CASAColumbia adds its voice to skeptics on e-cigarettes` effects

Nicotine needs to be incorporated fully into all substance use prevention, early intervention and treatment programs, and federal regulators must include e-cigarettes and all other nicotine products under its regulatory authority, the research and policy organization CASAColumbia suggests in a new report released today.

The report, Understanding and Addressing Nicotine Addiction: A Science-Based Approach to Policy and Practice, adds to a growing chorus of voices that are questioning electronic cigarettes' effectiveness in smoking cessation and are suggesting that their use may actually encourage use of conventional cigarettes rather than deter it. The report warns that the widening availability of alternative nicotine products threatens to undermine recent public health successes in curbing nicotine exposure.

“Public health and policy efforts have been remarkably successful in reducing rates of cigarette smoking in the United States over the past few decades,” the report's conclusion states. “However, both the commercial interests of the tobacco industry and the natural human proclivity toward risk-taking, pleasure seeking, and addiction require that we do not become complacent in allowing alternative nicotine products to undo decades of hard-won progress in reducing the enormous health and financial costs of tobacco and nicotine use.”

The report reiterates findings from some recent research that indicates that some users of e-cigarettes actually continue to smoke conventional cigarettes, and that many young people who have never shown an inclination to use tobacco become attracted to e-cigs and thus could be lured to smoking.

The report states with regard to e-cigarettes, “Although these products appear to pose less harm than conventional, combustible cigarettes, they expose users to nicotine—a highly addictive drug—and may convey pro-smoking messages to young people; therefore, their risks and benefits require further evaluation.”

CASAColumbia recommends that tobacco control regulations be strengthened in general, and that they be extended to all products containing nicotine. Its specific recommendations include:

• Prohibiting nicotine product marketing that targets or appeals to youths.

• Reducing the nicotine content in cigarettes and other nicotine-containing products.

• Having the Food and Drug Administration (FDA) regulate the production and marketing of all products containing nicotine, and prohibiting radio and television advertising of all of these products.

• Barring producers of alternative nicotine products from making claims about their effectiveness for smoking cessation unless the claims are backed by research evidence and subject to FDA review.

• Increasing taxes on all products containing nicotine.

Treatment actions

The CASAColumbia report calls for improvement in prevention, screening/early intervention and treatment approaches regarding nicotine. It states that healthcare training organizations, accrediting organizations and professional boards should include core competencies related to nicotine in their respective standards.

The report adds, “All addiction treatment programs, as well as criminal justice and social service settings, should be required to address addiction comprehensively—banning smoking and specifically including treatment for nicotine addiction in their services. Research has demonstrated that it is erroneous to assume that providing cessation services will compromise patients' ability to abstain from alcohol or other drug use.”

Other recommendations include integrating nicotine-related content into prevention programming rather than separating it from the rest of the prevention curriculum, and instituting random screening for all forms of nicotine use in primary and specialty healthcare settings.