E-Cigarette: A Lesson From Finland and Austria

Park et al. showed robust evidence that in the real-life setting, e-cigarette use among US youths is associated with the intention to smoke, not with the intention to quit smoking, confirming previous findings and early warnings against this gateway to addiction.^1,2 Indeed, the Centers for Disease Control and Prevention reported a dramatic increase in e-cigarette use among high school students from 1.5% in 2011 to 13.4% in 2014, and the American Academy of Pediatrics stressed that e-cigarettes have the potential to make a new generation of youths addicted to nicotine, reversing more than 50 years of progress in tobacco control.³ However, there are no federal regulations for e-cigarettes yet, not even a simple warning such as “This product is addictive and has not been evaluated as an effective and safe alternative to cigarettes.”

By contrast, Finland prohibited sale of nicotine cartridges, as nicotine is a prescription drug requiring an authorization that such cartridges do not yet have. Austria has classified nicotine-containing cartridges as medicinal products and e-cigarettes as medical devices. These beacons have not precluded the United Kingdom and France from flying in the face of both common sense and evidence. Public Health England, the executive agency in charge of the nation’s health and well-being, just claimed that “e-cigarettes were 95% less harmful than normal cigarettes.”⁴ Why are Public Health England experts fooled by the “harm reduction” motto, as laypeople were before with low tar and light cigarettes? In France, the High Council for Public Health went further in February, updating its recommendation with, “The e-cigarette can be an aid to smoking cessation for those who want to quit smoking and a way for tobacco harm reduction.”⁵ Why does the High Council not understand the following?

1. Smoking is a pediatric epidemic;

2. well-evidence-based treatments exist such as combination of various form of nicotine replacement therapy, psychotherapy (support and cognitive behavioral interventions), or varenicline; and

3. access to treatment is a critical issue, even more for smokers who frequently experience social deprivation.

Indeed in France, the costly and mandatory health insurance scheme only reimburses individuals €50 per year for nicotine replacement therapy and neither is cared by licensed clinical psychologists or treated with varenicline.