The use of e-cigarettes has increased dramatically in the last few years, among adults and teens, so it is important for health care providers to have a basic knowledge to be better able to help patients make safe decisions about this habit. This is Part I of a 2 part series on e-cigarettes.
E-cigarettes were first introduced to the market in 2004, as an effort to provide the “fix” from nicotine without the harmful and sometimes lethal effects of cigarette smoking. As of 2014, approximately 4% of US adults are regular users of e-cigarettes, and its use is rising in adolescents.
An electronic cigarette or e-cigarette is a handheld electronic device that simulates the feeling of cigarette smoking. It is a form of an electronic nicotine delivery system (ENDS). Some are single use and others are multi-use where the user adds a pod of e-liquid. It works by heating a liquid that makes an aerosol, also known as “vapor”, that the user inhales. Using an e-cigarette is commonly known as vaping. The liquid in an e-cigarette, also known as e-liquid is typically made up of nicotine, propylene glycol, glycerine and flavorings, although not all e-liquid contains nicotine. They can contain a varying concentration of nicotine. A pod of e-liquid in a Juul (an e-cigarette commonly used by teens because it can be used discretely) contains the same amount of nicotine as a pack of cigarettes.
Some people use e-cigarettes as a method to stop smoking or to reduce the risk of smoking. Other people use them because they are less expensive than tobacco cigarettes. E-cigarettes are not subject to tobacco taxes like tobacco cigarettes are. Still other people use them recreationally. Many prefer e-cigarettes to tobacco cigarettes because they are more discrete – some look like flash drives and can be recharged using a computer. Some use e-cigarettes or vape pens as a way to inhale cannabis or other psychoactive drugs.
Known side effects of e-cigarettes include: throat and mouth irritation, nausea, vomiting, coughing, elevated heart rate and increased blood pressure. Because e-cigarettes are so new, their long-term health effects are unknown. They are likely to be safer than tobacco cigarettes. The majority of carcinogens and other toxic chemicals found in tobacco smoke are absent from the vapor from e-cigarettes. E-cigarettes can contain nicotine to varying degrees, but e-liquid can contain enough nicotine to lead to or sustain nicotine dependence. Some of the known risks of nicotine include: addiction, cardiovascular disease and birth defeats. Nicotine is more addictive than heroin and cocaine. Nicotine stimulates the cortical regions that are linked with reward, pleasure and reducing anxiety, which is why it is so addictive. In terms of cardiovascular effects, it can lead to elevated heart rate and blood pressure and blood vessel constriction, which can lead to LDL elevation. It can increase the risk of a heart attack or stroke. It can lead to appetite suppression and weight loss. Pregnant women who use nicotine are at risk for preterm labor, premature delivery and having babies with birth defects. Withdrawal symptoms of nicotine include: anxiety, irritability, trouble sleeping, hunger and trouble concentrating.
Various medical entities, including the Centers for Disease Control and Prevention and American Cancer Society, are assessing if e-cigarettes are a viable option for smoking cessation compared to other nicotine replacement therapies (NRT). Studies have shown that patients who use e-cigarettes for smoking cessation are more likely to continue using it long-term compared to patients who use traditional NRT, most of whom stop using the NRT after a few months. Some health care providers advocate advising patients to switch to e-cigarettes if they are not interesting in quitting smoking. This approach is known as tobacco harm reduction (THR). The idea behind it is to reduce the health risks linked with cigarette smoking in people who are not interested in stopping completely, knowing that cigarette smoking kills 1 out of 2 chronic users. One concern with THR is that some limited research has shown that smokers who start using e-cigarettes are less likely to stop cigarette smoking altogether than smokers who never tried e-cigarettes.
The second part of this series will focus on the increasing use of e-cigarettes and the related concerns in adolescents.