A newly updated Cochrane living systematic review, released in October 2025, has further solidified this evidence base. Drawing on 104 studies and over 30,000 participants, the review found that nicotine vapes help more people quit smoking than traditional nicotine replacement therapies (NRTs) such as patches, gum, or lozenges. It also concluded that nicotine-containing vapes outperform their non-nicotine counterparts and no-therapy approaches.
The Cochrane team reported “high-certainty evidence” that nicotine vaping increases quit rates compared to NRT, and “moderate-certainty evidence” that vaping likely helps more people quit than non-nicotine e-cigarettes. In real terms, this translates to roughly three additional quitters for every 100 smokers who choose vaping instead of NRT—an effect size that public health experts describe as clinically meaningful on a population scale.
Strong results, minimal harm
The same review found no evidence of serious harm from regulated nicotine vapes. Minor side effects such as throat irritation or cough were typically short-lived, while serious adverse events were rare and comparable to those seen in other cessation treatments. Importantly, the research excluded unregulated or illicit products, which are known to carry different risk profiles.
These findings of course align with similar reviews by Public Health England (now the UK Office for Health Improvement and Disparities), Cancer Research UK, and the U.S. National Academies of Sciences, Engineering and Medicine, all of which have concluded that e-cigarettes are far less harmful than combustible tobacco.
In fact, public health agencies in the UK, New Zealand, and Sweden have already integrated such findings into their cessation strategies. Yet in much of Europe and the United States, the use of novel nicotine products continues to be treated with suspicion or outright hostility.
Same same but different
In another landmark report, the Cochrane Database of Systematic Reviews recently published the first scientific assessment of oral nicotine pouches as potential harm reduction tools. Though still limited—drawing on just four eligible studies—the review found early evidence that switching from smoking to nicotine pouches reduces exposure to harmful substances.
Unlike traditional Swedish snus (which is already significantly safer than combusitble tobacco), pouches use purified nicotine powder and flavourings, eliminating exposure to possible irritants. The review’s authors, based at the University of Massachusetts Amherst School of Public Health, noted that while more research is needed to confirm cessation effectiveness, the toxicological data already suggest a substantial risk reduction compared to smoking.
This conclusion aligns with the experience of Sweden, where decades of snus (and most recently nicotine pouches’ use) have produced Europe’s lowest smoking rates and some of its lowest tobacco-related mortality figures. Sweden is on track to become the first “smoke-free” nation in the EU, defined as adult smoking prevalence below 5%.
Regulatory recognition (and resistance)
Earlier this year, the U.S. Food and Drug Administration made history by authorizing the marketing of 20 Zyn nicotine pouch products, concluding that their availability would “likely result in greater overall benefit to public health than risk.” This marked the first FDA authorization for any oral nicotine pouch, signalling a shift toward evidence-based evaluation rather than moral panic.
Yet paradoxically, in many regions, both vapes and pouches are under fire. European policymakers are debating steep new taxes on smokeless nicotine products, while countries such as Belgium and France have moved to ban or heavily restrict them. While the World Health Organization’s Framework Convention on Tobacco Control (FCTC) continues to resist integrating harm reduction principles into global policy, framing all nicotine products as part of the same continuum of harm.
Such positions appear increasingly at odds with science. A 2023 review in Addiction concluded that smokers who switch to vaping experience “substantial improvements in respiratory and cardiovascular outcomes.” Similarly, a longitudinal study published in Nicotine & Tobacco Research found that exclusive vapers had significantly lower exposure to carcinogens and toxins than smokers. Even the Royal College of Physicians, one of the world’s most respected medical institutions, stated that long-term e-cigarette use is unlikely to exceed 5% of the health risks associated with smoking.
The politics of denial
Despite such consensus, harm reduction continues to face political resistance, evidently rooted more in ideology than science. Policymakers frequently cite youth vaping and marketing concerns to justify broad restrictions—sometimes at the expense of adult smokers seeking safer alternatives. While youth protection is vital, experts warn that blanket bans or punitive taxes often backfire, driving products underground and leaving smokers with fewer pathways to quit.
Often clinging to outdated fears, moral panic, or misinformation, prioritising optics over evidence, the harm reduction tools—proven to help smokers quit and save lives—are frequently lumped with the very products they are intended to replace. Ideological opposition, influenced by anti-tobacco zeal and regulatory inertia, has led to the counterproductive bans and restrictions that are driving consumers toward riskier illicit markets
The contradiction is striking. On one hand, governments fund smoking cessation campaigns, encourage pharmacological NRT use, and celebrate each percentage drop in national smoking rates. On the other, they simultaneously stigmatize or overregulate the very technologies that appear to accelerate those declines most effectively.
Evidence, ideology, and the future of quitting
If harm reduction is ever to fulfil its promise, public policy must begin reflecting the weight of scientific evidence rather than outdated fears. Looking solely at Cochrane reviews—spanning vapes, gums, patches, and now oral pouches—we already have a clear roadmap: regulated nicotine delivery can dramatically reduce smoking-related harm, provided access is maintained for adults who need it.
As Sweden’s experience shows, the path to a smoke-free future lies not in prohibition, but in pragmatic substitution—helping smokers move from high-risk to low-risk products through science-driven policy. The data speak louder than the politics: regulated nicotine alternatives save lives. The question is whether governments will ever listen.
The Latest Studies Indicating That Vapes Are The Most Effective Smoking Cessation Aids
