Nicotine e-cigarettes as a smoking cessation option? New guidance weighs in

Clinical takeaway: Discuss nicotine e-cigarettes as one of several evidence-based pharmacologic options for adults who smoke, using shared decision-making to match treatment with patient preferences while emphasizing complete transition away from combustible cigarettes.

New guidance from an international expert working group, published in JAMA, recommends that US clinicians routinely include nicotine e-cigarettes in discussions of evidence-based smoking cessation treatments for adults who smoke cigarettes. Developed by the Harm Reduction Work Group of the Society for Research on Nicotine and Tobacco's Treatment Research Network, the recommendations reflect growing evidence that nicotine e-cigarettes are more effective than nicotine replacement therapy for smoking cessation and may offer a harm-reduction option for patients who prefer them.

Rather than recommending e-cigarettes as first-line therapy for all patients, the authors advocate a patient-centered, shared decision-making approach. If a patient has no treatment preference, FDA-approved smoking cessation medications remain an appropriate starting point. However, patients who prefer nicotine e-cigarettes should not be required to try and fail other therapies before receiving support to use them.

The recommendations emphasize discussing the relative risks and benefits of all pharmacologic options, correcting common misconceptions that nicotine itself causes most smoking-related diseases, and explaining that the greatest harms from cigarettes arise from combustion. Although nicotine e-cigarettes expose users to substantially fewer harmful chemicals than combustible cigarettes, clinicians should also explain that they are not risk-free and that long-term safety data remain limited.

Practical guidance includes assessing patients' smoking history, prior quit attempts, and treatment preferences; recommending FDA-authorized nicotine e-cigarette products when available; encouraging complete transition away from cigarettes as quickly as possible rather than prolonged dual use; and combining any pharmacologic approach with behavioral counseling and follow-up.

The recommendations apply only to adults who currently smoke cigarettes and specifically do not support nicotine e-cigarette use by youth or individuals who have never used tobacco.

"Our goal isn't to recommend one product over another. It's to give clinicians the tools they need to have patient-centered conversations that get smokers closer to quitting," said coauthor Alana Rojewski, PhD.

Source: Leavens ELS, et al. (2026 July 30). JAMA. Nicotine E-Cigarettes for Cigarette Smoking Cessation: Recommendations to US-Based Clinicians