Is it sensible for an ambitious nonsmoker to use e-cigarettes?

by hg001 min read24th Nov 201519 comments

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Personal Blog

Many of you have already seen Gwern's page on the topic of nicotine use. Nicotine is interesting because it's a stimulant, it may increase intelligence (I believe Daniel Kahneman said he was smarter back when he used to smoke), and it may be useful for habit formation.

However, the Cleveland Clinic thinks they put your heart at risk. This site covers some of the same research, and counterpoint is offered:

Elaine Keller, president of the CASAA, pointed to other recently published research that she said shows outcomes in the “real world” as opposed to a laboratory. One study showed that smokers put on nicotine replacement therapy after suffering an acute coronary event like a heart attack or stroke had no greater risk of a second incident within one year than those who were not.

I managed to get ahold of the study in question, and it seems to me that it damns e-cigarettes by faint praise. Based on a quick skim, researchers studied smokers who recently suffered an acute coronary syndrome (ACS). The treatment group was given e-cigarettes for nicotine replacement therapy, while the control group was left alone. Given that baseline success rates in quitting smoking are on the order of 10-20%, it seems safe to say that the control group mostly continued smoking as they had previously. (The study authors say "tobacco use during follow-up could not be accurately assessed because of the variability in documentation and, therefore, was not included in the present analysis", so we are left guessing.)

29% of the nicotine replacement group suffered an adverse event in the year following the intervention, and 31% of the control group did--similar numbers. So one interpretation of this study is that if you are a smoker in your fifties and you have already experienced an acute coronary syndrome, switching from cigarettes to e-cigs will do little to help you avoid further health issues in the next year. Doesn't exactly inspire confidence.

Another more recent article states that older smokers should see health gains from quitting cigarettes, which hammers the nail in further for e-cigarettes. It also states:

More conclusive answers about how e-cigarettes affect the body long-term are forthcoming, Rose said. Millions in research dollars are being funneled toward this topic.

“There is some poor science,” Rose said. “Everybody is trying to get something out quick in order to get funding.”

So based on this very cursory analysis I'm inclined to hold off until more research comes in. But these are just a few data points--I haven't read this government review which claims "e-cigarettes are about 95% less harmful than tobacco cigarettes", for example.

The broad issue I see is that most e-cigarette literature is focused on whether switching from cigarettes to e-cigarettes is a good idea, not whether using e-cigarettes as a nonsmoker is a good idea. I'm inclined to believe the first is true, but I'd hesitate to use research that proves the first to prove the second (as exemplified by the study I took a look at).

Anyway, if you're in the US and you want to buy e-cigarette products it may be best to do it soon before they're regulated out of existence.

 

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19 comments, sorted by Highlighting new comments since Today at 12:37 AM
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[-][anonymous]5y 2

Beware, anecdotal evidence ahead:

I use an e-cigarette, but I have never smoked cigarettes habitually (I've had about three in my lifetime). I do have a cigar once every six months or so. About once a week, I use my e-cigarette like I would use caffeine while gaming on the weekends. When I am using it for its stimulant effects, I prefer a high nicotine concentration. Other times, I use nicotine-free liquid because I enjoy the vapor and have a terrible habit of putting everything in my mouth. If I don't use the nicotine-free e-cigarette, I start eating paper, chewing on pens, biting my nails, or chewing my hair. It's embarrassing, and the e-cigarette has been the only workable solution.

I did go through a period of prolonged use, at a high nicotine concentration. The withdrawal was not fun. Now, if I find that I'm using it more than I like, I again take the same approach as with caffeine. I take a break of about two weeks, and that seems to help.

passive_fist's source seems to be legitimate, so I wouldn't recommend prolonged, habitual use. If you find that you enjoy the flavored vapor without nicotine, then you might consider that route.

I also have a terrible nailbiting problem whose advanced progression comes to a point that it needs a solution. Good to know about the e-cig helping.

[-][anonymous]5y 1

I've gotten pretty good at redirecting childhood ticks and stimming into adult-appropriate behaviors.

It would be interesting to know what percentage of LessWrongers have OCD/stimming behaviors. Something for the next survey, perhaps.

Nicotine's stimulant properties rapidly fade after prolonged use. About increased intelligence, the effects seem minor and only exist for low doses and disappear with prolonged use: http://www.ncbi.nlm.nih.gov/pubmed/20414766

It seems that nicotine produces a combination of stimulant and sedative effects, the latter which may be more pronounced sometimes and can be unpredictable. This is consistent with my own experience. I experimented with occasional smoking of normal cigarettes (I never got addicted to them, however).

[-][anonymous]5y -1

I think that's only with frequent and repeated use. The optimal use might be to create a stack and rotate with other nootropics.

Nicotine is interesting because it's a stimulant, it may increase intelligence (I believe Daniel Kahneman said he was smarter back when he used to smoke)

I find it unlikely that there a strong case for it increasing intellgience and the tabacco companies not having run the studies to prove the effect.

[-][anonymous]5y 1

Smoking ecigarettes will give you way too much nicotine for what you need, and you'll habituate rapidly (not to mention the social cost). Get gum so you can better regulate the dosage, or potentially get the liquid from the ecigs and just rub a bit on your hands to let it soak into your blood stream.

I don't find that there's much of a social cost to smoking e-cigarettes. Most non-smokers don't mind them as they don't smell, and where I live (the UK) you can smoke them inside in lots of places.

Flavoring is optional, but the vast majority of e-cigarette users use strong smelling flavored liquids. Some of them smell worse than tobacco IMO.

My understanding is that nicotine gum is bad for your gums and rubbing nicotine on your skin is hard to dose effectively. I don't understand what the issue with vaping is: just use diluted e-cig fluid and restrict yourself to a puff or two. That's what has worked for me: I bought a e-cig starter pack and still haven't gotten through the first cartridge over a year later (with occasional use). Do we expect delivery route to affect habituation?

[-][anonymous]5y 2

I would expect dosage mechanisms that quickly bring the nicotine to the brain would be more addictive.

FYI, "habituation" is a technical term in psychology that does not mean "form habit". Got me confused there for a bit.

I would expect dosage mechanisms that quickly bring the nicotine to the brain would be more addictive.

Seems plausible.

[-][anonymous]5y 0

FYI, "habituation" is a technical term in psychology that does not mean "form habit". Got me confused there for a bit.

What I meant to say there was not"form a habit" but instead "tolerance", which is similar to habituation but for chemicals instead of external stimuli.

If you use caffeine: No. Nicotine increases your metabolism of caffeine, meaning you need higher doses of caffeine to achieve the same effect. http://www.ncbi.nlm.nih.gov/pubmed/9022872

Personal experience suggests tolerance development is less affected than metabolism (presumably because peak caffeine levels aren't affected, although I don't have studied backing that up), which means you'll develop a tolerance to caffeine faster, as well.

That study is testing the effect of tobacco use, not pure nicotine.

EDIT -- why is this downvoted? The linked study does not test your claim. Tobacco smoking is a CYP1A2 inducer so it will increase caffeine metabolism, but I am not aware of any studies demonstrating that the nicotine is responsible for this. Tobacco smoke contains PAHs and PAHs are known CYP1A2 inducers: https://www.ncbi.nlm.nih.gov/pubmed/25911656