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November 02, 2009
WHAT WE KNOW
A brief TRAC consult regarding e-cigarettes, electronic nicotine delivery systems
—by Deb Hrouda
CLEVELAND, OH—The topic of e-cigarettes came up at a recent "Tobacco: Recovery Across the Continuum (TRAC)" Program Leader Training on October 1st sponsored by the Center for Evidence-Based Practices (CEBP) at Case Western Reserve University, so we present a few thoughts and a summary of what is known to date about what are commonly called e-cigarettes.
1) "e-cigarette" is a misleading name.
These products are better referred to as "electronic nicotine delivery systems" (ENDS). The definition of a cigarette is "a roll of finely ground tobacco wrapped in paper that is burned." The e-cigarette does  not have tobacco, nor does it burn.
2) What is in an e-cigarette?
We don't know for sure. The U.S. Food and Drug Administration (FDA) (see links below) recently did a study where it examined two existing ENDS products. In short, the products differed widely on what was in them and in their concentrations of nicotine (even from the same manufacturer).
NOTE: If you ordered the high nicotine cartridge, you could get 18 mg of nicotine, or you could get 1.6 mg of nicotine. It wasn't consistent. Similarly, if you ordered the product with 0 mg of nicotine, you might get nicotine.
3) How does an e-cigarette work?
Essentially, there's a mouthpiece that has a cartridge with the nicotine in it (some have a sponge that's soaked in a nicotine solution which is refillable). There is also a battery (most are rechargeable) and a vaporizer that heats the nicotine solution, not to the point of burning, to make vapor. When you inhale, the suction turns on the vaporizer which turns the liquid (which includes propylene glycol) into vapor. This vapor has the nicotine in it. The vapor is also what looks like smoke.
NOTE: The nicotine solution is basically nicotine in propylene glycol, which is used in cosmetics and fog machines, but there is nothing that shows that directly inhaling this is safe.
4) They say there's no tobacco, but . . .
Some of the tests showed evidence of the cancer-causing chemicals that are found only in tobacco.
5) So, are e-cigarettes good or bad?
We don't know. There isn't enough research that shows whether or not they're safe, or if they deliver the nicotine they say they do. The little we do know is that quality control is seriously lacking. In addition, a few people who have tried them say they fall apart.
NOTE: In one of the tests, the amount of nicotine from the e-cigarette was twice that from a prescription nicotine inhaler.
6) Other interesting e-cigarette tidbits:
- The refills are vials of nicotine and can be bought in up to 1,000 mg bottles. There is the potential for people to misuse the refill liquid (30 to 60 mg could be fatal for an adult).
- Creative people have already found some potentially harmful adaptations through Internet-based recipes that add alcohol and other substances to the refill cartridges.
RESOURCES | ADDITIONAL INFORMATION ABOUT E-CIGARETTES
THE U.S. FOOD AND DRUG ADMINISTRATION (FDA)
FDA report on the only independent test of ENDS
| Click here |
Summary of FDA report on the only independent test of ENDS
| Click here |
FDA web page about e-cigarettes
| Click here |
AMERICAN LEGACY FOUNDATION
A two-page document that outlines some of the information about electronic nicotine delivery systems (ENDS)
| Click here |
A webinar held by the American Legacy Foundation. The video is two hours long, but the last hour includes questions and answers. Even if you can only watch the first 45 minutes, you'll get to hear some of the concerns floating around out there. Keep in mind that American Legacy Foundation has as part of its mission to eliminate tobacco use in the US.
| Click here |
ADDITIONAL RESOURCES
Motivational Interviewing (MI) is an evidence-based treatment that is one of the best available to address ambivalence to change. The Center for EBPs at Case Western Reserve provides consulting and training services for MI, which is one of the core components of the TRAC model.
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RELATED STORIES, THIS SITE
TRAC TRAINING
Ohio providers develop action plans for new tobacco intervention, stage-based approach to tobacco services for people with mental illness and substance use disorders
| click here for full story |
 STAGES OF CHANGE
Tobacco recovery for severe mental illness makes progress despite challenges from Ohio's declining economy.
| click here for full story |
ENTER STAGE RIGHT
“Stages of change” co-creator Carlo DiClemente discusses practical applications of his Transtheoretical Model for health, wellness and recovery.
| click here for full story |
TIPS FROM TOBACCO ROAD
Flash Phipps of Shawnee Mental Health Center fights centuries-old tobacco culture in Ohio River Valley, helps consumers kick the habit.
| click here for full story |
RELATED STORIES, OTHER SITES
 TOBACCO & RECOVERY
Time magazine article links tobacco use, early death among people with severe mental illness
| click here for full story |
ACADEMIC-COMMUNITY PARTNERSHIP
The Center for Evidence-Based Practices (CEBP) at Case Western Reserve University is a partnership between the Mandel School of Applied Social Sciences and the Department of Psychiatry at the Case Western Reserve School of Medicine. The CEBP works in collaboration with and is supported by the following:
- Ohio Department of Mental Health
- Ohio Department of Alcohol and Drug Addiction Services
- Ohio Rehabilitation Services Commission
- Ohio Department of Health
The Ohio SAMI Coordinating Center of Excellence (CCOE) and Ohio Supported Employment CCOE are both initiatives of the CEBP at Case Western Reserve.
 Mandel School of Applied Social Sciences, Case Western Reserve University.
Master's and doctoral programs; paid field placements; fellowships; studies in mental health and substance-abuse services, among others.
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 Department of Psychiatry, School of Medicine, Case Western Reserve University.
Post-residency fellowships in community psychiatry and addiction psychiatry, among others.
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Deb Hrouda, MSSA ('94), LISW-S, is project lead for the TRAC initiative and director of quality improvement at the the Center for Evidence-Based Practices at Case Western Reserve University.
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