Concern Number 2: The Nicotine Monkey
Nicotine is unquestionably one of the most addictive substances on earth. It travels quickly through the bloodstream to the brain, where it relaxes the user, relieving stress (despite upping heart rate) and even temporarily stimulating memory and reducing depression, technically making it a stimulant. “Nicotine mimics a chemical called acetylcholine, which is the chemical through which nerves communicate with each other,” says Glantz. “That’s what leads to its addictive characteristics.”
Many cigarette smokers who wish to quit try smoking-cessation aids: gums, sprays, lozenges, or patches that replace the nicotine they’d normally take in, without the slew of additional carcinogens. These methods are effective to varying degrees, but not surefire. A 2012 study in the journal Tobacco Control showed that nicotine gums and patches were only effective in the short term, and didn’t keep smokers off cigarettes in the long run any more than quitting cold turkey.
Now, smokers like Holdridge are switching to e-cigs because they feel this could be the game changer. A device that simulates smoking—satisfying the hand-to-mouth motion and the inhalation of nicotine—could be far more effective in curbing a smoker’s craving.
Cigarettes typically contain about 12–15 milligrams of nicotine, of which only about 1–2 milligrams are absorbed into the body when smoking. The nicotine content of e-cigarettes can vary greatly, ranging from 0 to more than 30 milligrams of nicotine, depending on which replaceable cartridge or refillable liquid a user purchases.
But taking in any amount of nicotine gives health advocates pause.
“I’m not sure why, in a general way, we’d want to sell nicotine addiction,” says Neil Schluger, M.D., chief scientific officer at the World Lung Foundation. “We know there have been adverse health effects linked to nicotine. It can raise blood pressure, for example, and cause problems in pregnant women.” Another problem with e-cigs is that, unlike combustible cigarettes, they don’t burn out. The cartridge carrying the juice to make the vapor can run out of liquid, or the battery can die—but that’s after 200–400 puffs, well over a pack of cigarettes’ worth of nicotine exposure. Conceivably, a user, especially one who isn’t used to nicotine exposure, could puff himself into nicotine poisoning.
What’s more, in 2013, Brown University’s Chi-Ming Hai, Ph.D., published a study showing that prolonged exposure to nicotine, even in e-cigs, could lead to atherosclerosis, a major contributor to heart disease. Nicotine stimulates rosettes, or clusters of invasive material that accumulate on the surface of cells, which ruin the scaffolding that protects vascular cells in the heart. Since e-cigs don’t burn out, Hai worries that extended exposure could do vapers in.
“I’m speculating,” he says, “but I think a potential problem is that if it’s so easy to get nicotine in your system, there’s no reason why people would not keep pushing the levels.”
Concern Number 4: (Im)proper Regulation
If e-cigs could be a more effective nicotine-delivery device, why aren’t they regulated as such, like nicotine gums? As Schluger notes, e-cig makers could have gone to the FDA, participated in medical trials, and sold their products as drug-delivery devices. “But that’s not what they did,” he says. Instead, they went to market unregulated.
“[Selling an e-cig as a nicotine-delivery device] restricts where you can sell it, how you can sell it, and the time line for it,” says Miguel Martin, president of Logic, an e-cigarette company. “It’s contrary to how cigarettes are marketed and sold.”
The fact that e-cig makers sidestepped FDA testing has health officials concerned. They see the ease with which one can buy an e-cigarette, smoke it anywhere, and inhale a not-insignificant amount of nicotine in one sitting. Regulators are starting to draft laws to regulate e-cigs either as tobacco products or drug-delivery devices. Meanwhile, studies and anecdotes like Holdridge’s show that, for adult smokers, e-cigs could be a new, more effective take on nicotine gum, regulated or not.
“There’s no tobacco and nothing combustible in an e-cigarette,” saysformer Surgeon General Carmona. “There are no cancer-causing ingredients in it. Really, it’s just a nicotine-delivery device. Our opinion was that it should be regulated just like nicotine gum or nicotine sprays.”
Though technically they don’t brand e-cigs as “smoking-cessation aids,” makers often come dangerously close to that, and the fine line between making health claims and offering an alternative to smoking has many confused. When we asked manufacturers and health officials, “Are e-cigarettes safer than combustible cigarettes?” the answer was usually a nonanswer.
“We are precluded from making any health claims, precluded from making any claims that it’s a quit assist,” says Logic president Martin. It’s a semantic juggle: Manufacturers don’t call it “quitting smoking” but “switching” from cigarettes to e-cigarettes. Despite anecdotal evidence that e-cigs may help smokers quit, many antismoking advocates fear that what they’re really doing is undoing the progress that’s been made over the last half-century.