Natassia V. Gaznick, MD, PhD Resident Physician Department of Psychiatry University of California, San Diego, Health Sciences San Diego, California
Robert M. Anthenelli, MD Professor and Executive Vice Chair Director, Pacific Treatment and Research Center Department of Psychiatry University of California, San Diego, Health Sciences Substance Use Disorder Section Editor, Current Psychiatry
Disclosures Dr. Gaznick reports no financial relationships with companies whose products are mentioned in this article or with manufacturers of competing products. Dr. Anthenelli provides consulting and/or advisory board services to Pfizer, Alkermes, and Cerecor. Dr. Anthenelli’s writing of this manuscript was supported, in part, by National Institute on Alcohol Abuse and Alcoholism grant No. U01 AA013641 and R01 AA019720 and National Institute on Drug Abuse/Veterans Affairs Cooperative Studies #1032 and 1033.
Preliminary studies on the use of electronic nicotine delivery systems for smoking cessation or reduction show some promise, but the jury is still out
The popularity of electronic cigarettes (E-cigs) and “vapes” has grown dramatically, spawning a new industry of electronic nicotine delivery systems (ENDS). With the increasing use of E-cigs not only for smoking cessation, but also as a primary nicotine source, it is important for mental health professionals to be prepared to discuss use of these devices with patients. In this article, we will describe:
the composition of E-cigs and their current use
evidence for their use for smoking cessation
adverse health effects
recommendations of major regulatory agencies.
Finally, we will provide recommendations for E-cig use in clinical populations.
What is an electronic nicotine delivery system?
ENDS produce an aerosol with or without nicotine that is inhaled and is thought to mimic the use of combustible cigarettes. ENDS evolved from basic E-cigs into a less “cigarette-like” and more customizable product (Figure 1). ENDS include a range of designs and go by various names, including “personal vaporizers,” “e-cigars,” and “e-hookahs” (in this article, we will use the term “ENDS” to refer to these devices).
The general design of ENDS is a plastic tubing system that contains a mouthpiece, battery, electronic heating element (“vaporizer”), and a cartridge with liquid solvent with or without nicotine or flavoring (Figure 2). One draw on the mouthpiece or press of a button activates the device, heats the solution, and delivers a vapor in a similar manner to taking a puff of a cigarette. Although studies have shown that ENDS result in significant increases in plasma nicotine concentrations in 5 minutes,1 the plasma nicotine levels obtained with the first-generation “cigarette-like” ENDS are much lower than those caused by inhaling tobacco smoke.2 Over time nicotine delivery capability has improved as ENDS have evolved such that the rate of nicotine delivery and peak concentration obtained with newer models more closely mirror tobacco cigarettes.3 Whether the rapid delivery of larger amounts of nicotine helps or hinders one’s efforts to break nicotine addiction remains to be determined because of the reinforcing properties of the drug.
