Can e-cigarettes improve the well-being of people with mental health disorders?

Introduction:
This text is a summary of a viewpoint article that discusses the potential benefits of e-cigarettes for people with mental health disorders, specifically those diagnosed with schizophrenia. The authors examine the relationship between nicotine and mental health, as well as the practical clinical benefits of supporting the use of e-cigarettes for those who continue to smoke.

Key Points:

* A recent RCT found that e-cigarettes were more effective than nicotine-replacement therapies in assisting smokers in the UK to quit smoking.
* Secondary analysis from another clinical trial found that e-cigarettes appeared to be as effective, safe and acceptable for people with a mental illness as those without.
* People diagnosed with schizophrenia in Western societies are at least three times more likely to smoke and daily smoking may accelerate the onset of first-episode psychosis in vulnerable individuals.
* An ethnographic study with 43 clozapine-treated schizophrenia patients in the United Kingdom and Australia suggested that patients explicitly used nicotine for its believed ‘antipsychotic properties’.
* Nicotine appears to alleviate the psychotic, cognitive, and negative symptoms of schizophrenia.
* Patients who opted to vape instead of smoke were better able to plan towards future health and reported increased engagement in wider health concerns.
* The switch to e-cigarettes was associated with increased engagement in more desirable health attitudes amongst clozapine-treated schizophrenia patients.

Main Message:
The main message of this text is that e-cigarettes have the potential to make an important contribution to mental health care, specifically for people with mental health disorders who smoke. The authors argue that considering the role and delivery of nicotine in psychiatric patients’ experience of well-being may result in more effective healthcare strategies and increase patient’s agency over their health. They suggest that clinicians should pay attention to people who accept an alternative form of nicotine delivery that may lead to health improvements, rather than dismissing their wishes altogether for fear of renormalising smoking. The text concludes that e-cigarettes may be a gateway not to smoking tobacco, but rather to engagement in more desirable health attitudes amongst this particularly marginalised population group.

Brown JEH, Gartner C, Carter A. Can e-cigarettes improve the well-being of people with mental health disorders? The International journal on drug policy. 2019;73:170-171. doi:10.1016/j.drugpo.2019.07.028