Electronic or e-cigarette sales picking up steam

Joined: 7:22 PM - Nov 11, 2008

12:55 PM - Mar 28, 2009 #1

Electronic or e-cigarette
sales picking up steam
Here at this site our focus is well defined and simple ... freedom from nicotine. Our primary focus is on how we live: free or slave. Spewing forth more than 3,500 chemical particles and over 500 gases that may include up to 81 cancer causing chemicals, health authorities report that cigarettes annually contribute to the deaths of 418,000 Americans, 47,000 Canadians, 1,200,000 Europeans (81,900 in England and nearly 7,000 in Ireland), 15,500 Australians and nearly 5.4 million worldwide. Many new less destructive nicotine delivery devices, including the electronic or e-cigarette, are now entering the market. It would appear that the days of the world's dirtiest drug delivery device -- the traditional combustion cigarette -- are numbered.

But we have no data showing the impact of continued nicotine use on health or life expectancy of an ex-smoker who has already been exposed to 10, 20, 30 or 40 pack years of cigarette use. Such data will not be available for decades. It's why health and safety claims and assurances made by those marketing e-cigarettes and other cleaner forms of nicotine delivery are sadly laughable. Clearly, the rate of additional, new destruction would obviously be less with arrival of one toxin versus scores. That being said, still burning in my ears are the cautions from Duke Medical University Professor Slotkin who asserts that of all the chemicals in cigarette smoke nicotine is clearly the most destructive.

In 2002 the FDA declared both the nicotine lollipop and nicotine lip balm as being illegal products on dual fronts, as being either unapproved nicotine cessation products or unapproved nicotine addiction treatment products. Now, the most sophisticated harm reduction device yet, the electronic or "e-cigarette," could itself see increasing FDA scrutiny. Marketed by a Scottsdale, Arizona based company calling itself "NJoy," the e-cigarette is being sold as an "alternative to smoking that offers reduced health risk."

What looks like a plastic cigarette houses a battery, an atomizer to vaporize nicotine into mist form and a liquid reservoir cartridge containing a nicotine solution (which comes in three different strengths) which also serves as a mouth piece.

When the e-cigarette is inhaled, a sensor detects air flow which activates a microprocessor. This in turn activates the atomizer which injects tiny droplets of the nicotine solution into the air flow, producing a vapor mist that's inhaled by the user. Propylene glycol is included in the nicotine solution so as to make the mist resemble normal cigarette smoke. The tip of the e-cigarette is an orange light-emitting diode that's activated during air flow so as simulate a burning cigarette.

This thread will become home to news articles and studies regarding the e-cigarette. Although nearly all will throw about terms such as "safer" or "safe," lets not kid ourselves. Nicotine is a natural insecticide with just 1mg, the amount inhaled by the average smoker with each cigarette, being sufficient to kill the largest rat you've ever seen (about a pound to a pound and a half).

Once sold as Black Leaf 40, an insecticide, nicotine's lethalness (LD50) is 166 times greater than caffeine. We've seen an explosion of disturbing nicotine research, including concern that the super-toxin nicotine may be responsible for eating brain gray matter.

The most horrific nicotine dependency burden may not be the nicotine addict's final illness or how they die, but how they spent an entire life in chemical servitude to nicotine's two-hour half-life inside human blood-serum, bouncing between dopamine generated "aaah" sensations and insula driven urges, craves and anxieties.

Not suprisingly, sites marketing e-cigarettes do not mention chemical addiction as an e-cigarette use risk. Understandably, they do not want to share nicotine use health risks such as artery hardening, accelerated tumor growth rates, early dementia or hair and tooth loss but clearly have obligations to do so. Another concern is youth access, not just their ability to purchase e-cigarettes via the Internet but the fact that while all states have youth tobacco access laws, few have laws governing youth use or possession of "tech-bacco" or tobacco-free nicotine products.

Powerful economic forces may be behind some of the below articles. For the first time ever, the traditional tobacco industry and NRT arm of the pharmaceutical industry have reason to combine forces to encourage governments to ban e-cigarette sales.

As you read the below articles consider smoker reactions to the e-cigarette. Some actually show concern in awakening to the realization that they are a real drug addict. Think about traditional tobacco industry flavor, aroma and taste marketing and the fact that there are zero tastebuds inside human lungs, the place we sucked and briefly held nicotine laden smoke. Think about the expense, social stigma and jokes that are sure to follow. Think about contining to allow nicotine's two-hour chemical half-life inside the human bloodstream to remain the basic clock governing emotions, mandatory feeding times and control over the flow of more than 200 neuro-chemicals that nicotine impacts.

Reflect on a "cure" for the supposed "cure" and where neo-nicotine delivery and pharmaceutical companies recommend that those hooked on the e-cigarette or NRT turn for help. Reflect on how some journalists and "experts" suggest that "quitting" has already occurred if a smoker uses these products. What message does the article send to youth? What message does it send to nicotine addicts?

Freedom is about real quitting, about fully arresting our underlying chemical dependency, about freedom from nicotine. There was always only one rule .... no nicotine today! N O N E! (NO Nicotine Ever)

Breathe deep, hug hard, live long,

Last edited by JohnPolito on 5:53 PM - Mar 28, 2009, edited 3 times in total.

Joined: 7:22 PM - Nov 11, 2008

1:01 PM - Mar 28, 2009 #2

Local Entrepreneur Thinks
'Liberty Stix' Will
Help Smokers Quit
POSTED: 1:20 pm EDT March 26, 2009
UPDATED: 11:46 am EDT March 27, 2009

There's a new kind of cigarette turning a lot of heads these days. It looks just like the real thing and its makers call it a "healthy smoking alternative." They even say it has helped people quit.

The device looks like a cigarette and delivers a nicotine mist, but no smoke.

"People initially say 'You can't do that.' But once they see what it is, they're like 'Wow!' " Sebastian Cangemi said.

Cangemi, a local entrepreneur, is the man behind Liberty Stix. They're electronic cigarettes which Cangemi said will deliver the nicotine smokers crave but not all the carcinogens that come with conventional cigarettes.

Though not FDA-approved as a stop-smoking product, Cangemi said they can help you quit by gradually reducing the amount of nicotine you get by changing the cartridges.

Cangemi said, "I used to smoke six packs of cigarettes, now I use four cartridges. You get your fix after two to three drags of this, so you actually wean yourself off that hand-to-mouth habit."

NewsChannel5 decided to run the product past one of the area's leading smoking cessation experts, Iyaad Hasan, Director of the Cleveland Clinic's Tobacco Treatment Center.

"I do not see any value or recommend it to my patients," Hasan said.

Hasan's issue is the fact that "smokers" will still be feeding their addiction with the nicotine and they're not breaking the "hand-to-mouth" habit.

Hasan also said, "Because of its weight, its size, etc. it keeps the patient hooked on the cigarette and that's what I really do not like. It does not break the behavior."

But what about the smokers themselves?

We asked long-time smokers Joanne Billie, MaryBeth Kosan and NewsChannel5 photographer Bob Seeley to put their real cigarettes out and Liberty Stix to the test.

"Sucking in, that is amazing. The (cigarette) I put out may have been the last pack I bought," Billie said.

Kosan added, "Oh, the whole feeling's there ... like you're really smoking. Not bad!"

Both Billie and Kosan would be willing to pay $35 for the starter kit thinking it may help them quit their increasingly expensive habit.

Seeley had a different opinion.

"I'd rather keep smoking or just go cold turkey than spend $35 on a plastic toy that I feel stupid holding," Seeley said.

NewsChannel5 marched all three of their testers into their non-smoking newsroom. Their Liberty Stix turned every head, as they would certainly do in any Cleveland restaurant.

In fact, they've already turned the head of Nick Kostis, one of the owners of Pickwick and Frolic.

Kostis is hoping to accommodate as many customers as possible in these tough economic times.

Kostis said, "I think this product -- if in fact its claims are valid, which they seem to be -- I'm interested in learning more. And I think the public will be also."

Cangemi said he's already sold more than 22,000 kits and has gotten interest from other restaurants and even drug store chains.

So will this trend really catch fire? That remains to be seen.

A New Jersey senator has written a letter to the FDA asking the agency to require approval for all e-cigarettes, but the FDA has not responded yet.

As far as using this product indoors, Health Reporter Alicia Booth called the state of Ohio's Smoking Ban Enforcement Office and was told right now, it's not a violation of the ban to use e-cigarettes.

Copyright 2009 by
. All rights reserved.

Online story source link
Last edited by JohnPolito on 1:05 PM - Mar 28, 2009, edited 1 time in total.

Joined: 7:22 PM - Nov 11, 2008

1:15 PM - Mar 28, 2009 #3

Health Canada Advises
Canadians Not to Use
Electronic Cigarettes Advisory
March 27, 2009
For immediate release

OTTAWA - Health Canada is advising Canadians not to purchase or use electronic smoking products, as these products may pose health risks and have not been fully evaluated for safety, quality and efficacy by Health Canada.

These products come as electronic cigarettes, cigars, cigarillos and pipes, as well as cartridges of nicotine solutions and related products. These products fall within the scope of the Food and Drugs Act, and under the Act, require market authorization before they can be imported, advertised or sold. The sale of these health products is currently not compliant with the Food and Drugs Act since no electronic smoking products have been granted a market authorization in Canada.

In recent months, a number of electronic cigarettes, cigars and pipes as well as cartridges of nicotine solutions and related products have been marketed in Canada, and through the Internet. Most of these products are shaped and look like their conventional counterparts. They produce a vapour that resembles smoke and a glow that resembles the tip of a cigarette. They consist of a battery-powered delivery system that vapourizes and delivers a liquid chemical mixture that may be composed of various amounts of nicotine, propylene glycol, and other chemicals.

Nicotine is a highly addictive and toxic substance, and the inhalation of propylene glycol is a known irritant. Although these electronic smoking products may be marketed as a safer alternative to conventional tobacco products and, in some cases, as an aid to quitting smoking, electronic smoking products may pose risks such as nicotine poisoning and addiction. Please visit the Health Canada website for further information about nicotine and addiction.

While no electronic smoking product has yet been authorized for sale in Canada, Health Canada has authorized the sale of a number of smoking cessation aids, including nicotine gum, nicotine patches, nicotine inhaler, and nicotine lozenges.

Electronic smoking products, including their nicotine cartridges, must be kept out of the reach of children at all times, given the risk of choking or nicotine poisoning. Nicotine is hazardous to the health and safety of certain segments of the population such as children, youth, pregnant women, nursing mothers, people with heart conditions, and the elderly.

Persons importing, advertising or selling electronic cigarette products in Canada must stop doing so immediately. Health Canada is providing information to interested stakeholders on how to apply for the appropriate market authorizations and establishment licences.

Canadians who have used e-cigarette products and are concerned about their health should consult with a health care practitioner.

Complaints involving electronic smoking products can be reported to the Health Products and Food Branch Inspectorate by calling the toll-free hotline at 1-800-267-9675, or by writing to:

Health Products and Food Branch Inspectorate
Health Canada
Address Locator: 2003C
Ottawa, Ontario K1A 0K9 You can also contact a Health Products and Food Branch Inspectorate Regional Operational Centre.

Online Health Canada Source Link


3:29 AM - Feb 16, 2010 #4

Do electronic cigarettes actually work?
Posted by Tiffany O'Callaghan Monday, February 15, 2010 at 2:04 pm
There are all sorts of products out on the market made to wean smokers off a dangerous habit—the patch, the lozenge, and the gum, for example. Yet, what about the e-cigarette? Though it's marketed as a "safer" alternative to cigarettes, and not necessarily a smoking-cessation device, unlike the other nicotine delivery products, e-cigarettes—battery-operated devices that supposedly work by heating up a liquid nicotine substance which "e-smokers" inhale as vapor—aren't regulated by the Food and Drug Administration (FDA). In fact, according to the American Medical Association, on January 14, a federal judge ruled that e-cigarettes should not be subject to FDA regulation because they are merely an alternative to traditional cigarettes, which are readily available. Medical experts counter that, though they may be marketed as alternatives to traditional cigarettes, people are turning to them as a smoking cessation product, which means that greater oversight is critical. In the midst of this heated debate, however, a researcher from the Institute for Drug and Alcohol Studies at Virginia Commonwealth University decided to put two brands of e-cigarettes to the test, to see just how they stack up against actual cigarettes. His findings, published in the February issue of the journal Tobacco Control, suggest that the e-smokes fail to deliver much nicotine, or help reduce cravings.
The study, led by psychologist Thomas Eissenberg, included 16 smokers. In four different phases of the study, each separated by two days, they were asked to: smoke a cigarette from their preferred brand; "sham smoke" a cigarette—or basically "puff" on it without lighting it; use an Njoy NPRO electronic cigarette filled with a 16mg nicotine cartridge; and use a Crown 7 Hydro e-cigarette filled with a 16mg nicotine cartridge. Both e-cigarettes' batteries were fully charged for each "smoking" session.

Prior to the trials, smokers were asked to abstain from nicotine for 12 hours. At the beginning of each session, they had catheters inserted into their veins, enabling researchers to take blood samples multiple times—5, 15, 30 and 45 minutes after the first puff—to measure for nicotine content. They found that, as you would expect, actually smoking dramatically increased nicotine content in the blood. Yet, when it came to the e-cigarettes, both brands increased nicotine content only nominally more than sham smoking. What's more, the products did little to reduce cigarette cravings.

In light of the findings, Eissenberg argues for more thorough testing and regulation of the products, as well as a greater awareness of potential health risks of misuse. As he points out, for example, the refill liquid for e-cigarettes, which is meant to be added by the drop, is sold in bottles containing some 500mg of nicotine, or 10 times the lethal dose. As Eissenberg concludes:

"[T]he results reported here all support the notion that electronic nicotine delivery devices (E- cigarettes) and their nicotine-containing solution should be evaluated, regulated, labeled and packaged in a manner consistent with cartridge content and product effect. At the least, consumers should be aware that, unlike several regulated nicotine products (eg, gum,patch), these putative drug delivery systems do not deliver nicotine effectively after acute administration."

Eissenberg's findings add to earlier concerns from the FDA, the World Health Organization, and other health organizations that have questioned the safety of the faux cigarettes and urged potential users to "exercise caution."

So, what's the bottom line? If you're looking for a safer alternative to cigarettes, it's hard to oversell the health benefits of kicking the habit. And if you're looking for products to help you quit smoking, it's best to look elsewhere.
© 2010 Time Inc. All rights reserved

Joined: 7:22 PM - Nov 11, 2008

1:02 PM - Feb 16, 2010 #5

Electronic nicotine delivery devices:
ineffective nicotine delivery and
craving suppression after acute administration

Figure 1

Mean (±1 SEM) plasma nicotine (top panel; assay's limit of quantitation=2 ng/ml) and response to a visual analogue scale item assessing ‘craving for a cigarette/nicotine’ (bottom panel; 0–100 scale) from 16 cigarette smoking participants who each abstained from tobacco/nicotine for at least 12 h before completing each of the study's 4 conditions. Arrows indicate timing of product administration (each administration consisted of 10 puffs with a 30-s interpuff interval). Filled symbols indicate a significant difference from the first assessment timepoint; asterisks (*) indicate a significant difference from sham smoking at each timepoint (ps<0.05; Tukey honestly significant difference test).
Last edited by JohnPolito on 1:04 PM - Feb 16, 2010, edited 1 time in total.


10:57 PM - Feb 18, 2010 #6

That's certainly an interesting finding. Maybe they should relabel the product as "E-Placebo"?

ETA: I don't mean that literally. I have no doubt whatsoever, that some e-cigs, with some strength cartridges, do indeed deliver nicotine and are therefore totally 100% taboo to all of us who are members here.
Last edited by hwc on 5:14 AM - Feb 19, 2010, edited 1 time in total.


10:16 PM - Jun 10, 2011 #7

i think the E-cigg are a waste of money.Before I went cold turkey i tried these things and I would puff on one,and would still find myself wanting the real cigg.I mean you will invest more money just trying to start the habit of using e-ciggs.Cold turkey is the way to go.I love life.

Joined: 7:22 PM - Nov 11, 2008

1:04 PM - Jul 02, 2011 #8

kevintaylor wrote:
i think the E-cigg are a waste of money.Before I went cold turkey i tried these things and I would puff on one,and would still find myself wanting the real cigg.I mean you will invest more money just trying to start the habit of using e-ciggs.Cold turkey is the way to go.I love life.
An important point, Kevin!  It concerns me that highly effective marketing associated with a host of new vastly cleaner nicotine delivery devices will tease the still challenged new quitters into thinking that they can have keep their cake while eating it too.  What they're not considering is that once they've relapsed that it will not measure up to the massive bolus of nicotine that arrived within seconds of smoking burning tobacco, nor will the satisfaction of dopamine pathway wanting last nearly as long. 

There is some still unknown chemicals in burning cigarettes that inhibit MAO A and MAO B, two dopamine clean-up enzymes.  It's thought that diminished MAO may be what make smoked nicotine's satisfaction of wanting last longer than cocaines and vastly longer than the relief felt between potato chips.

There is only one path to retiring dependency's daily urges and craves and arriving here on Easy Street with us hundreds of millions of comfortable ex-users,   no nicotine today!!!!  Nicotine addiction is about living a lie.  Let "one day at a time" carry you to truth!  Yes you can!!

Breathe deep, hug hard, live long,

John - Gold x12

Joined: 7:22 PM - Nov 11, 2008

2:25 PM - Jul 15, 2011 #9

Man accused of assaulting flight
attendant with peanuts, pretzels
By melinda Rogers,  The Salt Lake Tribune -  UPDATED jULY 14, 2011
A Sandy man is charged in U.S. District Court with assaulting a flight attendant with bags of peanuts and pretzels after he was asked to stop using an electronic cigarette aboard a flight from Los Angeles to Salt Lake City this week.

Pogos Paul Sefilian, 42, became combative on Southwest Airlines Flight 188, which departed Los Angeles at 6 p.m. on Monday, according to a complaint filed in federal court on Tuesday. Sefilian started using an electronic cigarette after boarding the plane. The device uses heat to simulate smoking tobacco-filled cigarettes with a vapor that is inhaled. A flight attendant spotted Sefilian with the electronic cigarette and informed him he couldn’t use it on the plane, the complaint states.

Sefilian argued with the flight attendant, but stowed the device, according to the complaint. But after takeoff, he pulled it out and became enraged when the attendant again asked him to put it away, the complaint states.

Later, he threw peanuts and pretzels at the flight attendant and at the flight deck door in an apparent attempt to protest the airline’s policy banning electronic cigarettes, the complaint states. The flight attendant asked Sefilian to stop his unruly behavior, but as the flight approached Salt Lake City International Airport, Sefilian jumped up and started opening overhead containers, the complaint states.

The flight attendant made six announcements for Sefilian to sit down, but he refused, instead posturing his chest out at the flight crew, according to the complaint.

FBI agents arrested Sefilian once the plane landed.

He is charged with interference with a flight crew. The case has been assigned to U.S. Magistrate David Nuffer.


Joined: 7:22 PM - Nov 11, 2008

12:47 AM - Jul 22, 2011 #10

“E-Cigarette or Drug Delivery Device?”
7/20/2011  -  Legacy
Schroeder Institute Researchers Raise Questions About Safety, Usage and Future Implications of New Nicotine Delivery Products Washington, D.C. – Devices marketed as “electronic cigarettes” are in reality crude drug delivery systems for refined nicotine, posing unknown risks with little new benefits to smokers, according to tobacco control experts.

In a “Perspective” published today in the New England Journal of Medicine, researchers from the Legacy’s Steven A. Schroeder National Institute for Tobacco Research and Policy Studies explore the current regulatory climate around electronic cigarettes (“e-cigarettes”) and their safety.  The authors, Nathan K. Cobb, MD, a pulmonologist and assistant professor at Georgetown University Medical Center, and David B. Abrams, PhD, executive director of the Schroeder Institute, also question future implications for physicians, policy makers and e-cigarette users.

E-cigarettes are constructed to mimic real cigarettes in size and appearance, but contain no tobacco and are not cigarettes at all. In reality they are delivery devices for refined nicotine, having more in common with inhalers used to treat asthma or other delivery devices for both approved and illicit drugs. Though individual brands vary in construction, the products generally produce a propylene glycol mist containing nicotine along with flavorings and other chemicals.

Currently, three interrelated products are being sold: the delivery device itself; cartridges that can contain up to 20 mg of nicotine; and refill kits that allow consumers to fill used cartridges with replacement nicotine solution. Some refill bottles, easily obtained over the Internet, contain enough nicotine to kill an adult if accidentally ingested.

The U.S. Food and Drug Administration (FDA) announced April 25, 2011, that it would regulate e-cigarettes as “tobacco products” and not as “drug-delivery devices.” That action came after federal courts blocked the agency from regulating the products as drug-delivery devices. The courts maintained that, under the 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA), the FDA must regulate as tobacco products any product that contains nicotine from tobacco and that makes no claims to be therapeutic. These decisions together, the authors note, “upend[ed] the status quo” by having the effect of allowing the sale of unregulated refined nicotine directly to consumers, unless and until the FDA takes further action.

“The court’s decision that e-cigarettes should be regulated as tobacco products and not as drug-delivery devices has substantially delayed the FDA regulatory process that normally protects the public health. It has the practical effect of allowing manufacturers to sell potentially dangerous refined nicotine products directly to consumers,” said Cobb. “It is entirely possible that future modifications to the products will improve the efficiency of nicotine delivery and could dramatically increase the risks of addiction, abuse and serious overdose.”

While most devices and nicotine fluids are produced by small manufacturers, Cobb and Abrams note that the fact that leading cigarette manufacturers Philip Morris International and British American Tobacco recently purchased sophisticated nicotine inhaler technologies may be an indication that both companies are developing next generation nicotine delivery devices of their own.

Abrams, a professor at Johns Hopkins Bloomberg School of Public Health added “Any refined nicotine product, whether used for smoking cessation and tested and approved by the FDA (like the Nicotrol inhaler) or a new product designed for  ‘reduced or modified’ risk, can and must be tested and strictly regulated before being introduced to the market”.

The authors argue that a comprehensive approach to regulating products containing refined nicotine is needed to protect the public’s health and should involve Congress, the courts and the FDA.

In this piece, Cobb and Abrams discuss several safety concerns:
• Testing of cartridges reveals poor quality control, variability in nicotine content among brands, and deviations between label claims and cartridge content.
• The devices do not reliably deliver nicotine, and have not been sufficiently evaluated in scientific studies the way the FDA requires of other drugs and devices used for smoking cessation. Smokers attempting to use e-cigarettes as quitting aids will most likely find them ineffective due to the fluctuating nicotine content and unpredictable delivery.
• Manufacturers sell cartridges with a range of up to 20 milligrams of nicotine. However, refill kits allow consumers to fill used cartridges with replacement solutions at much higher doses. In fact, the devices are not limited to delivering nicotine. The paper notes that instructions for filling cartridges with marijuana hash oil can be easily accessed on the Internet. 
• The safety of inhaling propylene glycol over an extended period of time has not been studied in humans.
• E-cigarettes may serve as a “bridge product” that smokers use in places where traditional tobacco smoking is prohibited, thus perpetuating their addiction and use of real cigarettes. Additionally, they may be used as a ‘starter’ product for young people considering smoking, especially since the cartridges can be purchased over the Internet with tempting flavoring like grape and chocolate.
In their conclusion, Cobb and Abrams counter the argument made by e-cigarette advocates that taking the devices off the market could mean current users would be forced to return to traditional tobacco products. Instead, the two researchers point to the multiple pharmaceutical-grade nicotine products on the market that have been regulated, approved and deemed safe and effective by the FDA, including patches, gums, lozenges, nasal sprays and even an FDA-approved inhaler. The two researchers also state that current users should pursue research-proven effective cessation tools, such as nicotine replacement products, telephone quit lines, and Web-based cessation services, as well as non-nicotine pharmacotherapies like bupropion and varenicline.
Story Source Link  -  © 2011 American Legacy Foundation

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 Stop-Tabac.ch between September 2010 and January 2011. We asked discussion forums and websites informing about ENDS or selling them to publish links to the survey (http://www.stop-tabac.ch/fr_hon/ECIG_EN). 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:  http://erj.ersjournals.com/content/38/5/1219.extract

Copyright European Respiratory Journal 2011

PubMed Citation Link: http://www.ncbi.nlm.nih.gov/pubmed/22045788
Last edited by JohnPolito on 7:06 PM - Nov 06, 2011, edited 1 time in total.