Vaping: Known Unknowns

Dec 21 2015 Published by under Drug Abuse Science, Nicotine

Unless you have been hiding under a rock, you know about e-cigarettes. These are devices which deliver a nicotine dose using a battery-heated element which vaporizes propylene glycol, polyethylene glycol, vegetable glycerin (mostly) and/or some other vehicles in which the nicotine has been dissolved.

These devices appeal to users as cessation aids to help quit smoking tobacco and as a safer alternative to cigarettes.

They also appeal to adolescents, apparently.

You will hear the occasional grand pronouncement hit the media circusit with more assertions than questions leaving people wondering.

Here is my general take on just about anything having to do with e-cigarettes: We don't really know and we need to do some more science to figure it out.

So here are the key questions all amenable to research, some of which is no doubt ongoing.

Do e-cigs help people quit smoking? The question is, in my view, do they do any better than cold turkey (accounting for subpopulations) and are they as effective or better than any other replacement therapy like the gum or patch.

Do e-cigs prolong nicotine use in individuals who would otherwise have quit smoking cigarettes? Very tricky question, this one. But if you have an individual who would have quit smoking but keeps using nicotine via e-cig, you've increased harm.

Do e-cigs cause novel harms? In other words, presumably the nicotine harm is the same (once individuals learn how to get their desired nicotine dose from these). But are there constituents of the vehicles, the flavorants or products created by the vaporization process that cause health risks? And no, just showing an ingredient is present is not evidence of harm. We need careful toxicology studies with relevant exposure doses and regimens.

Do e-cigs prevent well-established harms? The chronic smoking of tobacco, typically via the modern cigarette products, has very well established and very bad health consequences. Nicotine exposure is the cause of only a subset of the harms, even if it is the thing responsible for continued use. So getting combusted tobacco smoke exposure out of the situation cannot help but be a huge win. Huge. I don't see how this can really be argued until and unless we find some whopping big harms of the vapor exposure.

Do e-cigs addict new individuals to nicotine? One of the big fears of those concerned with e-cigs is that early data show that adolescents are more likely to try e-cigs than to try smoking cigarettes. There will be some work showing that daily nicotine users started off with e-cigs rather than tobacco cigarettes but as you know, it is impossible to establish causality with real human populations. The best we have, overwhelmingly likely causal relationships, has to wait on a whole lot of data. Which we won't have for many years.

Bonus Round:
Are e-cigs used without nicotine or other psychoactive? One parent I know has asserted that perhaps some adolescents are using e-cig devices with just the flavored vehicles and not to ingest nicotine or any other drug. Obviously this goes back to the above question about harms from the vehicle. But it also links to another concern...

Are e-cigs used to deliver other psychoactive drugs? The devices are very readily and broadly available. They are being used with crude marijuana extracts for certain sure. There have been media allegations that they are being used to ingest "flakka" (here, here, here). For a time, one assumes that by pretending to be smoking nicotine or the flavorant (see above) peope will be able to stroll about ingesting illegal substances in public view. Including adolescents, my friends. Yes, kids.

23 responses so far

  • Saban says:

    E cigs don't seem to be as harsh as conventional cigs, from personal experience. Regarding artificial flavors, e juice made from naturally extracted tobacco (NET) appear to circumvent this concern.

  • Crystal Voodoo says:

    I am an unrepentant ecig user. It got me off of cigarettes while I was writing my dissertation. However, I am not completely blind to the inherent risks involved. I do make efforts to minimize the risks, such as mixing up my own nicotine liquids using pharmaceutical grade ingredients and double checking the nicotine concentration in my base liquids (nicotine concentrations can be off as much as 10-fold in stock solutions, which is frankly terrifying).

    I am also okay with sensible government regulations. Ed Yong recently linked a surprisingly reasonable article discussing regulations. I found myself largely agreeing with the proposed measures.

    http://www.statnews.com/2015/11/09/experts-debate-how-tightly-should-electronic-cigarettes-be-regulated/

  • Ola says:

    Addictive substance - check
    Toxic at slightly more than standard doses - check
    Potential for harm to passersby - check
    Money to be made - check
    Product imported with poor quality controls - check
    Marketed and appealling to kids - check

    Sorry, I don't give a fuck if it's "less harmful than"...
    Just look at how quickly they shut down that powdered alcohol malarkey!
    Only difference this time is the big tobacco companies have a vested interest in vaping.
    So remind me again, what's the debate about? Why aren't we regulating this already!

  • Saban says:

    It certainly feels a lot less harsh than traditional cigs, from personal experience. Also, naturally extracted tobacco (NET) seem to circumvent the issue of having to vape juice with artificial flavors. Switching from traditional to e cigs for people that have trouble quitting is a positive change. Marketing to children and growing the nicotine addicted pool is certainly a major downside, however.

  • Jonathan Badger says:

    Because according to our NIDA-funded primate friend "we need to do some more science to figure it out." E-cigs aren't just money-makers for the tobacco industry -- they are grant opportunities to others!

  • DJMH says:

    Ok can you educated the non-smoking masses for a sec? What exactly is harmful about nicotine itself, other than the addiction? I thought the reason to ditch cigarettes was lung cancer from particulates. I get that it would be bad to addict teens to vaping who then later go on to pick up cigarettes, sure; but what is the harm in *adults* getting a nicotine hit without smoking?

    Not trolling here, genuinely have no idea.

  • drugmonkey says:

    The differentiation of nicotine effects vs smoking effects needs work too DJMH but I think there is reason to expect cardiovascular problems will still be increased.

    http://www.ncbi.nlm.nih.gov/m/pubmed/22779085/?i=63&from=chronic%20nicotine%20cardiovascular

    JB- I am entirely unashamed of my belief that policy is best made on the basis of scientific understanding rather than assumptions.

  • drugmonkey says:

    Oh and I forgot to elaborate on the "addict new people to nicotine front". Are such individuals going to stick to e-cigs forever? Or will some tobacco smoking creep in? The implications of addiction are not trivial.

  • A Salty Scientist says:

    Piggybacking on DJMH; if coffee contained nicotine and tobacco caffeine, would the social stigma and public policy for both drugs be reversed?

  • The Other Dave says:

    Dude, I get the feeling that you're one of those who would shout for more caution and research even if people were substituting water.

    A step in the right direction is a step in the right direction. Better than no steps.

  • drugmonkey says:

    ASS- Probably. The caffeine vehicle is nowhere near the problem the nicotine vehicle is. It ain't "stigma". It is "clearly established harms" that is at issue here.

  • The Other Dave says:

    And Ola -- that powdered alcohol thing was just stupid politicians. There is no more concentrated version of alcohol than liquid alcohol. The powder was way safer than a flask.

  • drugmonkey says:

    TOD- what part of "huge win" is unclear to you?

  • Eli Rabett says:

    DJMH, Nicotine is a powerful poison. As everything in chemistry, the dose is the controlling factor LD50 is 0.5 to 1.0 mg/kg

  • Crystal Voodoo says:

    As a follow-up to Eli Rabett, the nicotine stock solutions you can obtain on the internet are as high as 200 mg/ml (they are meant to be diluted in base liquid). Because nicotine is absorbed through the skin, anyone who doesn't know what they are doing could accidentally poison themselves very easily.

    I am doing a horrible job of defending my position as an ecig user.

  • drugmonkey says:

    Right, but you can see where identifying clear sources of harm (i.e., high concentration nicotine solutions) can lead to reasonable regulation such as prohibiting sale of solutions above X concentration. That is the point. To try to come up with fact based policy rather than flailing about in an excess of either optimism or conservatism. Science can help.

  • A Salty Scientist says:

    DM - I didn't mean to imply that the stigma was unwarranted, but fair enough. This is not my area of expertise, so I was curious about whether the nicotine "stigma" was due to smoking harms in general or if there would be noticeable negative effects due solely to nicotine. I naively assumed the issue with nicotine was its addictive properties. I'd be curious about studies on long-term nicotine gum/patch users. A quick search turned up this: http://www.ncbi.nlm.nih.gov/pubmed/8790020

  • drugmonkey says:

    Up until now chronic nicotine use is so thoroughly tied to tobacco that it is hard to say that nicotine has any independent reputation.

  • The Other Dave says:

    DM: Sorry, about missing those two tiny words. I was distracted by this: "Here is my general take on just about anything having to do with e-cigarettes: We don't really know and we need to do some more science to figure it out.".

    Personally, I think the killer for vaping will ultimately be the same thing that killed regular smoking: secondhand effects. If vaping exposes others to a drug (like secondhand smoke) or adverse effects of a drug (like driving drunk), then people are going to complain, and politicians and regulators are going to have to do something. No one cares whether you harm yourself. Intake of McDonald's food is relatively unregulated, right?

  • drugmonkey says:

    I was distracted by

    The fact that I bet heavily that harms will be reduced versus smoked tobacco means jack squatte. It is still possible that there are some nasty health risks of vaping. It should not be a stretch to hold these two ideas in mind at once.

  • Laffer says:

    How do the taxes work on e cigs? Is it the same as regular cigarettes and tobacco, or are they circumvented?

  • The Other Dave says:

    DM: Are you saying that research resources should be diverted to studies of vaping? Vaping's increasing popularity and unknown potential for harm makes it worthy of further investigation?

    Tell it to NIH, bro.

  • DM says:

    "Diverted"? What does that even mean? Are you saying it is obvious to you that we need the 546th grant on smoked tobacco rather than the third on vaping?

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