Getting e-cigarettes into clinicians’ tobacco treatment tool kit: Progress, barriers, and practical suggestion

Evidence has consistently supported that e-cigarettes are an effective tool to help adults stop smoking and are substantially less harmful than continuing to smoke.  Yet clinicians and patients alike are often skeptical and adverse to recommending or trying e-cigarettes.  Two distinct barriers are contributing to this stalemate.  First, there is a misperception of absolute and relative risks between e-cigarettes and combustible tobacco products.  Second, because no e-cigarette has received, or is likely to receive,  a medicinal approval under the “safe and effective” standard, these are not a type of traditional quit smoking product that clinicians are accustomed to recommending. Although a handful of products have been approved as “appropriate for the protection of public health” under the existing PMTA process, there is little education to differentiate these products from a much larger unregulated market which offers considerably more choice (specifically on flavors, which has proved important in trials), but would be next to impossible for medical clinicians to recommend.  Recognizing the urgent need for clinicians to support patients in their efforts to quit smoking, the question becomes whether and how to integrate non-medicinal e-cigarettes into the tobacco treatment toolkit and what regulatory pathway can be found to instil confidence for clinicians and patients alike, including safety, accessibility and acceptability.