Joined: 2:04 PM - Nov 13, 2008

1:36 AM - Sep 27, 2011 #11

Last edited by Joel Spitzer on 2:24 PM - Nov 07, 2012, edited 2 times in total.

Joined: 7:22 PM - Nov 11, 2008

7:03 PM - Nov 06, 2011 #12

E-cig users have nicotine levels similar to smokers

When reading the below journal letter by Etter and Bullen note that cotinine is a major nicotine metabolite, one of the chemicals that nicotine breaks down into. This paper suggests that experienced e-cig users are inhaling as much nicotine as smokers and have higher levels than NRT users. As Joel's above video notes, fifty years ago physicians were saying that cigarette smoking was safe and look where that led. While clearly less destructive than cigarettes, today all advocating e-cigarette use have absolutely no idea of the long term risks of inhaling vaporized nicotine into the lungs of a body already damaged by years of smoking.

Many of the "safety" assurances being made by those promoting e-cigarettes are reckless and often contrary to existing yet limited research findings. As Joel notes, there is currently zero regulation as to what can and cannot go into nicotine e-cig cannisters, nor is there ongoing testing to determine cannister contents or requirements for disclosing cannister contents.

Hardly a week passes without us receiving a request that we promote e-cigarettes on WhyQuit. Some e-cig activists see WhyQuit as a threat. Why? Because as Joel notes, we do not advocate nicotine replacement or harm reduction but nicotine cessation and harm elimination. The nicotine industry's primary objective will always be the same: to profit by getting people to purchase and use their nicotine delivery device. Our primary objective is the opposite: to help them stop using them. Those within harm reduction work under the assumption that a substantial percentage of users cannot quit while we are just as convinced that they can.

They cater and play to the addict's wanting and desire for that next fix, while we teach why it persists and the only path to ending it. They place great significance on how the addict eventually dies. While we fully agree that use risks are extremely important, life isn't just about how we die but about how each day gets lived.

While we fully support cleaner and less destructive nicotine delivery, not here. WhyQuit will continue to resist all attempts to undermine nicotine cessation and harm elimination. But this need not be any "real" quitter's concern so long as all nicotine continues to stay on the outside. There was always only one rule ... none today!

Breathe deep, hug hard, live long,

John - Gold x12

Saliva cotinine levels in
users of electronic cigarettes

European Respiratory Journal - Etter/Pauwels

ERJ November 1, 2011 vol. 38 no. 5 1219-1220

J-F. Etter and C. Bullen

To the Editors:

Electronic nicotine delivery systems (ENDS or electronic cigarettes) look like cigarettes but do not contain or burn tobacco. Instead, they comprise a battery-powered atomiser that produces a vapour for inhalation from cartridges containing humectants (propylene glycol or glycerol), flavours (e.g. tobacco, mint or fruit) and nicotine. Many smokers report using ENDS to quit smoking or to substitute for tobacco in smoke-free places [1, 2].

Because ENDS are purchased mainly on the internet [1, 2], we posted a questionnaire in English and French on the smoking cessation website between September 2010 and January 2011. We asked discussion forums and websites informing about ENDS or selling them to publish links to the survey ( The online questionnaire covered ENDS use (current/past and duration), smoking status, age, sex and postal address. Current ENDS users were sent by mail a plastic vial, a consent form and an additional questionnaire on paper, which covered ENDS use (days per week), brand and model, whether their current ENDS contained nicotine, nicotine dosage, puffs·day−1, refills·day−1, tobacco cigarettes per day (in smokers), quit date (in ex-smokers) and any tobacco, nicotine replacement therapy (NRT) and ENDS use in the previous 48 h. Participants were aged >18 yrs and the study was approved by the ethics committee of the Geneva University Hospitals (Geneva, Switzerland).

We found substantial amounts of cotinine in the saliva of ENDS users. These results contrast with two laboratory reports that concluded that ENDS did not reliably increase blood nicotine levels [3], or provided lower levels than nicotine inhalers or tobacco cigarettes [4]. The differences with our study may be explained by different durations of exposure, users' experience with the devices, puffing characteristics, models used and the swallowing of nicotine. In our study, experienced users puffed intensively and had been using ENDS regularly for months, whereas the previous studies were conducted in ENDS-naïve users. Experience with the device is likely to have influenced blood nicotine/cotinine levels. The correlation between puff number and cotinine suggests that puffing topography is an important factor that should be controlled for in future studies.

Nevertheless, cotinine levels in ENDS users were similar to levels previously observed in smokers [6] and higher than levels previously found in NRT users [7, 8]. Cotinine levels are roughly similar when measured in blood or in saliva [6, 9, 10], so studies using cotinine in blood and in saliva can be compared. Participants had not smoked for ≥20 days and had not used NRT or smokeless tobacco for ≥48 h (about three times the half-life of cotinine in smokers) [10]. Thus, results are unlikely to be contaminated by other sources of nicotine. All participants but one were former smokers, suggesting that ENDS are used much like NRT, to assist quitting, with similar or even larger effects on nicotine exposure. In this light, it seems logical to apply the same evaluation requirements to ENDS as to NRT. Even though propylene glycol is authorised as an additive in foods and medications, the effects of repeatedly inhaling a vapour containing propylene glycol over long periods are unknown.

We conclude that cotinine levels in ENDS users were similar to levels observed, in previous reports, in smokers and higher than levels usually observed in NRT users. This finding has important implications for ENDS use by smokers who want to quit, for future research, and for the regulation of these products.

Journal Link:

Copyright European Respiratory Journal 2011

PubMed Citation Link:
Last edited by JohnPolito on 7:06 PM - Nov 06, 2011, edited 1 time in total.