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    Electronic cigarettes CAN deliver nicotine
    Jonathan Foulds, PhD posted:
    Last week I attended the annual conference of the Society for Research on Nicotine and Tobacco (SRNT) in Toronto, and so this week I plan to discuss some of the more interesting developments presented at that meeting.
    One of the most interesting studies was presented in a poster by Dr Andrea Vansickel and colleagues at Professor Tom Eissenberg's laboratory at Virginia Commonwealth University. This group had previously published a study of e-cigarette use in cigarette smokers which found that they obtained only negligible levels of blood nicotine from the e-cigarettes. In the poster last week they reported preliminary results from the first 3 subjects in a new study of regular e-cigarette users. Each of these e-cigarette users used their own modified e-cigarettes and at least two of them obtained significant increases in blood nicotine concentrations, reaching more than 10 ng/ml from 10 puffs over 5-minutes, and one reached over 30 ng/ml with continued use. These levels are comparable to the venous blood nicotine levels that can be absorbed by a cigarette, and I believe this is the first time this has ever been reported. I am looking forward to reading the full results when the study is completed and published in a peer-reviewed journal.
    These preliminary findings raise some interesting issues and questions. Is it the specific characteristics of the devices used by the participants in this study that enable them to absorb significant amounts of nicotine, whereas other devices on the market are less able to deliver nicotine? Or is it that these experienced e-cig users have learned the technique required to absorb nicotine from an e-cig, that na?ve users in prior studies were unable to do? Maybe it is a combination of both factors?
    Some may be concerned that e-cigs are capable of delivering meaningful amounts of nicotine relatively quickly, but to me this raises the possibility (as many users have already claimed) that these devices may really help smokers to quit. Tomorrow I will report on additional studies (including those on e-cigs) with promising (and some not-so-promising) findings.
    wv2win responded:
    It is refreshing that as a prominent figure in the smoking cessation community that you seem to be willing to keep an open mind on the use of personal vaporizers as an effective alternative to smoking.

    As one who has been tobacco free for almost 2 years after smoking for 30 years and used a PV (personal vaporizer -e-cig) to make that transition, I can say from experience there is a significant difference in different PV models as well as user experience. The widely marketed devices such as "Blu" and Smoke Everywhere are generally the "bottom-feeders" of the industry and perform quite inconsistently and overall quite poorly.

    There is a definite "learning curve" with using PV's. There are also around 100 different PV variations as well as about 8 different nicotine strength e-liquids to choose from ranging from 0mg to 36mg. New users really need a resource to "wade" through all the options. The Electronic Cigarette Forum (ECF) is a good resource but one that requires a good amount of reading and asking questions. I read ECF for two weeks before I ordered my first PV. The people on ECF (just average "joes" like all of us) are a wonderful support community.

    Many of us veteran "vapers" have a basic understanding on a PV's effectiveness that the Rule of Thumb is: the more it looks like the real thing, the worse the performance. Although every user has different needs to a point, in general, the devices with larger/better batteries that are manual (small button) perform better and more consistently than the small, auto batteries like Blu. I good starter PV would be an eGo or Riva 510 device. As a comparison point, the Blu has an 80mAh battery, where as the eGo has a 650 mAh battery. Big difference in performance, consistency and effectiveness. Plus the better devices such as the eGo 510 usually cost LESS than the highly marketed devices. For a new person trying to transition away from cigarettes, it generally requires starting out with a nicotine level in the e-liquid of 18mg to 24mg. All these differences need to be considered in studing the effectiveness of vaping as an alternative to tobacco.

    Any way, I hope you keep your mind "open" on this device that saved my life and do more study and research.
    Vocalek responded:
    You are correct, Dr. Foulds. It is a combination of factors. The puffing technique is a little different for an e-cigarette and a puff of vapor delivers only 10% the nicotine as a puff of smoke (source: Murray Laugesen, Health New Zealand). Thus, as wv2win pointed out, many smokers who switch to vapor have a difficult time until they move to higher levels of nicotine and better equipment. More than half of the 2200 e-cigarette users who participated in a CASAA informal consumer survey reported they used nicotine levels of 18 mg/g or higher. In this same survey, more than 80% reported that they switched completely from smoking tobacco cigarettes to using the e-cigarette. Most of the participants are also part of the ECF community, and so had support and advice from other consumers in making a successful switch. As has been observed in all other surveys, over 90% report that their health has improved. I don't attribute this to any magic on the part of e-cigarettes, but rather to the fact that they stopped inhaling tar, CO, particulates, and thousands of toxins along with their nicotine. Feel free to contact me for further information: ekeller AT

    Smoke-free since 3/27/2009. No more wheezing, no more morning cough. Smoked for 45 years. Quit and relapsed too many times to count. Now, no urges whatsoever to go back to smoking.
    BrewladyKC responded:
    I agree with the previous posts, the online vaping community has played a large part in my success using a PV. There is a learning curve that one has to overcome to be successful. When my 13-year-old self smoked her first cigarette, the most difficult part was to inhale the smoke into my lungs without coughing or choking in front of my friends. Once I was able to do that, I was a smoker, and fit right in with everyone else in the neighborhood, smoking whatever the bigger kids had. 36 years later when I purchased my first kit, I charged, assembled and tried it by myself. Like many new users, I wanted something that looked and tasted just like a cigarette. I bought a dse901 kit because it was available in purple, but still not much bigger than a tobacco cigarette. I knew so little that I fell for what the sales lady told me, and bought boxes and boxes of prefilled cartridges, not realizing that I could purchase a bottle of nicotine juice to refill my own. Once I started vaping, I found the ECF and CASAA websites and became an active member. I ordered a Joye eGo kit because while the 901 battery only lasts a few hours, the eGo battery can last the better part of a day. As my taste buds re-awakened, I wanted to try the variety of juice flavors that are offered by the many U.S. vendors that use FDA-approved ingredients. Not only am I tobacco free, I have stopped using menthol in favor of waffle, popcorn and cinnamon flavored liquid, although I spent a good deal of money on liquid I didn't like before I found the ones that make me happy. I used the cartridges for a while, but found the constant cleaning and refilling to be inconvenient. I ordered cartomizers, but didn't like those at all. I then ordered drip tips, and quickly adapted to "dripping". I learned that many vendors were making "mods" that use rechargeable batteries, and purchased a few to see if I would like them better. I did. The cigarette-like quality that was my first concern has become unimportant, now I am more interested in function over form.

    My initial motivation to buy this product was monetary more than health. I have tried to quit too many times to count, but the horrible truth is I enjoyed smoking! Spending $8.28 a day for a pack of cigarettes was hard to justify with my daughter going off to college. Deep down inside I didn't want to quit, and I had even bargained with myself - I wouldn't really quit, I would just stop for 30 years, and on my 80th birthday, I'd start again. It may sound ridiculous but I really had that thought embedded in my brain, I just couldn't make the first move to quit. I was jealous of what I considered to be "social smokers" who could smoke on weekends while out with friends, and then go smoke free for days. That was just not me. Regardless of the NRT I tried, when I saw someone light a cigarette, the smell of the smoke, the thought of inhaling that smoke, was so enticing that my willpower threw up it's hands and gave up.

    So what happened? How did I go from loving smoking to finding it disgusting? What caused that wonderful smell of cigarette smoke to become vile? Why can I now comfortably go hours without vaping, when I HAD to have a cigarette every two hours? I had no withdrawal symptoms, because I still use nicotine. I would suck down two cigarettes on a break, now I use my PV once or twice and I'm good for a few more hours.

    Turns out my desire for nicotine is being satiated, the relaxing sensation of exhaling the stress out of me is still there, and I'm able to accomplish this without the harmful effects of tobacco smoke. I am so grateful that this product exists. Finally, we have a better alternative.

    It really is a product that can save lives, and I feel strongly enough about this that I will continue to advocate for this product to remain available to current adult smokers.

    Thank you for the opportunity to voice my experience.
    (And thanks to wv2win & vocalek)
    Traver responded:
    E-cigarettes deliver almost no nicotine.

    The above article states that they used 16 smokers. I assume from that the test subjects had no idea on how to vape or use an E cigarette. As sated above the equipment makes a difference but just as important is how you puff on a vaping device. Smokers tend to take quicker puffs than vapers do. This is because there is a limited amount instantaneous of power that can be delivered by the battery to the coil. This is especially true with smaller batteries. They just can't deliver the energy that quickly and so don't have the power to vaporize the liquid. So vapors tend to take longer slower puffs the get to the same amount of nicotine and smoke as they would from a cigarette. They may also vape more than they were smoking. This isn't just a matter of going to the store and picking up a pack of cigarettes or even an E cigarette at your local convenience store. In fact that just about the last place you would want to go.
    TheBoogieman responded:
    >>These preliminary findings raise some interesting issues and questions. Is it the specific characteristics of the devices used by the participants in this study that enable them to absorb significant amounts of nicotine, whereas other devices on the market are less able to deliver nicotine? Or is it that these experienced e-cig users have learned the technique required to absorb nicotine from an e-cig, that na?ve users in prior studies were unable to do? Maybe it is a combination of both factors?<<

    OR, perhaps, its because Eissenberg's first study was flawed. His research model was at fault. Not the electronic cigarettes.

    Here is a post from Eissenberg 02-21-2010:

    >>I used it last night (18 mg cartomizer) and tested my urine with Nicalert strips this morning. Result? 5/6. Clearly, this result is consistent with recent nicotine exposure. <<

    Yet this is what is put out in the media:

    >>In terms of nicotine delivery, these products were as effective as puffing from an unlit cigarette."<<

    His first study shows little to no absorbtion. At his home he gets a different result. But you didn't read about that in the media. Instead of his study being at fault. He still chose to blame the product.

    Wonder how many people decided NOT to try using an electronic cigarette based off his original study?
    Mcbeez responded:
    Dr. Foulds - I read your WebMD profile today and noticed that you studied Clinical Psychology (as I did). Forgive my professional curiosity, but I wondered how you developed your interest in smoking cessation? While I studied in one area of behavioral medicine (i.e., pain management), I admit that I avoided smoking issues entirely because I was a long-term smoker (but I am pleased to report that I recently quit using PV's/e-cigarettes). My research interests have been based on areas of interest that were somewhat personal, such as adoption. I noted that you had worked for a time at a large mental hospital and wondered if your interest began there (since so many chronic mentally ill patients smoke)?
    Jonathan Foulds, PhD replied to Mcbeez's response:
    My interest in smoking cessation developed more by chance and luck than anything else. After qualifying as a clinical psychologist in Scotland in the late 1980s I wanted to do research at the Institute of Psychiatry in London. The first job that came up was with the smoking research group there. I didn't know it, but at the time they were the top nicotine addiction research group in the world, and I quickly became fascinated by the subject. I liked the fact that by helping someone change a single behavior one could add about 10 healthy years to their life. That research group was led by Professor Michael Russell. Readers may be interested in his ideas and achievements, which shaped my own thinking, and are described in a post written shortly after his death.
    Mcbeez replied to Jonathan Foulds, PhD's response:
    I am glad that you have found a passion; some people never do. I have considered researching the effectiveness of PV's, but I have been out of the academia/research arena for a while now and private practice and family life keep me so busy. But, it is amazing how quickly and easily the excitement of the thought of a new research project can capture you (even 12 years since the last one!).
    Mcbeez replied to Jonathan Foulds, PhD's response:
    P. S. I read the information in your post on Professor Russell. You wrote "But he did not micro-manage at all. Rather he preferred to hire bright researchers and let them "get on with it"." I also had such a mentor, one who offered me the blessing of assuming that I was entirely capable of completing the tasks at hand - they are truly worth their weight in gold and will never be forgotten by those of us who have been lucky enough to train and work with them.
    ms_snark responded:
    e-cigs work. I know they work because they worked for me and nothing else I tried ever got me to stop smoking cigarettes for more than a few days. I tried patches, gum, hypnosis, acupuncture, chantix...none of it worked.

    I bought my first e-cig with NO intention of quitting (and I have smoked for 40 years) I bought it to use in my new car because I didn't want to stink it up by smoking in it. I was completely surprised when I realized that within two or three days of using the e-cig I had NO desire to smoke cigarettes. I had no withdrawl, no craving, nothing.

    I am closing in on two months of no cigarettes now and my health is demonstrably better and I have saved money too. The cancer society should distribute e-cigs to smokers if they REALLY want to get people off of cigarettes because it is the one thing that actually works! I will decrease the nicotine level in the liquid that I use over time, but I'm not going to do so drastically because I don't want to 'tempt fate' and end up going back to smoking.
    UncleB42 responded:
    I very much disagree. What you have described concerning the altered devices affirms that an addict will go to any lengths to obtain his/her drug and quitting is not at issue here. I am truly amazed at the, what looks to me as, inability to recognize drug seeking behavior.
    Jonathan Foulds, PhD replied to UncleB42's response:
    Dear UncleB42,
    Noone is failing to recognize drug seeking behavior. Many of us are simply recognizing that seeking a drug that generally doesnt kill you (e.g. caffeine in coffee, or nicotine in a nicotine replacement medicine) is of much less concern than drug seeking when that drug comes along with thousands of dangerous chemicals proven to cause premature death (as in cigarettes) or along with other dangers (e.g. risk of contracting HIV when seeking a drug via a shared syringe).
    Jedeye responded:
    Been a vaper for over 2 years. Tested myself with cot device. Registered at 200 ng/ ml, so I'm getting nicotine I guess....

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