Q&A: Is vaping as addictive as cigarettes?

November 15 is the Great American Smokeout, an American Cancer Society event that encourages smokers to quit or use the day to make a quit plan. Tobacco use remains the single largest preventable cause of disease and premature death in the United States.

And it’s just not cigarettes that are to blame — e-cigarettes or vaporizers, touted as a safe alternative to cigarettes, have seen a huge increase in usage since their introduction in 2004. However, e-cigarettes often still contain nicotine, an addictive compound found in traditional cigarettes.

About 10.8 million adults in the United States are vaping, and more than half are younger than 35. So it’s no wonder the Food and Drug Administration is looking to ban sales of most flavored e-cigarettes, which appeal to younger users and come in flavors such as mango and rocket Popsicle.

For more information about vaping and its health effects compared to smoking, we talked to Abigail Plawman, MD, a family medicine doctor with MultiCare East Pierce Family Medicine, and Douglas True Borst, MD, a family practice specialist in Tacoma who is affiliated with MultiCare Good Samaritan Hospital.

What is vaping?

“Vaping” is slang for the use of electronic cigarettes. E-cigarettes use current from a battery to create a vapor from a solution (usually containing nicotine) that can be inhaled. This is opposed to combustion, which creates vapor as well, but also produces smoke from the breakdown of the tobacco leaves, paper and other contents of a cigarette.

E-cigarette devices range in size and appearance: from disposable devices that look like a plastic cigarette, large “tank” devices that contain a refillable vessel and large batteries, to devices that resemble USB drives (known as Juul pods).

These devices use lower temperatures than are present in cigarettes and do not involve combustion, which means you’re inhaling small particles of the vape liquid suspended in air.

How addictive is vaping compared to smoking cigarettes?

Nicotine is the best-studied addictive compound in cigarettes. Most people who use e-cigarettes use devices with solution that contain nicotine. Because both vaping and cigarettes contain the same underlying addictive substance, vaping has all the intrinsic addictive potential as cigarettes.

Given social acceptability and confusing messaging around the harms of vaping (vaping is a safer alternative for smokers, but not safe for non-smokers), as well as the presence of flavorants and increasing product placement in movies, televisions shows and advertisements, you might expect more people to get hooked than would become addicted to cigarettes in our current social environment.

Despite having less nicotine than traditional cigarettes, it’s not a safe assumption that e-cigarettes are healthier. Experiments with light (low-nicotine) cigarettes showed that smokers changed their inhalation depth, frequency of inhalation and other factors to maintain similar blood levels of nicotine.

Although some vaping solutions don’t contain nicotine and instead contain flavorants, some solutions labeled “nicotine free” have been found to contain nicotine. It’s difficult to know how widespread this is, but it will hopefully improve with further FDA regulation.

What are your views on the current state of vaping?

Vaping is promising for current smokers because it provides a way to reduce their use of tobacco, even if they’re not interested in fully quitting. Similarly, for people who want to quit smoking but relapse, vaping might be a lower-risk alternative until they try to quit again.

Many people are interested in vaping as a quit-aid similar to nicotine replacement products, but studies have not found this form of use has been effective.

Unfortunately, the societal benefits of reducing the number of people who use traditional combustible smoking may be totally erased if teenagers continue to adopt vaping en masse.

While there are fewer direct toxic components and carcinogens in vapor, there are still plenty. Vapor contains heavy metals, carcinogens, direct toxicants and many other products that contribute to worse health outcomes. Nicotine itself is also very harmful, contributing to increased cardiovascular events and adverse events in pregnancy. Nicotine blood levels are not related to the amount of nicotine in solution, but rather by use pattern (puff rate, depth, length and other factors). People will unconsciously change these factors to achieve their body’s desired nicotine level.

What are your thoughts about the increase in adolescents who vape nicotine?

It’s very concerning and likely by design. The explosion of flavors of vapor products suggest that the industry is targeting children and teens, which is what the tobacco industry did in the early 1990s. The industry has also been aggressive with product placement in new, less regulated areas such as Instagram, Twitter and Facebook. Marketing for vape products continues to mislead by comparing vaping to breathing in fog or mist.

Abigail Plawman, MD, is a family medicine doctor with MultiCare East Pierce Family Medicine, and Douglas True Borst, MD, is a family practice specialist in Tacoma who is affiliated with MultiCare Good Samaritan Hospital.

Learn more about MultiCare’s Tobacco Cessation Program