a few key limitations: Participants and the clinicians who counseled them knew who was using e-cigarettes and who was using traditional nicotine replacement therapies. That knowledge could have skewed the results if they thought one strategy was better than the other. Plus, the findings might not carry over to other brands of e-cigarettes. So far, results of these types of studies appear to be product-driven, says study co-author Maciej Goniewicz, a tobacco researcher at the Roswell Park Comprehensive Cancer Center. “If we use something like NJoy, or Blu, the results might be different,” he says. Still, he hopes the results will help doctors have conversations with their patients about e-cigarettes, particularly if that patient hasn’t succeeded at quitting any other way. “I hope that clinicians would feel more comfortable to talk about it. Because we know that smokers are asking,” he says.
Here’s the catch: Of the people who kicked combustible cigarettes, 80 percent of the people in the vaping group were still using e-cigarettes when the trial ended. That’s a huge fraction compared to the only 9 percent of people who were still using traditional nicotine replacement therapies at that point. So while vaping made it somewhat easier to quit cigarettes, it didn’t help much with quitting nicotine altogether.
Getting off nicotine completely wasn’t the goal of the study, and study participants weren’t told to do so, Goniewicz says. That’s a question for future research. It could be that the e-cigarettes helped more people quit because they actually stuck to them. “It might be a bad thing in terms of that they’re still addicted to nicotine, they’re still inhaling nicotine,” Goniewicz says. “But the positive thing is that they’re still not smoking.”
Still, figuring out the health risks of vaping will be especially important if using e-cigarettes means swapping one addiction for another. “The hard thing is that we don’t really know what the long term effects are of use of electronic cigarettes,” says Michael Ong, professor of medicine and public health at UCLA.
We do know that nasty chemicals can form in the e-liquids while they sit on the shelf, for example, and vapers’ pee shows signs of exposure to carcinogens and irritants. Plus, the science around the health effects of nicotine itself is still murky: some studies suggests it might be risky for people with heart problems. And it’s addictive — which can lead people to feel controlled by their cravings, or to unpleasant withdrawal symptoms.
Even if more studies wind finding that e-cigarettes are helpful for adult smokers, they aren’t a silver bullet for quitting cigarettes. And while scientists wrestle with the long term costs and benefits, there are other ways to help more people here in the US give up cigarettes. Those include better access to FDA-approved medications and behavioral counseling — but that will take a more difficult change to our health care infrastructure than a new nicotine-delivery gadget can provide. “If we want to really help people quit, we need to have all of these things together,” Ong says.
The big question, St. Helen says, is what now? Yes, the study adds weight to something vapers have been saying for awhile: that e-cigarettes might be useful tools to help a fraction of smokers quit. But it’s impossible to look at the findings in a vacuum without considering that 3.6 million high school and middle school students are using e-cigarettes in what the US Surgeon General has declared an epidemic. “That risk remains, but will it be prioritized even as this well-done study shows e-cigarettes can help adult smokers quit smoking?” St. Helen says. The answer likely rests with regulators and the e-cigarette industry: if they can stop young people from vaping in record numbers, then maybe.
Updated January 31st, 1:45PM ET: Updated to include quotes from Maciej Goniewicz, Belinda Borelli, and Michael Ong.