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The American Association of Public Health Physicians Recommends E-Cigarettes for Tobacco Harm Reduction

Date Posted: October 18, 2011

In February 2010, while the Food and Drug Administration (FDA) was attempting to have e-cigarettes classified as drug-delivery devices, the American Association of Public Health Physicians (AAPHP) issued 2 petitions on behalf of the Tobacco Control Task Force of the American Association of Public Health Physicians directed at the FDA, urging them to instead, reclassify e-cigarettes as a tobacco product primarily based on the potential public health impact and on 3 conclusions:

1)      reclassification of e-cigarettes as a tobacco product could open the door to a new tobacco harm-reduction (THR) component to current tobacco control policy

2)      this new THR component presents the only feasible approach to rapidly and substantially reduce tobacco-related illness and death in the United States

3)      with appropriate regulation of marketing now possible through the new FDA/Tobacco law, the public health benefits of this new THR component could be secured without increasing the numbers of teens initiating nicotine use

Tobacco harm reduction is already a well-established principle in tobacco control which entails substituting smoking with low-risk nicotine products, namely nicotine replacement therapy (NTR) products, over a long period of time (over 12 weeks). However, long term uses of NTR products have not yet been approved by the FDA.  Currently available NRT products tend to be unattractive, unsatisfying to smokers, unduly expensive and as specified by FDA regulation, only for temporary use (10-12 weeks). In contrast, to effectively reach current smokers, lower risk tobacco related products such as electronic cigarettes, are attractive to smokers, competitively priced, available where cigarettes are sold and may be used long term.

Stating that they favored “a permissive approach to e-cigarettes because the possibility exists to save the lives of four million of the eight million current adult American smokers who will otherwise die of a tobacco-related illness over the next twenty years,” the AAPHP argued that the FDA should classify electronic cigarettes as a reduced harm tobacco product while abandoning the idea that it is a new drug, citing it would be in the best interest of public health.

Ultimately, on April 25th, 2011 the FDA did in fact classify e-cigarettes as a tobacco product subject to regulations under the 2009 Tobacco Act. Currently, the AAPHP continues to support electronic cigarettes and recommend them as part of tobacco harm reduction products: “e-cigarette use emulates successfully the cigarette handling rituals and cues of cigarette smoking, which produces suppression of craving and withdrawal that is not entirely attributable to nicotine delivery.”

“A cigarette smoker can reduce his or her risk of future tobacco-related death by 98% or better by switching to a low risk smokeless tobacco product. He or she could cut that risk by 99.9% or better by switching to a nicotine-only delivery product like one of the pharmaceutical products or E-cigarettes.”

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