Pod-style electronic cigarettes found to be more addictive than nicotine gum

A new paper in Nicotine and Tobacco Research, published by Oxford University Press, finds that today's pod-style electronic cigarette devices are more addictive than nicotine gum, indicating that such devices have a very high potential for abuse.

Since entering the market in 2003, electronic cigarettes have become very popular in the United States, particularly among youth and young adults. A significant proportion of people who use electronic cigarettes devices never used other tobacco products regularly. Over 30% of adult users of vaping devices report no history of regular cigarette smoking, a rate that increases to 61.4% for those between aged 18 and 24. This pattern was likely due to the emergence of pod-style devices about a decade ago, either in reusable (e.g. Juul) or disposable (e.g. Elf Bar) form. These devices contain nicotine in high concentrations and in salt form, and are more efficient at delivering nicotine to users than earlier vaping devices. Both never smokers and younger adults are more likely to report vaping with higher nicotine concentrations like those found in pod-style devices.

The abuse potential for nicotine/tobacco products exists on a continuum. On the high end combustible cigarettes are very addictive. Replacement products like nicotine gum-which has been available in the US since the early 1980s-are generally less addictive, and have limited potential for abuse. Previous research found electronic cigarettes to have lower abuse potential than traditional cigarettes, and comparable to replacement products like nicotine gum. But this work was done mostly using subjects who were current or former cigarette smokers. People who have never smoked cigarettes regularly, particularly young people, represent a growing population of nicotine users.

Researchers here compared the subjective and behavioral effects of pod-style electronic cigarettes to nicotine gum in such a sample of adults under 25, all of whom were regular e-cigarette users but nonsmokers, in the Morgantown, West Virginia-area. Participants abstained from nicotine/tobacco overnight and then either used their own vaping device or chewed nicotine gum for 30 minutes. Before and/or after each session the subjects completed subjective (e.g., craving, product effects) and behavioral (multiple choice procedure) questionaries about their cravings.

The study found that participants' own pod-style vaping devices were more reinforcing than active and placebo nicotine gum. Specifically, electronic cigarettes significantly decreased craving and withdrawal, and increased satisfaction, relative to both doses of gum. The researchers believe that users may find pod-style vaping devices more appealing because they contain liquid with nicotine salts. Relative to nicotine in freebase form, nicotine salts reduce the harshness and bitter taste associated with higher nicotine concentrations, an effect that is more pronounced in those who never smoked traditional cigarettes.

Today's electronic cigarettes have great potential to produce addiction in populations that are otherwise naive to nicotine. This often includes youth and young adults."

Andrea Milstred, paper's lead author

The paper, "Abuse Liability of Electronic Cigarettes in Never-Smoking Electronic Cigarette Users," is available (at midnight on May 20^th) at https://doi.org/10.1093/ntr/ntaf096.