Nicotine E-Cigarettes for Smoking Cessation: JAMA | July 2026

Introduction:

Cigarette smoking remains one of the leading causes of preventable death worldwide. This expert consensus statement from the Society for Research on Nicotine and Tobacco (SRNT) provides practical recommendations for clinicians on incorporating nicotine-containing e-cigarettes into shared decision-making for adult smokers seeking smoking cessation.

Why was this article needed?

• Cigarette smoking continues to cause substantial preventable morbidity and mortality.
• Many smokers struggle to quit despite FDA-approved cessation therapies.
• Growing evidence suggests nicotine e-cigarettes are more effective than nicotine replacement therapy for smoking cessation.
• Clinician uncertainty and misconceptions have limited appropriate counselling.
• Updated, evidence-based recommendations for patient-centered smoking cessation discussions were needed.

Key Takeaways:

• Nicotine e-cigarettes should be discussed alongside FDA-approved smoking cessation therapies (nicotine replacement therapy, varenicline, and bupropion) during shared decision-making with adult smokers.
• Completely switching from cigarettes to nicotine e-cigarettes substantially reduces exposure to harmful combustion-related toxicants and is associated with higher smoking cessation rates than nicotine replacement therapy, although long-term safety beyond two years remains uncertain.
• Clinicians should correct common misconceptions, emphasizing that combustion—not nicotine—is the principal cause of smoking-related disease, while acknowledging that e-cigarettes are less harmful than combustible cigarettes but are not risk-free.
• Patients choosing e-cigarettes should be advised to use FDA-authorized products, transition completely from cigarettes as quickly as possible, minimize prolonged dual use, and combine treatment with behavioural counselling and structured follow-up.
• Long-term complete abstinence from combustible cigarettes is the primary treatment goal. Continued e-cigarette use may be acceptable if it is necessary to prevent relapse to cigarette smoking, with eventual nicotine discontinuation considered when feasible.

Clinical Impact:

This expert consensus supports a harm-reduction approach for adult smokers who are unable or unwilling to quit using conventional therapies alone. Clinicians should incorporate balanced, evidence-based discussions about nicotine e-cigarettes into routine smoking cessation counseling while individualizing recommendations according to patient preferences and clinical circumstances.

Bottom Line:

Nicotine e-cigarettes should be considered a legitimate smoking cessation option for adult cigarette smokers within a shared decision-making framework. When used to completely replace combustible cigarettes, they appear to provide greater cessation success than nicotine replacement therapy while substantially reducing exposure to smoking-related toxicants, although continued long-term safety monitoring remains essential.