Appropriate Policy Implications of the Fact That High Content and Flavored E-Cigarettes Have Higher Abuse Liability

Extract

Gades et al. recently published a comprehensive review of 104 epidemiological studies ranging from human epidemiology to animal studies that concludes that “higher nicotine concentration and access to a variety of flavors are likely to be associated with higher abuse potential and appeal of e-cigarettes for adult current and former cigarette and e-cigarette users.”¹ The major substance of the scientific review is thorough and represents an important contribution to our understanding of how nicotine levels and flavors impact abuse liability of e-cigarettes.

The paper, unfortunately, is shallow when assessing the health and policy implications of these findings. In particular, the authors see higher abuse potential and product appeal as a good thing because is “may help facilitate complete switching from cigarettes to e-cigarettes.” (The FDA made the same assumption² when authorizing the sale of RJ Reynolds’ Vuse Solo e-cigarettes.

The authors take it as given that e-cigarettes are an effective smoking cessation tool (for “switching completely”), positing that, “Despite the controversy, there is ―moderate-certainty evidence that [e-cigarettes] with nicotine increase quit rates compared to [nicotine replacement therapies].” This statement is based on a citation to a single Cochrane review³ of randomized controlled trials and uncontrolled intervention studies. These studies are relevant to use of e-cigarettes as “supervised medical interventions.”