E-Cigarettes: Gateway Drug or Smoking Cessation Tool?

Sometimes it seems like everybody’s blowing smoke about e-cigarettes: this one says it entices young people to try tobacco; that one swears it helped him give up the “cancer-sticks” for good. Who’s right? And what implications does that have for the vaping policies and smoking-cessation programs in your workplace?

The regulations are scattershot, and the available research is mixed. Is vaping a serious health hazards that can serve as a gateway drug to cigarettes—or is it the latest thing in smoking cessation? Here’s what we know.

Are E-Cigs a Gateway Drug to Tobacco Use?

One of the concerns with a milder form of any drug is that it will lead users to seek out stronger formulations. Although these concerns have been raised about e-cigarettes—the American Heart Association expresses concern on its webpage that “[v]aping may help re-normalize tobacco use and get kids started, even leading them to regular cigarettes over time”—the evidence is mixed. Two recent studies (one from 2015, the other from 2016) found that teens who smoked e-cigarettes were more likely to use or try tobacco products. But data from the Centers for Disease Control and Prevention (CDC) suggest that the relationship may be incidental, rather than cause-and-effect: the agency’s teen smoking statistics show that teen use of e-cigarettes increased to 24% in 2015, while teen tobacco use hit a record low of 11%.

So, for individuals who have never smoked, there’s no conclusive evidence that e-cigarettes are their first step onto tobacco road.

Can E-Cigs Help People Stop Smoking?

In 2016, a review of literature on e-cigarettes and smoking cessation conducted by Cochrane (a nonprofit group that aggregates and analyzes research to create evidence-based health practice guidelines) found some evidence that e-cigarettes may help people who are trying to quit smoking. Success rates appear to be similar to those for nicotine-replacement therapies (nicotine patches and nicotine gum). But don’t expect to find it recommended by the CDC, the American Heart Association, the American Lung Association, or the American Cancer Society anytime soon.

• The American Heart Association classes e-cigarettes with all other tobacco products, insisting that “There is no such thing as a risk-free tobacco product” and discouraging their use for any purpose.
• The American Lung Association points out that there is an established procedure for determining whether a drug or device serves a legitimate therapeutic purpose, and e-cigarettes have not met the “safe and effective” standard required of such products.
• The American Cancer Society points out that people claiming e-cigarettes are safer cannot reliably know, because e-cigarettes are largely unregulated.
• The CDC admits that e-cigarettes may not be as dangerous as tobacco cigarettes for some users, however, it also notes that they have not been shown to be a safe and effective tool to use for people who want to stop smoking.

Stopping Smoking—or Enabling Smokers?

They may not be U.S. Food and Drug Administration (FDA) -approved for use as a smoking cessation method, but e-cigarettes are certainly less toxic than cigarettes, and there’s plenty of anecdotal evidence to suggest that they do help some people. So, should you maintain a relaxed policy toward e-cigarettes, for the sake of people who are trying to quit tobacco?

Maybe. But there’s a caveat.

People who switch from tobacco to e-cigarettes improve their health status indicators—lung function, cardiovascular health—and they may find that it helps them quit. But research shows that many people don’t switch—instead, they switch off. In other words, they continue to smoke tobacco products at home, and in their car—but switch to an e-cigarette in restaurants, at work, and in other places where smoking is forbidden.

People who use e-cigarettes as a way to enable their tobacco habit don’t improve their health indicators—and if you permit them to vape in the workplace, you may be enabling their bad habit.