According to an accompanying editorial, although consensus has emerged that e-cigarettes are safer than traditional combustible cigarettes, it remains controversial whether they should be recommended as a first-line treatment to assist smoking cessation, alongside FDA-approved treatments. In addition, the appropriate duration of e-cigarette “treatment” for smokers trying to quit is also uncertain. It recommends from a US perspective that e-cigarettes be used only when FDA-approved treatments (combined with behavioural counselling) fail, that patients be advised to use the lowest dose needed to manage their cravings, and that there be a clear timeline for use. It also calls for monitoring of use of e-cigarettes by health care providers, like other pharmacologic smoking-cessation treatments, as well as research on their efficacy and safety in high-risk subgroups, and on the health consequences of long-term use.
An editorial on flavoured e-cigarettes notes their success in the marketplace and expresses concern about the alarming rise in rates of vaping among teenagers and the fear that the creation of a generation of nicotine-addicted teenagers will lead to a resurgence in the use of combustible tobacco in the decades to come. It notes that nicotine is a gateway drug that lowers the threshold for addiction to other agents, and suggests the use of e-cigarettes could help spawn even more opioid addiction Furthermore, there are no long-term data on the effects of decades of vaping on health. It calls on the FDA to ban the sale of flavoured nicotine products for use in e-cigarettes, as the public health problem that e-cigarettes can help solve is adequately addressed by liquids that are not flavoured to appeal to adolescents