What is the nicotine delivery profile of electronic cigarettes?

ABSTRACT

Introduction: Electronic cigarettes (e-cigarettes) are a rapidly evolving class of tobacco products intended to deliver nicotine to users. There are many types of e-cigarettes available and the most popular type today in the United States are ‘pod’ based devices that use high nicotine concentration liquids. Understanding the nicotine delivery capabilities of e-cigarettes is imperative for understanding their addictive potential and safety profile, informing regulation, and revealing their potential use as smoking cessation aids.

Areas covered: This review discusses nicotine content of e-cigarettes, effectiveness of nicotine aerosolization by devices, delivery of nicotine to users, and user and device characteristics that impact each of these.

Expert opinion: Modern e-cigarettes have the potential to deliver equal or more nicotine compared to a tobacco cigarette. Future research needs to identify the nicotine delivery profiles likely to benefit public health and the means to regulate them appropriately while also identifying those that are likely to cause harm. Public health benefit accrues if e-cigarettes help smokers quit combustible cigarettes completely. Harm is possible if inadequate nicotine delivery undermines cessation attempts, e-cigarettes facilitate continued combustible cigarette use, long-term e-cigarette use is associated with substantial morbidity/mortality, and/or e-cigarettes increase the initiation of combustible cigarette use among never smokers.

KEYWORDS:

• e-cigarettes
• nicotine
• addiction
• dependence
• tobacco control

Article highlights

• E-cigarettes are battery powered devices intended to deliver aerosolized nicotine to users.

• There is a large amount of variation in the devices and e-cigarette liquids available to users, and the technology continues to evolve rapidly.

• There is substantial variation in the nicotine delivery of e-cigarettes based on device, liquid, and user characteristics.

• E-cigarettes have the potential to deliver equal or more nicotine compared to a tobacco cigarette.

• Nicotine delivery is an important aspect of the potential for e-cigarettes either to benefit or harm public health.

This box summarizes key points contained in the article.

Declaration of interest

T Eissenberg is a paid consultant in litigation against the tobacco industry and is named on a patent for a device that measures the puffing behavior of electronic cigarette users. M Goniewicz received a research grant from Pfizer and served as a member of the scientific advisory board to Johnson&Johnson, manufacturers of smoking cessation medication. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This project was supported in part by the U.S. National Institutes of Health's (NIH's) National Institute on Drug Abuse (NIDA) grant R01DA037446, NIH's National Cancer Institute (NCI) and Food and Drug Administration Center for Tobacco Products (FDA CTP) grant U54CA228110; and NIDA and FDA CTP grant U54DA036105. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.