7 Things No One Tells You About Quitting E-Cigarettes

IMAGEN PUNTO DE LUZ / 500px/500Px Plus/Getty Images

If you want to quit your e-cigarette, you're not alone. E-cigarettes and vapes are hugely popular, particularly among younger people; 16% of U.S. college students use e-cigarettes with nicotine, while 5% use vapes with just flavoring, according to a 2019 report from Pew Research. Many people pick up an e-cigarette or a vape in the hope that it will help them quit cigarettes. However, while users may have the idea that these devices carry fewer health risks and are easier to quit than traditional cigarettes, that's not necessarily the case, according to experts.

"The real problem with e-cigarettes is that many people have switched to e-cigarettes in the belief that it will help them quit nicotine, which it doesn't," Dr. Albert A Rizzo, M.D., the Chief Medical Officer at the American Lung Association, tells Bustle. "Many people are dual users; they smoke cigarettes when they can and use vaping devices at other times." Vapes don't expose users to the carcinogenic chemicals in traditional cigarettes, but their nicotine content means they're also addictive, and their health effects are still being uncovered. Quitting e-cigarette and vaping products with nicotine ingredients, evidence suggests, can be as tricky as quitting regular cigarettes.

There are also powerful medical reasons for e-cigarette smokers to quit. "The evidence is certainly mounting that e-cigarettes can have acute and chronic effects on the lung," Dr. Michael Blaha, M.D., Director of Clinical Research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, tells Bustle. Because vapes and e-cigarettes are comparatively new products, researchers are still discovering their potential health effects — but experts tell Bustle that right now, if you want to quit e-cigarettes, there are seven things you need to know.

1. E-Cigarettes Don't Necessarily Contain Less Nicotine Than Cigarettes

Ryley Metzler / EyeEm/EyeEm/Getty Images

Nicotine is the addictive element in traditional cigarettes, and e-cigarettes don't necessarily have lower nicotine levels than your conventional cigarette. In fact, it's hard to know how much nicotine they actually have. "The problem with e-cigarettes is that there are many products out there that have little regulation with regard to the amount of nicotine in their devices," Dr. Rizzo tells Bustle. "Individuals who buy these are not sure they’re getting nicotine doses that are lower than cigarettes; several products ... have more nicotine in them than traditional cigarettes."

E-cigarettes don't produce the same sensations as cigarettes because they're formulated differently. "Because of the formulation of nicotine, newer e-cigarettes can deliver nicotine with less throat irritation or other unpleasant effects than before," Dr. Blaha tells Bustle. However, that doesn't impact their nicotine levels, or how addictive they can be.

Part of the issue with nicotine in e-cigarettes may be that users are inadvertently consuming more than they expected. "Many people who buy these pens don’t understand how they can be adjusted to give a lower or higher potency," Dr. Mark Dylweski, chief of general thoracic surgery at Miami Cancer Institute, tells Bustle. "Someone who is not versed on how these pens work can put it on the highest setting right from the start."

2. E-Cigarettes Weren't Designed To Help People Quit Smoking

While e-cigarettes are occasionally marketed as a way to help people quit cigarettes, it's important to remember that they weren't designed for the purpose. "E-cigarettes were not designed scientifically to be a smoking cessation device, or to be safer than a cigarette," Dr. Rizzo tells Bustle. "They were designed to appeal to people who wanted to use something beside a cigarette, or in addition to a cigarette." They aren't approved by the FDA as a way to quit smoking in the U.S., because there isn't enough evidence to show that they might be helpful.

3. The Health Risks Of E-Cigarettes & Vapes Are Still Unknown

If you're wavering about quitting because you're not sure e-cigarettes are necessarily bad for you, evidence suggests strongly that they carry health risks.

"E-cigarettes have been shown to have adverse effects on lung health in cell-based models, in animals, and now in humans," Dr. Blaha tells Bustle. "This is now further supported by the surge in acute lung injury cases in e-cigarettes users." Vaping-related lung injuries rose to 1,888 cases across the U.S. in 2019, according to the Center for Disease Control & Prevention, and Dr. Blaha recently published research in BMC Pulmonary Medicine in which e-cigarette use was linked to asthma in young adults.

Longer-term health effects are more difficult to pinpoint. "Research into the health effects of e-cigarettes is not standardized because the products are not standardized," Dr. Rizzo tells Bustle. Studies have found that the ingredients in e-cigarettes are often mislabeled, while research indicates that many e-cigarettes contain microbial and fungal toxins, heavy metals, and carcinogens. "E-cigarettes all have chemicals that are released when the pods or devices are heated," Dr. Rizzo says, and those chemical reactions may cause damage over time. "The likelihood is that if you use an e-cigarette for 15 years, you will have a higher risk of lung cancer than somebody who has never smoked."

Nicotine creates other health risks beyond lung issues. "While we do not know the complete health ramifications of these products because they have not been around long enough, we do know that nicotine is a stimulant," Dr. Dylweski tells Bustle. "Nicotine reacts in the body and can cause hypertension and high heart rate, among other reactions."

Using vapes without nicotine is also risky. "Those products include derivatives of flavors that are safe to ingest orally, but once you heat and ingest them, they become toxins," Dr. Rizzo says. "They’re not designed to be inhaled into a lung, which has a lining much more sensitive than the stomach." One 2016 study in Tobacco Control found that vape flavorings are damaging to lung cells, while research published in Frontiers In Physiology in 2018 found that vape flavorings trigger inflammatory responses in lung tissue.

4. Quitting E-Cigarettes Can Be Tricky Because You Absorb Nicotine From Them Quickly

Joshua Resnick / 500px/500Px Plus/Getty Images

Quitting e-cigarettes may be more difficult than you anticipate because the sheer amount of nicotine absorbed in an e-cigarette session, Dr. Rizzo tells Bustle. "When you think about smoking a regular cigarette, it may take you a period of time to puff through a whole cigarette," he says. "That is different and quicker when puffing a Juul or a pod with liquid nicotine in it."

Nicotine itself isn't carcinogenic, but it is known to have many negative effects on health beyond its addictive properties. Quitting e-cigarettes involves weaning yourself off nicotine, and the amount of nicotine that can be transmitted via e-cigarette can be considerable. Dr. Blaha tells Bustle that one pod in a Juul, for instance, can deliver as much nicotine as an entire pack of cigarettes.

5. Quitting E-Cigarettes May Be Different To Quitting Smoking — But It's Just As Difficult

Quitting e-cigarettes is just as tough as quitting normal cigarettes because of the nature of nicotine, experts tell Bustle. "E-cigarettes can be just as addictive as traditional cigarettes," Dr. Blaha tells Bustle. However, he says, treating e-cigarette addiction is in its infancy, and many users are young, so they may need different approaches and support compared to older cigarette smokers. "There is not much known about the best strategies for quitting e-cigarettes," he says. As we understand more about e-cigarette and vaping, we may also determine that there are particularly effective ways to quit them — but for now the best method is unclear.

6. People Who Are Quitting E-Cigarettes Should Have A Support System & A Plan

For those who are thinking of quitting e-cigarettes, lessons can be drawn from medical knowledge about quitting cigarettes. "Quitting is most successful for individuals who are ready to make the commitment to try to quit," Dr. Rizzo says. "That has to be coupled with some form of support system or counseling."

Families, roommates, and spouses need to be on board, he says, as that greatly increases the possibility of success: "I see people often who are finding it difficult to quit because they’re living with a smoker or their social group does a lot of smoking," Dr. Rizzo tells Bustle. Medical professionals might also prescribe a nicotine replacement product like a patch, to help wean a user off e-cigarette usage.

7. Going Cold Turkey Is Bad Quitting Advice

Going cold turkey — stopping e-cigarette use suddenly — isn't actually an effective way of breaking the habit, Dr. Rizzo tells Bustle. "My main advice is not to just go cold turkey; that works for about 2 to 3% of individuals, but it’s not the way most people are able to sustain coming off nicotine," he says.

Quitting e-cigarettes also needs to occur at the proper time. "If there are financial issues, marital issues, or family issues, that’s not a good time to quit," Dr. Rizzo says. "I always want people to try to quit, but I want them to be realistic about choosing the right time." If you've been using e-cigarettes to cope with stress, he says, it may be a good idea to wait to quit until life is less stressful overall, and you're sure you have the right support.

E-cigarettes are definitely not a risk-free choice or an easy alternative to cigarettes. If you do want to quit, experts say it's important to have a plan and a network of helpful, supportive people around you — because, like quitting smoking, it can be a difficult undertaking.

Studies referenced:

Glantz SA, Bareham DW.(2018) E-Cigarettes: Use, Effects on Smoking, Risks, and Policy Implications. Annu Rev Public Health. 1;39:215-235. doi: 10.1146/annurev-publhealth-040617-013757.

Hess CA, Olmedo P, Navas-Acien A, Goessler W, Cohen JE, Rule AM. (2017) E-cigarettes as a source of toxic and potentially carcinogenic metals. Environ Res. 152:221-225. doi: 10.1016/j.envres.2016.09.026.

Kucharska M, Wesołowski W, Czerczak S, Soćko R. (2016) Testing of the composition of e-cigarette liquids - Manufacturer-declared vs. true contents in a selected series of products. Med Pr. 67(2):239-53. doi: 10.13075/mp.5893.00365.

Lee, M.S., Allen, J.G., Christiani, D.C.. (2019) Endotoxin and (1→3)-β-D-Glucan Contamination in Electronic Cigarette Products Sold in the United States. Environmental Health Perspectives. 127 (4): 047008 DOI: 10.1289/EHP3469

Leigh NJ, Lawton RI, Hershberger PA, et al. (2016) Flavourings significantly affect inhalation toxicity of aerosol generated from electronic nicotine delivery systems (ENDS)Tobacco Control. 25:ii81-ii87.

Mishra, A., Chaturvedi, P., Datta, S., Sinukumar, S., Joshi, P., & Garg, A. (2015). Harmful effects of nicotine. Indian journal of medical and paediatric oncology : official journal of Indian Society of Medical & Paediatric Oncology, 36(1), 24–31. doi:10.4103/0971-5851.151771

Muthumalage T, Prinz M, Ansah KO, Gerloff J, Sundar IK, Rahman I. (2018) Inflammatory and Oxidative Responses Induced by Exposure to Commonly Used e-Cigarette Flavoring Chemicals and Flavored e-Liquids without Nicotine. Front Physiol. 8:1130. doi: 10.3389/fphys.2017.01130.

Osei AD, Mirbolouk M, Orimoloye OA, Dzaye O, Uddin SMI, Dardari ZA, DeFilippis AP, Bhatnagar A, Blaha MJ. (2016-17) The association between e-cigarette use and asthma among never combustible cigarette smokers: behavioral risk factor surveillance system (BRFSS) BMC Pulm Med. 19(1):180. doi: 10.1186/s12890-019-0950-3.

Reilly SM, Bitzer ZT, Goel R, Trushin N, Richie JP. (2019) Free Radical, Carbonyl, and Nicotine Levels Produced by Juul Electronic Cigarettes. Nicotine Tob Res. 21(9):1274-1278. doi: 10.1093/ntr/nty221.

Tang MS, Wu XR, Lee HW, Xia Y, Deng FM, Moreira AL, Chen LC, Huang WC, Lepor H. (2019) Electronic-cigarette smoke induces lung adenocarcinoma and bladder urothelial hyperplasia in mice. Proc Natl Acad Sci USA. 116(43):21727-21731. doi: 10.1073/pnas.1911321116.

Experts:

Dr. Michael Blaha, M.D., Director of Clinical Research at Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease

Dr. Mark Dylweski, M.D., chief of general thoracic surgery at Miami Cancer Institute

Dr. Albert A Rizzo, M.D., Chief Medical Officer at the American Lung Association