Recently the American Heart Association and the American Cancer Society issued statements on e-cigarettes that include guidelines on whether to recommend e-cigarettes for smoking statement. Both state e-cigarettes should be considered in those who have not responded to or are unwilling to use proven treatments. The AHA statement says “If a patient has failed initial treatment, has been intolerant to or refuses to use conventional smoking cessation medication, and wishes to use e-cigarettes to aid quitting, it is reasonable to support the attempt. However, patients should be informed that although e-cigarette aerosol is likely to be much less toxic than cigarette smoking, the products are unregulated, may contain low levels of toxic chemicals, and have not been proven to be effective as cessation devices.” (Circulation, preprint for vol 130, 2014).
To me this seems imminently sensible. If e-cigarettes deliver more nicotine and faster than NRT and are more acceptable than NRT, why would they not be at least as effective as NRT? But clearly, inhaling higher levels of nicotine is likely to be more harmful than obtaining nicotine via skin or oral routes. But if e-cigarettes were able to increase quitting by even 10% among NRT failures, this would, in my opinion, likely outweigh any risks of e-cigarettes themselves. We have to remember that smoking leads to illnesses in half of smokers who persist and, importantly, the risks of e-cigarettes pales in comparison to that for treatments for these illnesses (eg, chemotherapy or digitalis.)