This is the second part of my comment on a New York Times opinion piece about e-cigarettes by Maia Szalavitz. I am proposing that while e-cigarettes may cause less medical illness than tobacco cigarettes, they may be more addictive. The devices can be used inconspicuously and are therefore more available during the day than are combustible cigarettes. Many of my patients describe a pattern of e-cigarette use that is more continuous than is that for tobacco cigarettes. Their vaping device is usually in their hand, often in their mouth and can be taken to bed and used during the night. As a result, use is more frequent and becomes more automatic and outside of awareness, rather than being used in response to a particular stress.
The high frequency of use establishes body memories that creates a powerful behavioral dependency that combine with the physical dependence of nicotine. Even after the nicotine withdrawal symptoms are resolved, patients struggle with “what do I do with my hands?” As a transitional step to deal with this aspect of quitting vaping, patients have found it useful to temporarily use the vape device with nicotine-free vape fluid. This allows the two aspects of the combined dependence to be separated and can make the quitting process less difficult.
As for the nicotine dependence, e-cigarette manufacturers are incentivized to enhance this in order to bind their customer more tightly to their product. They accomplish this by adjusting the composition of the vaping fluid. Some of what has been done are:
Increasing the percentage of nicotine in the fluid
Combining the nicotine with acid to produce nicotine salt that prevents the higher concentration of nicotine from irritating the throat and lungs
Adding appealing flavors and cooling ingredients to reduce irritation
Adding propylene glycol to create a “throat hit” that vapers enjoy
So where does this leave the cigarette smoker who is wondering what to do? I suggest following the consensus advice offered by nicotine experts at the 2024 meeting of SRNT, which is that if smoking cessation efforts have not been successful:
Switch completely to e-cigarettes – do not use both, which can be more harmful than using either.
Use the e-cigarettes for a limited period of time because there are not yet any studies on their long-term safety. The only exception is if the person already has a tobacco-related medical illness and stopping the e-cigarettes would create a high likelihood of returning to the use of tobacco cigarettes.
For those of you who are fortunate to not have used nicotine products, I hope that you will not be misled by the sales skills of the e-cigarette industry and instead choose to remain not just tobacco free but nicotine free as well.
If you are already struggling with how to quit vaping, our staff is available to talk with you and can be reached at https://www.tripletrack.com/lets-talk.
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