There is a lot of negative press out there about the efficacy of e-cigarettes for smoking cessation with the lack of clinical trials being cited as the reason. The problem is, clinical trials are usually done with drugs that are intended to treat a specific condition. The strict protocols of drug trials can’t really be used for a consumer product like e-cigarettes. However, there have been large smoking cessation trials that involved the use of e-cigarettes. The last of these trials was from 2014 and tested the first generation cigalike products. Even with those early vaping devices, the results still showed the success rate was on par with other nicotine replacement therapy products. Prof. Peter Hajek of Queen Mary University of London described a randomised trial that compared smokers attempting to quit using vape products with users of alternative NRT. After one year 18 per cent of the vaping group had sustained their abstinence from cigarette smoking, which was almost twice as many as the pharmaceutical nicotine products which managed 9.9 per cent. Although the figure may sound low, Prof Hajek points out that if they had been attempting to quit on their own, the rate would have only been around 3 per cent. This made the use of vapes, with proper advice and support, six times more effective than trying to quit with no help. Researchers involved in the study came from Queen Mary, and some other British universities along with some from an American institution and the study was published in the New England Journal of Medicine. However, the Journal was so embarrassed by the positive results that it immediately commissioned two accompanying editorials to condemn e-cigarettes. The first was offering questionable advice to doctors insisting that only after failing with another NRT product the smoker should use a low nicotine vaping device, and the other saying there should be a ban on flavour choice. Study Method In the study, 886 smokers were divided into two groups, with one group being given their choice of NRT products and the other group a simple all in one vape kit. The NRT group were given three months supply and were allowed to use multiple products. The vaping group were given an Aspire One Kit or Innokin One Kit 2016 along with one or two 10 ml bottles of 18 mg/ml tobacco flavoured e-liquid. Both groups were given once a week counselling sessions for the first month and the e-liquid users were given instructions on how to use the vape devices. The vaping group were also encouraged to visit a vape shop to buy refills or other devices if needed. Although counselling may have helped the new vapers, it would have been more useful for them to actually visit a vape shop to ask questions or join a vaping community online. The vaping group were given a 2 – 8 day supply, whereas the NRT users were given 90 days supply. The primary outcome of the study was sustained abstinence for one year to be biochemically validated on the final visit. Any that failed to show up were considered to not be abstinent. The secondary outcomes included reported treatment usage and respiratory symptoms. Study Results Out of the 886 participants, the one-year abstinence rate was 18.0 per cent in the e-cigarette group and 9.9 per cent in the nicotine replacement group. It was also found that 80% of the e-cigarette users still used their assigned product at the 52-week point, that’s a total of 63 out of the overall 79. Whereas the nicotine replacement group only had 9% of the users still using their assigned product at the 52-week mark, that is 4 out of 44 participants. Throat or mouth irritation was more frequent in the e-cigarette group, 65.3% vs 51.2% in the NRT group. Whereas nausea was more frequently reported in the nicotine replacement group, 37.9% vs 31.3% in the e-cigarette group. The e-cigarette group saw a greater decline in the incidence of coughs and phlegm production from the baseline to 52 weeks than the nicotine replacement group. Neither group showed significant differences from one another in the incidence of wheezing or shortness of breath. (Figures taken from the original report; https://www.nejm.org/doi/10.1056/NEJMoa1808779). Further Results The vaping group experienced significantly less intense cigarette cravings, didn’t suffer an increase in irritability and had fewer concentration issues than the NRT group. While vaping opponents may comment about the fact that a higher percentage of vapers still used their e-cigarettes after a year, the goal was not to eliminate nicotine use but to stop smoking. Vaping after quitting is more likely to prevent an ex-smoker from reaching for a cigarette later down the line. So while there is no evidence that nicotine use causes severe health problems, there is significant evidence that proves a high number of ex-smokers relapse long after quitting. Forty per cent of the vaping group who continued to smoke also continued to vape. However, only four per cent of the nicotine replacement therapy group kept using their NRT while smoking. NRT products are proper medicinal replacements; they are based on practicality, not to look attractive or fun. They also don’t give a smoker something to replace the physical feeling of holding a cigarette in the hand. The advantage of vaping is that it replaces the void of something to hold in the smoker’s hand. The Future The study authors are continuing to follow the participants of the trial to see if any of the current vaping and NRT group who quit smoking relapse. They are also monitoring if any participants that were still smoking at the one-year point managed to quit after the study. Some full-time vapers reportedly take more than a year to make the full transition to e-cigarettes. With the variety of devices, e-liquid strengths and flavours available coupled with the similarity to the experience of smoking; it is thought that the dual users will gradually reduce the number of cigarettes they smoke until they are smoke-free.