Electronic Cigarettes

Thank you to everyone who provided such great feedback about the Mind Matters blog and my last entry on smoking cessation! It is truly your comments and questions that will fuel the discussion and direction of this blog. 

One common question I have received and often get asked by my patients is: What do you know about electronic cigarettes? 

I will do my best to answer the most common questions I am asked regarding electronic cigarettes. It turns out there are 9 of them and they follow:

Q1: What are electronic cigarettes (e-cigarettes)?

A: E-cigarettes are battery-powered electronic nicotine delivery systems that vaporize nicotine that is then inhaled. They provide the flavor and a sensation similar to that of a tobacco cigarette. As you can see above, from a distance it can be hard to tell a traditional cigarette from an electronic one. (The bottom two are e-cigarettes.) However, they lack tobacco and combustion products that are accountable for the damaging effects of smoking by operating at 5 to 10% of the temperature of a lit cigarette. (see the illustration below for more information about the components of e-cigarettes). 

Q2: Do all e-cigarettes contain nicotine?
A: No. While millions of e-cigarette products have been sold, they all vary in some degree. Some do contain nicotine and others do not. (See question 8 for which works better.) The e-cigarettes that do contain nicotine generally utilize a cartridge that has nicotine dissolved in propylene glycol, vegetable glycerin and water. This is the major benefit over a tobacco cigarette which contains greater than 50 carcinogens including: tar chloroform, arsenic and more than 3,500 other chemicals. (see the illustration below)

Q3: How much nicotine can you get out of an e-cigarette?

 A: Experienced uses can extract as much nicotine as from a tobacco cigarette.Q4: How does an e-cigarette work?

Q4: How does an e-cigarette work?

A: As the user inhales, the rechargeable battery creates a charge inside of the atomizer which produces a vapor from the liquid in the cartridge. (see the illustration below)

Q5: Are there side-effects?

 A: Yes. The most common are similar to that of a traditional tobacco cigarette. Users report throat irritation, mouth irritation, sore throat, cough, dry mouth, mouth ulcers, dizziness, headache and nausea. These adverse effects are generally well tolerated and resolve as the user becomes accustomed to using the e-cigarette. (see the graph below).

Q6: What are the health risks of e-cigarettes?A: The FDA has not found any carcinogens or toxic chemicals in their trials. However, in one study I reviewed, diethylene glycol was detected in one sample at non-toxic levels. Overall, similar levels of tobacco-specific nitrosamine are found as compared to nicotine patches and gum. By comparison, the levels in e-cigarettes are significantly lower than traditional cigarettes. The bottom line is that we do not know the

A: The FDA has not found any carcinogens or toxic chemicals in their trials. However, in one study I reviewed, diethylene glycol was detected in one sample at non-toxic levels. Overall, similar levels of tobacco-specific nitrosamine are found as compared to nicotine patches and gum. By comparison, the levels in e-cigarettes are significantly lower than traditional cigarettes. The bottom line is that we do not know the long term effects on e-cigarette smokers or bystanders. The American Cancer Society is awaiting further research on this topic, and has not taken a position on whether electronic cigarettes should be banned from the US market. However, some jurisdictions are proactively banning e-cigarettes in work and public places out of the unknown risks to bystanders. (The table below compares some of the unhealthy byproducts of different nicotine containing products.)

Q7: What are the pro’s and con’s of e-cigarettes?
A: The major benefit is the lack of products that are the result of the combustion of tobacco. These products, also called smoke, are what lead to many of the health problems caused by tobacco cigarettes. The smoke can also affect the metabolism of medications, while the vapor of e-cigarettes does not. The tobacco smoke can lead the body to increase metabolism of many common medications. Therefore, when you quit, blood levels of the medications can rise. I always advise my patients to quit, however, I also advise that you discuss your plans with your primary care physician. If you decide to try an e-cigarette you should also let you doctor know and they may need to make dose adjustments. Remember, it is the smoke and not nicotine that causes these interactions. Because e-cigarettes do not produce smoke, you will have the same changes to medications as if you are quitting.

There are many other benefits and also several disadvantages. (See the chart below).

Q8: Do e-cigarettes work? I mean, can they help me quit?

A: Overall, the data shows nicotine containing e-cigarettes lead to better relief of nicotine withdrawal symptoms and improved smoking cessation results than the non-nicotine versions. People seem to be better able to cut-down the number of cigarettes they smoke using an e-cigarette versus being able to use an e-cigarette alone to become fully abstinent. Data shows they work as effectively as other forms of nicotine replacement, including gum and patches.Q9: Bottom line… should I try them? 

Q9: Bottom line… should I try them? 

A: As always, one opinion should not serve in the place of a formal consultation with your physician because everyone has a unique history and situation. Generally, I advise my patients that using an e-cigarette is safer than a traditional tobacco cigarette for the reasons mentioned above. Although we do not know the long term effects of e-cigarettes, we know how devastating traditional cigarettes are to smokers and bystanders via secondhand smoke. Therefore, you are certainly decreasing your health risks if you can use an e-cigarette to cut down from 2 packs per day, or 1 pack per day of traditional cigarettes. The additional benefit is that most of my patients find it easier to remain abstinent when they cut-down-to-quit in this manner. Once you get down to around half a pack per day you may find it a lot easier to quit for good than if you try to quit from a pack or more per day. In that way, using e-cigarettes can be a nice bridge to achieving and maintaining full abstinence.

Please use the comments section or email to ask questions, suggest future post topics or make comments!

Hope everyone had a healthy and happy thanksgiving!


Dr. Goldenberg


Matthew Goldenberg, D.O. Matthew Goldenberg D.O. is double Board Certified in Psychiatry and Addiction Psychiatry and is a certified Medical Review Officer (MRO). He is an expert in the evaluation and treatment of mental health disorders and is an addiction specialist for adults in his private practice in Santa Monica, California. Dr. Goldenberg also provides addiction psychiatry consultations to some of the nation’s top residential and outpatient treatment programs in the Los Angeles area and is experienced in the evaluation and treatment of professionals working in safety-sensitive positions. In addition to his clinical work, Dr. Goldenberg is an active author, researcher and invited speaker at local and national conferences. He also volunteers his time as a Clinical Instructor in the Department of Psychiatry at UCLA and is an Assistant Professor of Psychiatry at Cedars Sinai Medical Center.

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