Electronic Cigarettes - Quit Smoking or Quit Nicotine?

The electronic cigarette was developed in China in 2004 and designed to replace the smoking of tobacco cigarettes and cigars. In spite of indoor smoking bans sweeping across the globe, many smokers are finding it difficult to quit. There are a variety of nicotine replacement products but these drug delivery systems in no way replicate the smoking experience. The e-cigarette is different in that it aims to both deliver nicotine and also simulate to some extent the experience of smoking a traditional cigarette.

Using an E-cigarette

The e-cigarette, or e-cig, consists of a mouthpiece containing a cartridge with a nicotine solution, a heating element or atomizer, a lithium-ion battery holder and finally an LED at the tip of the e-cig. The way e-cigarettes function means they also contain some electronic circuitry and an airflow meter. They come in different designs, often made to look like a fountain pen so can be discreetly kept in one's pocket but also available as a replica cigarette.

Using an electronic cigarette is pretty much like one of those nicotine inhalers one can buy in the pharmacy. There is no need to switch it on but rather just inhale through the mouthpiece. The airflow sensor then becomes activated and switches on the heating element. A short burst of heat vaporizes a little of the nicotine solution which is then inhaled. At the same time, the LED at the tip of the e-cig lights up showing that the battery is functional and the device operational but also simulating the burning tip of a tobacco cigarette. The nicotine vapour is largely absorbed through the lungs, just like tobacco smoke. Exhaling actually creates a “smoke” vapour even though, obviously, the tip of the e-cig doesn't emit smoke. After an e-cig puff the device switches itself off automatically.



The Smoking Experience

One question that arise is why develop an electronic device, with the possibility of it breaking one day, when there are already cheaper nicotine inhalers on the market? The motivation here is that the experience of using an inhaler is just not particularly enjoyable. It may be an effective nicotine delivery method, but it tastes like... well, like nicotine! On the other hand, e-cigarettes come in different flavours depending on the cartridge used, some of them even trying to duplicate traditional brands such as Marlboro and Camel. As has already been stated, the real aim of the electronic cigarette is to replicate the smoking experience, not just to deliver nicotine.

The nicotine solutions are available in different strengths and flavours with the main solvent being propylene glycol. Different recipes exist, sometimes with tobacco essence added or flavourings such as menthol. Rather like some pipe tobaccos e-cigs also come in exotic flavours such as strawberry, vanilla or coffee. Although tobacco smoke contains a huge cocktail of chemicals the novelty of the liquid nicotine ingredients has raised concerns about their safety. According to the US Food and Drug Administration, propylene glycol is considered safe for human consumption in foods and medicines, but there are indications that inhaling the chemical can cause irritation to some individuals. The profile of electronic cigarettes has suddenly increased when they were exhibited at the Consumer Electronics Show in Las Vegas in January 2009. There are many online stores selling them and they can also be bought on eBay. The arguments as to their safety and their legality have just started to heat up.

Are E-cigarettes Healthier Than Tobacco?

Early marketing of e-cigarettes advertised them as a healthier alternative to tobacco cigarettes, some going so far as to claim WHO approval. However, the World Health Organisation stepped in with a strongly worded disclaimer. "The electronic cigarette is not a proven nicotine replacement therapy," said Dr Ala Alwan, Assistant Director-General of WHO's Noncommunicable Diseases and Mental Health Cluster. "WHO has no scientific evidence to confirm the product's safety and efficacy.” The organisation does go on to say that clinical tests are urgently needed. There have now been some tests done in China and the UK, with New Zealand seemingly at the forefront of research. However, the Health New Zealand website claims that government funding for research is not forthcoming. In the USA e-cigarettes can be sold as alternatives to cigarettes as they contain no tobacco but are not approved as smoking cessation products. It is thus becoming clear that there are real moral and liberty issues here. Is quitting smoking the same as quitting nicotine?

Quit Smoking or Quit Nicotine?

Products such as the electronic cigarette highlight the fact that tobacco smoking and nicotine addiction are two separate issues. Yes, tobacco has been the main transport mechanism for nicotine intake. But we are in the situation where one nicotine product – tobacco – is freely available and highly taxed, whereas any other nicotine product needs clinical trials and sold as a medicine. This all starts to smell like the lobbying efforts of tobacco companies. But is nicotine bad for humans? Long term tobacco use is certainly unhealthy yet cigarettes are still on sale. But the idea that smoking cessation nicotine products actually work is highly debatable. The way that nicotine reacts in the brain and body means that even a small amount will keep the nicotine addiction thriving. Although due testing of the chemical cocktail inside e-cigarettes is definitely needed for health and safety reasons, the product should be welcomed as a stigma-free non-polluting alternative to tobacco cigarettes. But some governments disagree.

Are E-cigarettes Legal?

The eBay Australia auction site has this week (late January 2009) removed all e-cigarettes for sale after the Federal Department of Health and Ageing stressed that every form of nicotine, except replacement therapies and cigarettes, are classified as poisons. In October 2008 the National Drugs and Poisons Schedule Committee reiterated their earlier stance that e-cigarettes were a form of poison, thereby making it illegal to sell them. Although illogical and ridiculous to class the same chemical as poisonous in one product but not in another, the real reason is that the Australian government sees e-cigs as an insidious product designed to hook non-smokers onto nicotine and then onto smoking tobacco. They fear a similar sequence of events as with alco-pops. Across the world, laws on e-cigarettes are currently in utter confusion with some countries like the UK openly accepting them whereas many others classing them as medical products and needing to comply with the same regulatory requirements as other medicines. The question needs to be asked again: is nicotine bad for humans?

The Effects of Nicotine

What does nicotine actually do to make it so addictive? For a detailed explanation please read the Wikipedia article, but the important thing is that nicotine passes through the blood-brain barrier and increases the levels of various neurotransmitters. “It is thought that the increased levels of dopamine in the reward circuits of the brain is what is responsible for the euphoria and relaxation and eventual addiction caused by nicotine consumption.” Nicotine also increases the flow of adrenaline (or epinephrine) which is a stimulating hormone and increases the heart rate, blood pressure and breathing. Many other hormones and neurotransmitters are activated but just these two show that the same nicotine can have opposite effects. This is largely determined by the quantity of nicotine in the system, with low levels causing a stimulating effect and high levels acting as a sedative. In this respect nicotine is unique when compared to other drugs, with amphetamines showing the opposite profile.

Its effects as both a stimulant and a sedative don't yet explain its addictive nature. The addiction seems to be due to the effects of dopamine on the reward pathways in the brain. Bizarrely, as dopamine levels increase the brain tries to compensate by decreasing its natural production when not smoking. Because of this decrease in background level the brain also increases the number of dopamine receptors so it can react more sensitively to the lower default level. This then means that just one puff of a cigarette will increase the dopamine level to such an extent as to activate all these extra receptors. This is the buzz of that first cigarette of the day. It is also the reason that nicotine increases the sensitivity of the reward pathways in the brain. Again, this is the opposite effect of other addictive drugs such as heroin and cocaine. Although nicotine withdrawal symptoms are mild compared to, say, heroin, those brain receptors and neural pathways take many months to return to their pre-nicotine levels.

Is Nicotine Addiction a Medical or Moral Issue?

Now, the medical profession seems happy enough to prescribe mood altering drugs to millions of people and yet somehow nicotine is an evil that needs to be fought. Perhaps because it is a natural product and freely available without prescription that it needs to be either banned or brought within the pharmaceutical industry. The development, manufacture and sale of electronic cigarettes has caught them by surprise and needs to be regulated. The “soma” pills taken in Huxley's Brave New World could very easily be nicotine tablets. But perhaps, with a cultural history of smoking cigarettes people might prefer an e-cig rather than a pill.

So perhaps the case against nicotine is not a medical one but a moral one. Being addicted to anything means not being wholly free. Being addicted means having to do things to feed the addiction. This can cause other parts of life to suffer as a consequence. The negative health effects of smoking tobacco is proof of the power of addictive behaviour in spite of the consequences. But we now know that it is not the smoking that is addictive but the nicotine in the smoke. In a bid to halt smoking related illnesses there has been a worldwide drive to make cigarettes expensive and socially unacceptable. Replacement therapies give an illusion of attacking the underlying problem whilst at the same time feeding the nicotine craving. But quit smoking aids are really not much fun! In the e-cigarette we have a product that users seem to enjoy and delivers the needed nicotine without the tobacco smoke. Perhaps governments should just ban the sale of tobacco and switch to e-cigs. The tobacco giants would love that! Watch and see who owns the e-cigarette manufacturers to see how this story will end.

For the moment, electronic cigarettes are easily available online but do check the regulations for your particular country or risk the possibility of them being confiscated by customs. The arguments for and against e-cigarettes are only just beginning.