Taking a drag from an e-cigarette may be just as safe and effective as slapping on a nicotine patch for smokers struggling to quit, according to the first physician-run trial to compare the two products.
About one in 20 people who used either patches or e-cigarettes managed to quit completely six months after the test started, according to research published today in The Lancet. Meanwhile, users of electronic cigarettes -- battery-powered devices that deliver vaporized nicotine -- were more likely to have cut their use of the real thing in half even if they didn’t quit entirely.
The 657-person trial wasn’t big enough to draw definite conclusions about whether e-cigarettes are better than nicotine patches, researchers said. Still, the results should be a signal to the regulators in the U.S. and Europe now weighing restrictions on e-cigarettes, Peter Hajek, a professor of clinical psychology at the Wolfson Institute of Preventive Medicine, said in a comment published alongside the results.
“Health professionals will now hopefully feel easier about recommending e-cigarettes to smokers, or at least condoning their use,” Hajek wrote.
If European and U.S. regulators treat e-cigarettes as medical devices, yet leave cigarettes on general sale, tobacco makers “will retain their market monopoly, and we will never learn whether e-cigarettes would replace traditional cigarettes if allowed to continue evolving and competing with smoked tobacco on even terms,” he wrote.
The results will also be presented today at the European Respiratory Society’s annual meeting in Barcelona.
E-cigarettes have taken Europe and the U.S. by storm. In France, there are more than 1 million regular users, according to a government-commissioned report published in May. Sales worldwide will probably approach $2 billion by the end of this year and top $10 billion by 2017, according to a forecast by Wells Fargo & Co.
That success has brought scrutiny. The French government said it planned to ban e-cigarettes from public places. The U.K. has moved to treat them as medicines. The U.S. Food and Drug Administration may announce potential restrictions as soon as next month.
French magazine 60 Million Consumers reported in its September edition that it found formaldehyde and other chemicals, along with traces of heavy metals, when it tested a range of the devices. Certain brands contained dangerous substances in greater quantities than cigarettes, and the amount of nicotine in an e-cigarette is sometimes far more than what’s listed on the label, according to the magazine.
The percentage of U.S. high school students who reported ever using an e-cigarette rose to 10 percent in 2012 from 4.7 percent a year earlier, according to the Centers for Disease Control and Prevention’s National Youth Tobacco Survey released this month. CDC Director Tom Frieden called the trend “deeply troubling,” saying students might start smoking real cigarettes as well.
For the team of New Zealand-based researchers that conducted the latest study, the point was not to figure out whether e-cigarettes might lead new users to smoke, but rather how well the devices could help entrenched smokers to quit. The trial was funded by the Health Research Council of New Zealand.
The team recruited smokers through newspaper advertisements. Participants had smoked an average of almost 20 cigarettes a day for the past 25 years, and to join the study, they had to want to stop. The team then divided its recruits into three groups: assigning them to wear nicotine patches, or to get an e-cigarette with nicotine, or to receive an e-cigarette with a nicotine-free placebo vapor.
Nicotine e-cigarette users who quit took more than twice as long as patch users to relapse -- an average of 35 days. And at six months from the start of the study, 57 percent of the people “vaping” on nicotine e-cigarettes had cut their use of tobacco cigarettes at least in half. By comparison, 41 percent of patch users cut their cigarette use by the same amount.
“It’s not like this is a magic bullet,” said Chris Bullen, director of the National Institute for Health Innovation at The University of Auckland, who led the study. “If you continue to smoke, obviously that’s not ideal, but it’s something that’s a stepping-stone toward quitting. We just have to be a little patient. They’ve been doing it for most of their lives, and it’s not surprising they find it incredibly hard.”
Importantly, side effects were similar between the nicotine patch and e-cigarette groups, he said. Researchers are confident in the safety results over the short term, as measured in the study, Bullen said.
If people keep on vaping for years, longer-term safety data is needed, the researchers said.
E-cigarette users told the researchers they wanted to keep using their devices, and 88 percent of users in the nicotine e-cigarette group said they’d recommend the devices to friends.
Even users of the placebo e-cigarettes, while not as successful at cutting back on smoking, got attached to their gadgets -- 92 percent said they’d recommend them to friends.
“They replicate a lot of the ritualistic behavior people have about getting a cigarette out, putting it in their hands, touching it, and there’s the vapor,” Bullen said. “These are very powerful sensory indicators.”