Healthcare providers are being encouraged to include vapes in their cessation toolkit. Photo credit: Elvobar, CC0.
A new expert consensus published in JAMA recommends that healthcare providers include nicotine e-cigarettes among the smoking cessation options they discuss with adult smokers, marking a notable shift in clinical guidance as evidence supporting vaping as a quitting aid continues to grow.
The recommendations encourage clinicians to use shared decision-making when counseling adults who smoke, particularly those who have failed to quit using FDA-approved medications or who do not wish to use conventional cessation therapies. Rather than treating vaping as off-limits, the authors argue that physicians should openly discuss its potential benefits and risks alongside established treatments such as nicotine replacement therapy, varenicline, and bupropion.
"The main takeaway is for clinicians to include e-cigarettes in their toolkit of smoking cessation options," said Tracy Smith, an addiction scientist at the Medical University of South Carolina and one of the paper's co-authors. According to the authors, the most effective quitting strategy depends on each patient's goals, preferences, and medical history.
The guidance comes from a multidisciplinary panel of tobacco treatment experts, including researchers from the University of Rhode Island and other US institutions. Their recommendations address a gap in clinical practice, noting that many healthcare providers remain uncertain about how to discuss vaping with patients despite growing evidence that nicotine e-cigarettes can help some adults stop smoking.
The panel emphasizes that clinicians should distinguish between adults who already smoke and youth or people who have never used tobacco. The recommendations support discussing nicotine e-cigarettes only with adults who currently smoke combustible cigarettes and should not encourage non-smokers or adolescents to initiate vaping.
The experts also stress that completely switching from cigarettes to vaping offers greater potential health benefits than dual use. Patients who choose e-cigarettes should aim to replace combustible cigarettes entirely and eventually develop a plan to quit vaping as well.
The latest recommendations align with an expanding body of research suggesting that nicotine e-cigarettes can outperform some traditional cessation approaches. A 2023 systematic review concluded that vaping appears to help smokers quit while exposing them to fewer harmful substances than combustible cigarettes, although the authors noted that long-term health effects continue to require study.
Researchers also point to persistent public misconceptions as a barrier to smoking cessation. Recent survey data from the UK found that more than half of smokers incorrectly believe vaping is as harmful as smoking, a perception experts say discourages smokers from switching away from combustible cigarettes.
At the same time, the consensus acknowledges that vaping does not come without risks. The authors advise clinicians to discuss the remaining uncertainties surrounding long-term e-cigarette use while emphasizing that combustible cigarette smoking poses substantially greater health risks. They also recommend using regulated nicotine e-cigarette products whenever possible and monitoring patients throughout their quit attempts.