Vaping Supported By Gold Standard Research
As valuable as our vaping success stories are, it is always gratifying to have personal observations verified by peer-reviewed research in high impact scientific journals. A research team led by Peter Hajek, a psychologist at Queen Mary University in London, found that e-cigarettes were almost twice as effective for smoking cessation as nicotine replacement therapy. This vindication is particularly sweet because it was published in the New England Journal of Medicine (NEJM).
Back in 2015, NEJM
was responsible for publishing a notorious and now debunked study on formaldehyde in e-cig vapor.
The study was sponsored by the National Institute for Health Research and Cancer Research UK. The results also demolished the myth that e-cigarettes are used by smokers to supplement, and not replace, their cigarette habit. These findings correspond with a Cochrane review, which determined e-cigarettes with nicotine were more effective than the combination of the patch and e-cigarettes with zero nicotine.
For millions of former smokers, nicotine replacement therapies simply cannot match the authentic and enjoyable experience of an electronic cigarette. The NEJM study confirmed the shared experiences of millions of vapers with gold-standard evidence.
The study was administered through the stop smoking services of the UK’s National Health Service (NHS). Participants were screened through their offices and provided expert cessation services. A total of 886 adults completed this randomized trial. Both the nicotine replacement therapy and e-cigarette group were provided with the same multisession behavioral support. Self-reporting and expired carbon monoxide levels were tested to verify smoking cessation.
Participants in the nicotine therapy group were screened to make sure they had no preexisting preference for e-cigs or replacement therapy. They were permitted to choose from and switch between a smorgasbord of nicotine products: the patch, gum, lozenge, nasal spray, inhalator, mouth spray, mouth strip, and microtabs. The e-cigarette group was encouraged to purchase new devices and juices if the device provided did not meet their needs.
The one year cigarette abstinence rate in the e-cig group was nearly double the nicotine replacement therapy group. The e-cigarette group also reported a greater decline in the incidence of cough and phlegm production, a finding which will hopefully be a final nail in the coffin of the debunked popcorn lung scare. The nicotine replacement group also endured nausea more frequently than the e-cig group. Both e-cigs and nicotine replacement were more effective when coupled with behavioral support resources.
The E-Cigarette Group
The study took place between 2015 and 2018. As a result, pod devices like Juul and powerful subohm mods were not provided to the e-cigarette group. Instead, they were provided with second generation mouth-to-lung
style e-cigs. This setup has much to recommend and is often preferred by heavy smokers due to the authenticity of the experience. The tight draw and throat hit of classic stick battery cartomizers effectively mimics smoking and kicked off the e-cigarette revolution.
Members of the e-cigarette group were initially provided with the One Kit UK. The kit consisted of a 650-mAh battery, a clear cartomizer and five 2.1 ohm resistance coils. Participants were also provided with a 30 ml bottle of Tobacco Royale e-juice. Although sweet fruit and dessert flavors are more popular overall, a comprehensive e-juice study by Dr. Farsalinos
found that tobacco flavor is still the go-to for many long time and heavy smokers.
The original One Kit was eventually discontinued and the final 42 participants were given the One Kit 2016. This 14 watt e-cig kit is powered by a 1000-mAh battery. It uses 1.5 ohm atomizer with a capacity of 2.5 ml. Both the device, now known as “The One Kit” and the Tobacco Royale e-juice are still available for sale in the UK.
E-cigarettes vs. Nicotine Replacement Therapy
The first stage of the study involved smokers setting up a quit date, generally the week after screening and acceptance into the study. It is notable that far more members of the nicotine replacement therapy group began to immediately revert to combustible cigarettes.
“Those in the e-cigarette group had less severe urges to smoke than did those in the nicotine-replacement group.”
Members of the e-cigarette group also reported less irritability, restlessness and inability to concentrate. The same trend was also in place when measuring hunger and depression. Just four weeks into the study, only 30 percent of nicotine replacement group were still abstaining from smoking. The e-cigarette group was ahead by nearly 50 percent at this first checkpoint, with 43.8 percent continuing to abstain.
Between weeks 26 and 52, the margin of e-cigarettes being almost twice as effective as nicotine replacement therapy had been established: 21.2 versus 11.9 percent. The final rates of sustained abstinence was 18.0 percent from the e-cigarette group and 9.9 percent for nicotine replacement therapy cohort. These results have a confidence interval of 95 percent.
The study’s authors did not equivocate when concluding:
“E-cigarettes provided greater satisfaction and were rated as more helpful to refrain from smoking than nicotine replacement products.”
The UK’s Rational Approach to Vaping
The UK is light-years ahead of the US in harm-reduction strategies. It is not surprising that the U.K. National Health Services (NHS) was called on to facilitate the study, or that a London institution was the driving force behind the research.
As a publicly funded healthcare provider, the NHS has plenty of skin in the smoking cessation game and a history of discarding health modalities that they determine are ineffective. In 2017, the NHS pulled the plug on homeopathic and herbal treatments
as a misuse of resources. Whatever your thoughts are on alternative medicine, this move makes it clear that the NHS is not afraid to act if it means saving money.
The official NHS stance on e-cigarettes is humane and rational:
An estimated 2.9 million adults in Great Britain currently use e-cigarettes and of these, 1.5 million people have completely stopped smoking cigarettes. They carry a fraction of the risk of cigarettes and can be particularly effective when combined with extra quitting support.
Public Health England
, an executive agency in the UK’s Department of Health and Social Care, views vaping as being 95 percent less harmful than cigarettes. They have worked tirelessly to educate the public and squash the zombie vaping myths
that scare smokers away from e-cigs.
In 2018, they proposed legislation that would make e-cigs available for prescription and sold at hospitals. The London Fire Brigade has also endorsed e-cigs as an alternative to combustible cigarettes after confirming that vaping prevents house fires
UK government agencies have no hidden agenda. Their mandate is to comprehensively serve and protect taxpayers. Their approach has been successful. The UK has outperformed EU countries in smoking cessation
. They credit their scientific based approach to e-cigarettes and argue that countless lives could be saved if other countries were willing to follow their lead.
E-cigarettes easily outperformed nicotine replacement therapy, despite the fact that the full-range of these products and expert guidance was made available to participants. The study’s authors observed,
“E-cigarettes were more effective in alleviating tobacco withdrawal symptoms and received better ratings than nicotine-replacement therapy.”
Concerns have been raised by vaping critics about the continued use of e-cigarettes after the conclusion of the study. Among the e-cig users in the study who abstained from cigarettes, a full 80 percent continued to vape a year after their quit date.
A much smaller number of smokers in the nicotine replacement therapy group stopped smoking, but only 9 percent of those who successfully ceased smoking continued to use nicotine after one year. The reduced harm from a success rate that is double that of nicotine replacement therapy carries more weight than these concerns, but it is an issue worth addressing.
What Needs to Be Done
Nicotine replacement therapy has been available for over three decades. Expert guidance and best practices have been formulated for the use of these products. E-cigarettes have not had this level of investment, scientific support or resources. Despite the best efforts of the UK’s National Health Service, the depth and breadth of experience surrounding nicotine replacement therapy greatly exceeds that of e-cigs.
The obvious solution is to fully embrace e-cigarettes as a smoking cessation tool. By dedicating resources and expertise to e-cigarettes, a systematic approach to tapering down nicotine levels to zero can be devised. The potential is there. The study’s authors concluded that e-cigs, “allowed better tailoring of nicotine dose to individual needs.”
Many vapers already taper off of nicotine on their own but it is not codified in the same way the nicotine replacement therapy is. It is time to give smokers the tools and information they need to gradually reduce nicotine levels on their preferred e-cigarette platforms. Vaping was shown to be almost twice as effective as nicotine replacement therapy for smoking cessation. There is no reason to continue to back the wrong horse.
Thirty four years have passed since the transdermal nicotine patch was released. Time, money and resources have been directed into making it as effective as possible. Billions have been invested into making newer, more effective and faster acting delivery systems. Nicotine replacement therapy is the US medical establishments preferred method of smoking cessation
Despite nicotine replacement therapy’s enormous head start and the backing of the US Center for Disease Control, a humble 650 mAh cartomizer was proven to be comprehensively superior for smoking cessation.
In our trial, refillable e-cigarettes had greater efficacy than nicotine-replacement therapy, even though nicotine replacement was provided in combinations and under expert guidance.