Nicotine e-cigarettes help more people quit smoking than conventional nicotine-replacement therapy (NRT), according to a Cochrane review of 88 studies involving 27,235 participants. 

There is “high certainty” that nicotine e-cigarettes increase quit rates compared with NRT, the report finds. The likelihood of cessation was 59 per cent higher with e-cigarettes than NRT. “Moderate-certainty evidence” suggests that the adverse event rate was similar with e-cigarettes and NRT. The reviewers also found “low-certainty evidence” that quit rates were 88 per cent higher with e-cigarettes than with no support or only behavioural interventions.

Eight to 10 of every 100 people using nicotine e-cigarettes to stop smoking would be expected to successfully quit. This compares with six using traditional NRT and four with no support or only behavioural interventions.

The most common adverse events were irritation of the throat, mouth or both, headache, cough and nausea. Adverse events usually resolved with continued e-cigarette use. While the reviewers “did not detect evidence of serious harm from nicotine [e-cigarettes] … the longest follow-up was two years and the number of studies was small”.

“People who don’t smoke shouldn’t use e-cigarettes, but we have very clear evidence that, although not risk-free, nicotine e-cigarettes are substantially less harmful than smoking,” says Dr Jamie Hartmann-Boyce, the review’s senior author, who went on to compare tobacco smoking to opioid abuse. 

“We are not going to prescribe methadone to people who aren’t addicted to opioids,” she says, “but for people addicted to opioids, we recognise that methadone is … helpful.”