Vaper Therapy?

Helen Redmond, who generally advocates e-cigarettes as a harm reduction tool, stresses their benefits in particular for those who use nicotine to treat the symptoms of mental illness:

That almost 90% of people diagnosed with schizophrenia smoke—despite tobacco’s well-known adverse health consequences—is a testament to the addictiveness of nicotine. But it is also evidence of nicotine’s power to chemically quell anxiety, depression and other upset. (The prevalence of smoking among people with bipolar and panic disorder, depression, anxiety and PTSD is also high.) …

For smokers who have chronic mental illness, the case for nicotine maintenance via e-cigarettes is even more powerful. Many are simply unable to remain completely abstinent. In a current JAMA study, Harvard researchers report that the decline in smoking, from 2004 to 2011, among people with mental illness was significantly less (from 25.3% to 23.8%) than among those without mental illness (from 19.2% to 16.5%). This is not only because of nicotine’s addictiveness but also because of its significant therapeutic benefits. Health-care providers should encourage their mentally ill patients to switch to e-cigarettes; psychiatric facilities should make them widely available and provide space for their use.

Last week, Keith Humphreys compared research on snus to the emerging research on e-cigarettes. His bottom line:

The science on snus is … unsatisfying for those desiring a simple answer regarding the public health value of putatively less harmful forms of tobacco. In one context, snus was enormously beneficial. In another, it appears to have made things worse. The effect of snus also varied across historical time periods as younger and older people used it in distinct ways.

The experience of e-cigarettes may very well follow the same pattern – or perhaps it is better said – the same lack of a pattern. An empirically grounded, universally valid judgment on the impact of e-cigarettes may be difficult to attain. Whether they are a net positive or negative for public health will depend on the context in which they are used, the degree to which different generations adopt them, and the regulations society sets regarding them.