Gut feelings are the deciding factor in e-cigarette debate

Debates examining nicotine and its related health issues seem to come in waves. From C. Everett Koop’s seminal report on the addictive nature of nicotine in 1988 to the recent New England Journal of Medicine article (September 4, 2014) that suggests electronic cigarettes might prime the brain for a more dramatic response to cocaine, the healthcare community continues to seek answers.

The emerging e-cigarette market has grown to $3 billion, catching the attention of advocates and lawmakers. How the new nicotine-delivery product impacts smokers—positively or negatively—has been the topic of many recent discussions.

Let’s boil down the various opinions within the debate:

·        E-cigarettes  help smokers quit

·        E-cigarettes reduce harm because they don’t contain the toxins found in conventional cigarettes or in second-hand smoke

·        E-cigarettes quell cravings for smokers in places where smoking is not permitted

·        E-cigarettes create dual-use smoking habits rather than helping smokers quit

·        E-cigarette makers are enticing a new generation of young nicotine addicts with candy flavorings and clever marketing

·        E-cigarettes are a gateway to marijuana and cocaine use

You’ll need to decide where you position yourself and your organization on the debate because many of your patients are probably using or considering e-cigarettes. Do your research before you decide, but unfortunately, you might find more opinion than trial data to support your position. Researchers tend to agree that more investigation is needed. Even peer-reviewed studies comparing e-cigarettes as a cessation tool against patches and oral drug treatments seem to be inconclusive.

More study needed

Although experts agree e-cigarettes are less toxic than conventional ones, they still deliver nicotine. That’s why the World Health Organization (WHO) this summer called for stiffer regulation of the products, bans on indoor use and restrictions on advertising and sales to minors. WHO was heavily criticized for being too alarmist in its language, and U.K. researchers argued that the organization lacked evidence for its conclusions.

Since no one knows the ultimate answer, you might be tempted to hold off on addressing the e-cigarette trend until there’s more data or some endorsed best practice. There’s no telling how long you’ll have to wait, however.

 It’s hard to tell exactly what percentage of treatment centers have gone fully smoke-free, but I’m guessing it’s less than half. For those that do allow smoking on campus, it’s time to decide how that organizational policy extends to e-cigarettes and communicate that to your staff and clients. Perhaps you can even involve them in the decision making process. If you’re still unsure, an interim policy might help you transition in the meantime.

What if e-cigarettes eventually overtake conventional cigarettes as the smoker’s product of choice? I can see that happening within a decade. Think about the pressure you might be under to allow smoking indoors, during meals or possibly during therapy sessions if smokers feel that pink-lemonade-flavored Vapor4Life is a safer alternative to Marlboro.

It’s also a touchy subject from a marketing standpoint. Consider how one choice or the other might impact your referrals as well as your clinician recruitment now and in the future. Without data, it’s a tough question to answer. I suspect many of us will rely on gut feeling more than we’d like to.