Concerns that electronic cigarettes are dangerous, because of their alleged unregulated nature and because nicotine is a paralytic drug with toxic effects resulting from allegedly relatively low overdoses, may be allayed by some hard data.
Nicotine is indeed a toxic substance. A single dose of 30 to 60 mg of nicotine can be fatal for an adult; the amount is about 10mg for children.
However, nicotine has a half-life of about two hours and is completely expelled from the body in 8 to 10 hours.
In normal electronic cigarette usage nothing indicates that nicotine has harmful side effects. Indeed, the US Food and Drug Administration states that “although any nicotine-containing product is potentially addictive, decades of research and use have shown that NRT (Nicotine Replacement Therapy) products sold OTC (Over The Counter) do not appear to have significant potential for abuse or dependence”.
It is very hard to quantify the addictive nature of nicotine on its own. For it to be addictive it seems to have to be associated with other factors. Evidence is provided by the fact that medicalised nicotine replacement products are singularly ineffective. Except in the rarest cases they have not been reported to lead to nicotine addiction.
It can be interesting to look at how nicotine is used.
Nicotine patches may contain up to 25 mg of nicotine delivered over 16 hours.
A nicotine gum may contain up to 4 mg; up to 15 can be used every 24 hours and it may be used in conjunction with patches. This gives a maximum availability of nicotine over 24 hours of 60 to 80 mg.
The NICORETTE® Inhaler, authorised for use in Europe, uses 10 mg cartridges and the maximum number of cartridges recommended for use in one day is 16, giving a maximum availability of nicotine over 24 hours of 160 mg.
Concerning electronic cigarette usage in the UK, ready-made liquid typically contains nicotine concentrations of 18 to 23 mg/ml. Assuming 3 ml are consumed in a day, around 69 mg of nicotine will have been inhaled (of which only a fraction is absorbed into the body). Concentrations up to 45 mg/ml are not unknown, although it appears that their users ‘puff’ much less frequently than others. Consumers learn very quickly to self-regulate their dosage; dosage rates varying considerably according to the individual.
This, by the way, means that medicalising the product will substantially reduce its attractiveness and therefore its potential to save millions of lives. As Professor K Farasalinos says, “medicinal regulation means that you should define specific dosage, determine consistent nicotine delivery and give specific instructions of use. These are impossible to implement in e-cigarettes since every consumer has a different pattern of use… NRTs have failed for the same reasons (among others). Now, imagine prescribing e-cigarettes with a dosage like “15 puffs lasting 4 seconds, every 4 hours”…. E-cigarettes are effective because they provide pleasure to the user. And every consumer has a different perception of pleasure. This precludes any efforts to regulate it as medication.”
Whereas the labelling of the nicotine concentration in phials of liquid was inaccurate in the early days of electronic cigarettes, in the past few years the proper application of the laws and regulations relative to general consumer products has ensured far more reliable adherence to proper safety and labelling standards. This has been confirmed by Professor JF Etter’s study of e-liquids (published in May 2013) which concluded that “the nicotine content of electronic cigarette refill bottles is close to what is stated on the label”.
On the electronic cigarette users forums in the UK and in France (where the total membership of the two main forums is 39000), no long term deleterious effect on anyone’s health caused by the consumption of nicotine has been reported.
Hopefully this will help allay fears that have recently been stirred up about electronic cigarette use.