How can something so good be so bad?

Blog Post created by dr_hays on Apr 10, 2019

Shortly after electronic cigarettes came on the market in 2011 people became interested to know if these devices might help smokers to quit smoking tobacco.  There were a number of early studies and observations that made people believe electronic cigarettes might ultimately be a very helpful product and might be the solution to help people quit long-term tobacco use.  Scientific publications from a number of highly regarded government and non-governmental organizations declared that electronic cigarettes were as much as “95% safer” than standard cigarettes.  Studies also confirmed the vapor from electronic cigarettes contained concentrations of harmful chemicals that were many times lower than the concentrations found in cigarette smoke.  In the early days of electronic cigarettes it was also true that nicotine delivery was unreliable and quite a bit lower than a person could get from a standard cigarette.  All of this information made most people feel electronic cigarettes were safe and unlikely to the cause the kind of addiction we had been used to seeing with standard cigarettes. 


Then, it seemed, everything changed…..


In fact, things did not change suddenly in the electronic cigarette world but they did change dramatically over the course of a few short years.  Electronic cigarettes were changing and the way people use them was also changing.  The newer devices were able to deliver higher and more reliable doses of nicotine and the number of devices and the number of electronic cigarette solutions available to purchase grew into the thousands.  And while this was happening, teenagers were taking up electronic cigarette use in larger and larger numbers, so that between 2011 and 2015 the percent of high school student in the United States using electronic cigarettes had quadrupled.  We were briefly reassured that this was not going to continue when the number of high school students using electronic cigarettes or other tobacco products stabilized and fell slightly in 2017; but then in 2018 there was a dramatic rise again in tobacco product use among high school students.  Most of this rise was due to the increasing use of electronic cigarettes, particularly the ”Juul” device.  Juul raised the stakes a lot by providing a device that was very appealing to teenagers (it looks like a flash drive for a computer, and is easily hidden from naïve adults) and used disposable pods containing flavored nicotine solutions (fruit flavors and candy flavors appealing to kids).  The solution in these pods also contains highly concentrated nicotine and the Juul device delivers high concentrations of nicotine in the vapor which is absorbed quickly into the blood stream when inhaled.  Sounds a lot like a cigarette doesn’t it?


Nicotine addiction from use of electronic cigarettes is now becoming more common both in children and young adults.  In our clinic, where we treat nicotine dependence we are now starting to see more and more people who are addicted to electronic cigarettes after they made the switch to these devices thinking it would help him stop smoking tobacco.  Most adults continue to use tobacco while using electronic cigarettes but many teenagers are using electronic cigarettes exclusively and become heavily addicted.


Our approach to treatment for addiction to nicotine due to electronic cigarettes is very much the same as for the standard cigarette.  Through counseling, we move people toward positive health behavior change and commitment to a plan to quit.  We use medications such as nicotine replacement to reduce withdrawal and craving for electronic cigarettes so that they can have early success and reduced risk of relapse as they put their quit plan in place.  We expect to see more patients like this as electronic cigarettes become better and better at delivering nicotine (“better” meaning more addictive).  As we and others learn more about how to treat people who now are addicted to electronic cigarettes, we are certain we will get better at it. Our mission continues to help people become free of addiction to tobacco as well as electronic cigarettes.


Dr. Hays