Alternative nicotine delivery systems: current evidence.

Abstract

Alternative nicotine delivery products (ANDS) have gained popularity in recent years. Their potentially lower harm compared to traditional cigarettes and the possibility of using them as part of a harm-reduction strategy in tobacco addiction treatment have been discussed. Current epidemiological trends show a gradual increase in ANDS use by the general population, especially among adolescents and young adults, but also among non-smokers. The most comprehensive evidence regarding health effects is available for e-cigarettes, which suggests that their use does not increase cardiovascular risk, except for hypertension, compared to non-smokers, and reduces the risk of respiratory diseases compared to smoking traditional cigarettes; however, long-term data are lacking for older individuals. In the case of heated tobacco products, there is not enough reliable evidence on health risks compared to current smokers or non-smokers, while concerns remain about the potential toxicity of substances found in these products but absent in cigarette smoke. For nicotine pouches, there is a lack of reliable evidence on long-term effects. Electronic cigarettes are used as a smoking cessation tool in some countries, such as the UK. Existing evidence leans towards the potential use of e-cigarettes as a harm-reduction strategy, although there is currently no global consensus on their role in tobacco addiction treatment. Complete cessation of all tobacco and nicotine products remains the primary recommended approach.