The Psychobiological Problems of Continued Nicotine Dependency in E-Cigarette ‘Vapers’. Commentary: “Electronic Cigarettes”

Electronic cigarettes were originally introduced as devices to facilitate smoking cessation, but their efficacy in this regard has not been established. Instead, they are often used to facilitate continued cigarette smoking in adults, and are common entry devices for nicotine dependency in children and adolescents (1). The aim of this commentary is to emphasize these problems since far from improving health, E-cigarettes may paradoxically be damaging physical/psychological health. Furthermore, while this is certainly an issue for active smokers, itmay become an increasing problem for those who are “passively vaping” E-cigarettes. E-cigarettes are battery-operated devices, which deliver hits of nicotine via the inhalation of an aerosol spray, which contains a mixture of nicotine, flavorings, and other chemicals (1–3). The E-cigarette was originally introduced as an aid to facilitate smoking cessation. It followed the successful development of earlier nicotine substitution devices, such as nicotine chewing gum, nicotine transdermal patch, and the inhaler (4–6). However, these earlier products were only partially effective at nicotine delivery, with 2mg gum producing around 25% of the psychophysiological effects of a nicotine cigarette and 4mg nicotine gum producing around 40% of its physiological effects (7). Yet, despite their comparative inefficacy at nicotine delivery, they partially assuaged nicotine cravings, which allowed them to double the success rates for smoking cessation (4). Crucially, this was achieved without making these early nicotine substitution devices attractive to non-smokers. E-cigarettes were consciously designed to make them attractive, but unfortunately this can now be seen as a mistake since it has encouraged their use as a facilitator for continued smoking in adults, and has introduced many youngsters into nicotine and nicotine dependency. Grana et al. (1) note that they were designed to look like cigarettes; also they were given “kid-friendly flavors, including grape, chocolate, bubble gum, and gummy bear”; furthermore, they have also been marketed “aggressively” often using simplistic and misleading messages. Since first introduced into the USA and Europe in 2006, their usage has risen dramatically, with sales doubling every year [Wells Fargo Internet report cited in Ref. (3)] so that instead of being used to aid tobacco cessation, they are often being used to facilitate continued cigarette smoking. Grana et al. (1) noted that many adult smokers continue to smoke tobacco in private, but vape E-cigarettes where smoking is banned. Furthermore, E-cigarettes are providing a simple introduction into nicotine