Doctors Should Consider Vapes for Smoking Cessation, JAMA Panel Advises
A committee of international researchers published in JAMA recommends that physicians discuss e-cigarettes with adult smokers seeking to quit. While smoking prevalence in the United States dropped from 22.5 percent in 2002 to 11.6 percent in 2022, combustible cigarettes remain a leading cause of preventable death worldwide, prompting clinicians to re-evaluate underutilized cessation tools.
The guidance, authored by researchers from the United States, Britain, and Australia, argues that e-cigarettes should be treated as an initial clinical option alongside conventional cessation methods.
Why E-Cigarettes Aid Cessation Better Than Traditional NRTs
“E-cigarettes are one of the most controversial topics in medicine and public health,” said Nancy Rigotti, professor of medicine at Harvard Medical School and Massachusetts General Hospital. However, recent evidence shows that vaping can match or exceed the efficacy of nicotine patches and gums.
Traditional nicotine replacement therapies (NRTs) often fail because of how slowly they deliver nicotine. “When you smoke a cigarette, nicotine gets delivered to the brain very quickly,” explained Tracy Smith, associate professor at the Medical University of South Carolina. Vapes mimic that delivery speed, while gums and patches take considerably longer to take effect.
In addition, vapes address the psychological and behavioral routines of smoking. Jamie Hartmann-Boyce, associate professor at the University of Massachusetts Amherst, noted: “For many people, nicotine e-cigarettes can mimic those cues better than, say, wearing a patch.”
| Cessation Method | Nicotine Delivery Speed | Behavioral Replication | Relative Harm Profile |
|---|---|---|---|
| Combustible Cigarettes | Rapid (seconds) | High (original source) | Highest (combustion produces carcinogens) |
| Nicotine Vapes | Rapid (comparable to smoking) | High (hand-to-mouth action) | Lower (aerosol without combustion) |
| Patches & Gums (NRT) | Slow absorption | Low (no physical smoking action) | Lowest (medicinal grade) |
Health Concerns and Unregulated Market Devices
Despite the cessation data, medical skepticism persists. In 2019, the EVALI outbreak caused more than 2,800 hospitalizations and over 60 deaths in the United States. Health authorities later linked the outbreak to illicit, black-market THC vaping cartridges cut with vitamin E acetate, rather than regulated nicotine e-liquids.
Even so, e-cigarette vapor contains heavy metals and volatile organic compounds. “At this point, we don’t have a lot of data on the long-term effects of e-cigarettes,” said Dr. Noreen T. Nazir, chair of the Smoking Cessation and Prevention Work Group at the American College of Cardiology. For this reason, cardiology groups have hesitated to endorse widespread clinical adoption.
Experts caution that adult smokers who switch should use devices authorized by the Food and Drug Administration (FDA) to avoid unverified additives common in illicit supply chains.
Clinical Recommendations: Full Switching as a Stepping Stone
The panel stated that smokers do not need to fail other therapies before trying e-cigarettes. However, the intervention must be targeted strictly at adult smokers looking to quit, rather than non-smokers or youth.
“You have to switch completely to really reduce your exposure to known carcinogens and toxicants,” said Benjamin Toll, director of the Tobacco Treatment Program at the Medical University of South Carolina. Dual use—smoking both traditional cigarettes and vapes—fails to eliminate toxic exposure.
Neal Benowitz, professor emeritus of medicine at the University of California San Francisco, summarized the clinical objective: “The bottom line is smoking is so much worse than any other form of nicotine, and anything we can do to get people off cigarettes is really going to benefit their health.”
Clinicians maintain that while e-cigarettes offer a viable bridge away from combustible tobacco, the long-term medical objective remains the cessation of all nicotine products.
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