Nicotine vaporizers, usually referred to as e-cigarettes, show substantial promise as a vehicle for tobacco harm reduction (THR). Skyrocketing sales of e-cigarettes, consumer advocacy for these products, and a flood of new scientific papers relating to these products suggest the possibility that e-cigarettes may be the greatest advance in reducing tobacco-attributable illness and death in decades. Moreover, progress to date has been accomplished at no cost to the taxpayer and with little or no recruitment of teen non-smokers.

This paper makes the case for the Food and Drug Administration (FDA) and other public health authorities to add a THR element to current public health programming, highlighting e-cigarettes as a THR modality under FDA guidance, skillfully crafted to recognize both the potential public health benefits and theoretical harms of a THR initiative.

Optimal FDA regulation will involve strict control of the quality of manufacture and marketing without threatening the removal of e-cigarettes from the market, even on a temporary basis, and without stifling continuing product improvement.

There currently exists strong opposition to THR within the public health community. While those familiar with the scientific literature readily agree that smoke-free tobacco products present far less risk of potentially fatal tobacco-attributable illness than cigarettes, they object to any consideration of THR because of their unsubstantiated belief that a THR initiative would necessarily increase the number of teens initiating tobacco/nicotine use and necessarily decrease quit rates.

Reconsideration of this intense distrust of all non-pharmaceutical tobacco/nicotine products will open major new opportunities to reduce tobacco-related addiction, illness and death. We now know about the huge differences in risk, comparing cigarettes to the smokeless tobacco products available on the U.S. market. We know more about the lack of attractiveness of e-cigarettes to non-smoking teens and non-smoking adults. We also know that, for a large number of mental health patients, self-administered nicotine is highly effective in helping them get through the day.

Experience to date with currently unregulated e-cigarettes strongly suggests they already are securing substantial public health benefits among current smokers without increasing teen initiation of tobacco/nicotine use and without adverse impact on quit rates.

Many in the public health community seem unaware of the research findings demonstrating the potential public health benefits of a THR initiative. They seem unaware of the research findings demonstrating both the relative safety and unattractiveness to non-smokers of e-cigarettes. This paper is intended to help close these gaps.