Nicotine E-Cigarettes for Cigarette Smoking Cessation: Recommendations to US-Based Clinicians

Importance: Cigarette smoking, maintained predominantly by nicotine dependence, is a long-term and relapsing behavior that continues to be a leading cause of preventable death and disease worldwide. E-cigarettes with nicotine are less harmful than cigarettes and have been shown to be more effective for smoking cessation than US Food and Drug Administration-approved nicotine replacement therapies. However, misperceptions of the harms of e-cigarettes are common, even among clinicians. This Special Communication is a position manuscript developed by a working group within the Treatment Research Network of the international Society for Research on Nicotine and Tobacco. The aims of the manuscript were to summarize the evidence on the use of e-cigarettes for smoking cessation and to provide recommendations for clinicians on how to engage in conversations with adult patients who currently smoke cigarettes. Specifically, advice is provided on (1) integration of e-cigarettes into patient-centered shared decision-making conversations on the risks and benefits of various pharmacologic smoking cessation treatments; and (2) practical guidance on the use of e-cigarettes for smoking cessation. Observations: This Special Communication includes one overarching recommendation: integrate e-cigarettes into conversations on the risks and benefits of all evidence-based pharmacologic treatments for smoking cessation. In support of this recommendation, specific guidance is provided regarding how to discuss potential misperceptions and suggests questions to guide patient conversations. Finally, evidence-based best practices are provided for using e-cigarettes to quit smoking, which can be shared with patients. Conclusions and Relevance: The significant burden of cigarette smoking, coupled with scientific evidence supporting e-cigarettes for smoking cessation, clearly indicates that it is appropriate to include e-cigarettes in discussions of evidence-based pharmacologic treatment for smoking cessation to reduce the harms of cigarette smoking. These recommendations are intended to provide evidence-informed guidance to clinicians regarding use of e-cigarettes for smoking cessation.