Intended for healthcare professionals

Head To Head

Should we recommend e-cigarettes to help smokers quit?

BMJ 2018; 361 doi: (Published 25 April 2018) Cite this as: BMJ 2018;361:k1759
  1. Paul Aveyard, professor of behavioural medicine1,
  2. Deborah Arnott, chief executive2,
  3. Kenneth C Johnson, adjunct professor3
  1. 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2Action on Smoking and Health, London, UK
  3. 3School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to: P Aveyard paul.aveyard{at}, K C Johnson ken47johnson{at}

Smokers want to vape, it can help them quit, and it’s less harmful than smoking, say Paul Aveyard and Deborah Arnott. But Kenneth C Johnson argues that smokers who vape are generally less likely to quit and is concerned about youth vaping as a gateway to smoking, dual use, and potential harms from long term use

Yes—Paul Aveyard, Deborah Arnott

Smokers are asking their doctors for advice on using electronic cigarettes, and guidance is clear on what doctors in England and Wales should say. The National Institute for Health and Care Excellence (NICE) says that smokers should be told that many people have found e-cigarettes helpful aids to cessation, and the evidence indicates that e-cigarettes are substantially less harmful to health than smoking, although not risk free.1

E-cigarettes seem to double the likelihood of achieving abstinence and seem as effective as nicotine replacement therapy (NRT) in supporting cessation, according to the few trials and appropriately conducted cohort studies.23 This conclusion is bolstered by evidence that NRT and e-cigarettes have a similar pharmacological profile.4

Smokers want e-cigarettes

What makes e-cigarettes remarkable is that so many smokers who wish to cut down or stop choose e-cigarettes over NRT,5 even though NRT is cheaper because it is available on prescription. E-cigarettes are popular cessation aids, and this may have led to increases in the success of quit attempts in the population and quitting as a whole in England and the United States.67

NRT is most effective when it is prescribed and combined with behavioural support.8 Observational evidence indicates the same may be true for e-cigarettes.9 Licensing e-cigarettes as another form of NRT could be of financial benefit. NICE has estimated that for every pound invested in cessation, £2.37 could be saved on treating smoking related diseases and the cost of …

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