How strong should an e-cigarette be, in terms of how much nicotine it delivers? It’s a question worth asking for several reasons, and there may be just as many answers, none of them entirely straightforward.
In Europe, under the EU Tobacco Products Directive (TPD), the common regulation is a nicotine limit of 20 mg per ml of e-liquid (2%). This means Juul, for example, has to produce lower-strength pods for its European markets than it sells in the US, where there is no legal limit.
When the then US Food and Drug Administration (FDA) commissioner Scott Gottlieb turned his sights on nicotine levels in cigarettes three years ago, he somewhat pointedly excluded e-cigs from his proposed (and subsequently apparently ignored) clampdown. And while proposals have been put forward in a few states to impose limits on nicotine in e-cigs, no such bill has yet been passed.
While US legislators appear to be fixated on vaping flavours, average nicotine levels have risen steeply and strengths that would be illegal in Europe now make up something like a third of the market.
Is this a good thing or a bad thing? Has Europe got it broadly right and the US totally wrong – or is it the other way round? Is there perhaps a right answer somewhere between the two? Is Canada – where a European-style nicotine cap is now on the agenda – maybe on the right lines?
Before leaping to any conclusions, let’s consider a new piece of research from the University of Catania in Italy, in collaboration with medical and mental health experts at City University of New York and Cornell University.
The study, published this week by the Oxford University Press journal Nicotine & Tobacco Research, found that the use of high-strength nicotine e-cigarettes can help adults with schizophrenia spectrum disorders quit smoking. And that’s a big deal because people with schizophrenia are four times as likely as the population at large to be smokers.
They also tend to smoke more and puff harder, extracting more nicotine, than people with no mental health problems. Their physical welfare – and their life expectancy – are therefore more affected by smoking than other people’s.
The researchers provided Juul e-cigs with 5% nicotine to 40 adults with schizophrenia spectrum disorders who smoked and did not intend to cut down or quit. By the end of the 12-week study, 16 of them had stopped smoking, most of the rest were smoking less and overall median daily cigarette consumption had fallen from 25 to six.
When visited again 12 weeks later, 14 of the participants had completely quit smoking, while continuing to vape.
Quality of life
Interestingly, while indicators of physical health such as blood pressure, heart rate and weight had all improved, there was no significant difference in symptoms of schizophrenia – though 25 (62%) of the participants felt more awake, less irritable, and able to concentrate better.
While these figures are impressive, one thing the study didn’t do was compare results with different nicotine levels, which might have been instructive (and perhaps help answer the question we began with).
Neither does it mention the anxiolytic quality of nicotine – its capacity to reduce anxiety – which may be a factor in its use by those with mental illness, and plausibly another point in its favour in this context, once separated from the tars and carcinogens etc that make smoking such a perilous habit.
For those who succumb to the ad hominem school of argument, it should perhaps be pointed out that Riccardo Polosa, one of the authors of the Catania study, has a history of finding evidence to support vaping. He is, nevertheless, a highly respected scientist and his conclusion is well worth noting:
“Smoking is the primary cause of the 15-25 years mortality gap between users of mental health services and the general population. This study demonstrates that switching to high-strength nicotine e-cigarettes is a feasible, highly effective smoking cessation method for smokers who have schizophrenia. And it improves their quality of life too.”
– Aidan Semmens ECigIntelligence staff
Photo: Roman Pavlyuk