The question: I’ve heard that e-cigarettes may contain far more nicotine than regular cigarettes. Does that mean vaping is more addictive than smoking?
The answer: It’s true that some vaping devices can deliver more nicotine than cigarettes. But there are many different types of electronic cigarettes, and how they are used can affect the amount of nicotine that ends up in the bloodstream, and eventually the brain, says Robert Schwartz, a professor in the Dalla Lana School of Public Health at the University of Toronto.
The battery-powered e-cigarettes heat up a liquid containing nicotine to produce an aerosol, or vapour, which can be inhaled. (Flavourings and other chemicals may also be added to the fluid mixture.)
A lot depends on the nicotine concentration in the fluid and the power, or heat, generated by the e-cigarette. Other variables include how hard, how long and how often a person inhales. “Unless you know how to puff on the thing properly, and for long enough to heat the liquid sufficiently, you are not going to get huge amounts of nicotine,” Schwartz says.
So, it isn’t clear-cut whether cigarettes or e-cigarettes deliver more nicotine. But one thing is clear:
“What we do know is that both smoking and vaping can be addictive,” says Peter Selby, chief of medicine and psychiatry at the Centre for Addiction and Mental Health in Toronto
In fact, any amount of inhaled, chewed or snorted nicotine can be problematic – meaning that a person is likely to progress to daily use after a period of experimentation. “Nicotine is one of the most addictive substances we are aware of. It’s as addictive as heroin,” Schwartz says.
Originally, many public-health experts looked upon vaping as potentially less harmful than smoking cigarettes, which produce about 7,000 toxic chemicals – including carcinogens – by burning tobacco. Some hope the devices might serve as quitting aids – or, at the very least, help reduce the number of harmful substances that smokers inhale.
But the recent surge in vaping among teens has set off alarm bells in the public-health community. And those concerns are intensified by reports of lung injuries among some vapers.
“My biggest concern is that we have already addicted a whole new generation of people to nicotine,” Schwartz says.
Teenagers – whose brains are still developing – are especially vulnerable to the addictive powers of nicotine, according to a growing body of research.
Nicotine attaches to receptors in the brain, thereby triggering the release of dopamine – a chemical messenger involved in pleasure and a wide range of other neurological functions. It basically produces a feel-good high.
When teens smoke or vape, it is believed that their brains create more receptors to handle the influx of nicotine. As the number of receptors increases, they need higher levels of nicotine to get the same buzz.
Some researchers have dubbed this effect the “nico-teen” brain. They also speculate that these neurological changes may have long-term consequences for mood and mental focus.
In the debate over vaping, much of the recent attention has been about the spate of serious lung injuries. Many of these cases appear to be linked to the vaping of cannabis oils such as tetrahydrocannabinol or THC. The latest evidence suggests that vitamin E acetate, a filler sometimes added to black-market THC, might be causing the injuries.
But even without THC, routine vaping – and the other chemicals in vaping liquids – may lead to long-term health problems.
“Kids who vape have almost twice the rate of coughing and wheezing as kids who don’t vape,” Schwartz says. Are these symptoms the early warning signs of chronic respiratory conditions such as asthma? Or might vaping contribute to the development of cardiovascular disease? "We don’t yet know for sure,” Schwartz says. He adds that it will likely take some time to establish a clear picture of the risks.
Selby is also concerned that young people who have never used tobacco are now being drawn to vaping. He says better government regulations are needed to safeguard adolescents. However, he thinks vaping should not be vilified to the point where the devices are actually banned.
“Some individuals are going to take up tobacco smoking anyway, and they will be better off if they have the option to vape,” Selby says. “It’s all about relative risks between combustible cigarettes and vaping devices that deliver fewer dangerous chemicals.”
Indeed, despite the various problems linked to e-cigarettes, “there is very broad consensus in the scientific community that smoking is the most harmful way to use nicotine and it’s known to cause premature death in at least half of users,” Schwartz says.
According to Selby, “it would be completely ridiculous to ban the sale of vaping devices, while giving free reign to the most dangerous form of nicotine delivery – cigarettes.”