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Electronic Cigarette
Aka: Electronic Cigarette, E-Cigarette, E-Cig, E-Pipe, E-Cigar, Vaping, Juul
- See Also
- Vaping-Associated Lung Disease
- Nicotine Replacement
- Tobacco Abuse
- E-Cigarette Cessation
- Acute Nicotine Poisoning
- Epidemiology
- Relative Risk of Tobacco Abuse among teens using e-cigs: 4 fold increase
- Of teens, 80% have the misconception that Vaping is harmless
- Prevalence (U.S.)
- High School: 1 in 9 (increased to 1 in 4 as of 2019)
- Middle School: 1 in 30
- Adults: 5%
- Background
- In U.S., FDA will regulate e-cigs as Tobacco products as of August 2016
- In late 2021, Vuse was FDA approved
- However, this is not an FDA endorsement, only that the product may remain on market
- Mechanism
- Battery powered electronic device vaporizes a concentrated nicotine liquid in a replaceable cartridge
- User inhales nicotine vapor (or in some cases Marijuana or other substances)
- Various nicotine preparations are sold and not regulated
- Some nicotine solutions are flavored or colored (attracting young children)
- Nicotine concentrations vary by device
- Juul 5% (high concentration)
- Contains 40 mg nicotine per pod (equivalent to one pack of Cigarettes)
- Blu 1.2%
- Contains 18 mg nicotine per pod (slightly less than one half pack of Cigarettes)
- Labeling of nicotine concentration is highly inaccurate
- Raymond (2018) J Addict Med 12(2):127-31 +PMID:29280749 [PubMed]
- Pods (e.g. Juul, Vuse) are alternative devices (appear similar to US drives)
- May be filled with high concentration nicotine or THC
- Each Vuse pod contains equivalent nicotine to a pack of Cigarettes
- Precautions
- Not recommended as Nicotine Replacement
- However in a COPD patient who refuses to quit nicotine, e-cigs appear to cause less harm than Tobacco
- Cibella (2016) Clin Sci 130(21): 1929-37 [PubMed]
- Polosa (2016) Respir Res 17(1): 166 [PubMed]
- NOT a Nicotine Replacement device (unlike Nicotine Patch, Nicotine Gum)
- E-Cigarette may replace Tobacco, but subsequently weaning from E-Cig often fails (in contrast to Nicotine Replacement)
- Hajek (2019) N Engl J Med 380(7):629-37 [PubMed]
- New, inventive way for companies (several that market Tobacco) to market an unregulated (in 2014), addictive nicotine product
- E-Cigarette has had a recent increase in use among U.S. high school students
- Nicotine solutions are not regulated and their labels may be inaccurate and their contents contaminated
- Inadequate safety data available for these devices and the inhaled vapor compared other Nicotine Replacement forms
- Adverse Effects: Nicotine Toxicity
- See Acute Nicotine Poisoning (esp. children)
- Nicotine solution is sold in large refillable 100 mg bottles
- Nicotine solutions are highly concentrated (up to 100 mg/ml)
- The solution is well absorbed by the Gastrointestinal Tract
- Toxicity risk is high when ingested by young children
- See Acute Nicotine Poisoning
- Toddlers experience symptoms with 1 mg ingestion
- Lethal dose at 6-13 mg/kg
- Nicotine has a Succinylcholine-like stimulatory effect on nicotinic receptors
- Results in Seizures followed by paralysis
- Nicotine affects teens differently than adults
- Teens are more likely to become addicted than adults
- Teens have a more significant adverse cognitive effect on memory and attention
- Teens are more likely to have respiratory adverse effects
- Longterm Vaping adverse cardiopulmonary effects are not yet clear
- May have carcinogenic effects
- Second hand exposure of potential toxins for friends and family
- Adverse Effects: Miscellaneous
- See Vaping-Associated Lung Disease
- See Acute Nicotine Poisoning
- Heavy Metal toxin and other contaminant exposure
- Lead
- Chromium
- Arsenic
- Propylene Glycol
- Formaldehyde
- Hydrogen cyanide has been isolated from black market cannibis Vaping solutions
- Nicotine is Teratogenic (effects fetal brain structure and function)
- E-Cigarette use increases increases risk of starting to use Cigarettes (Odds Ratio 3-6) and Marijuana
- Soneji (2017) JAMA Pediatr 171(8): 788-97 [PubMed]
- Dai (2018) Pediatrics 141(5): e20173787 [PubMed]
- E-Cigarette second-hand smoke exposure is common in middle and high school and triggers Asthma attacks
- Bayly (2019) Chest 155(1): 88-93 [PubMed]
- Prevention
- See E-Cigarette Cessation (same as Tobacco Cessation)
- Try to prevent teens from using e-cigs before they start
- Resources
- Electronic nicotine delivery systems: is there a need for regulation?
- http://www.talbotcentral.ucr.edu/AAA_04_publications/Electronic nicotine delivery systems is there a need for regulation.pdf
- Berkeley Wellness: Why Tobacco Companies Love E-Cigs
- http://www.berkeleywellness.com/self-care/over-counter-products/article/why-tobacco-companies-love-e-cigarettes
- References
- (2018) Presc Lett 25(11): 64
- (2014) Presc Lett 21(6): 36
- Swadron and Nordt in Herbert (2014) EM:Rap 14(6): 14
- Klein (2019) Am Fam Physician 100(4): 227-35 [PubMed]
- Vardavas (2012) Chest 141(6):1400-6 [PubMed]
- Trtchounian (2011) Tob Control 20:47-52 [PubMed]