@EddardinWinter
Eissenberg 1, which is how we refer to the study you mentioned, was conducted with new vapers using minis that were incorrectly set up for beginners, and they were not given the right advice on how to use the equipment. As a result, little or no nicotine was delivered - and this could be expected to be the norm under that particular set of circumstances.
Dr Tom Eissenberg is a member here, and it was pointed out to him how the study parameters could be improved, assuming that efficient nicotine delivery was the goal. He then re-ran the study with results we refer to as Eissenberg 2 (these studies are in the medical literature as Vansickel, Eissenberg). The new results were completely different and showed that significant amounts of nicotine were delivered. As a result of this, Dr E. adjusted his view.
Nicotine or cigarette equivalency via e-liquid nic strength
It is worth pointing out that there is no possible way of determining any form of equivalency to cigarettes by using any form of numerical comparison involving the nicotine content of e-liquid. There is a massive logic error here which is pointed out in this article:
Nicotine equivalency of e-cigarettes vs cigarettes
You can compare tobacco and e-liquid (the pre-conversion phase), and you can compare cigarette smoke and vapor (the gas/vapor phase) - but you can't compare tobacco and vapor, or e-liquid and smoke, as that is about as relevant as comparing the Golden Gate bridge and a peanut.
It should also be pointed out that 1ml of e-liquid is about 6 cigarettes (at most) in terms of time/session equivalence (the nicotine issue is a separate one):
The number of cigarettes in a carto
A 20-a-day smoker would use about 3 cartos a day, assuming they got the nicotine strength right. This is because a regular carto contains about 1ml, which is about 22 drops, and most experienced vapers say that a 'cigarette equivalent session' is around 3 or 4 drops.
Vapor research
No real research has been conducted into the amount of nicotine in ecig vapor. Some numbers have been quoted as a by-product of research that was examining other issues. The three sets of numbers published that we have are not sufficient to base any factual statements on, as (a) they were not the main subject of the study, which addressed other issues, and (b) the numbers have not been repeated or are not repeatable.
1. Ecig vapor contains about 10% of the nicotine in cigarette smoke, per unit volume (i.e. per litre).
2. The total vapor produced by an ecig from a carto contains about 50% of the nicotine that was in the carto originally.
3. There is very little nicotine in exhaled vapor, and this amount can be described as 'not present' or 'detectable but of non-significant quantity'.
1: From a Laugesen, NZ study of a Ruyan V8 penstyle, using an average/low strength carto. For various reasons it is likely that this number could easily be increased to 50%.
2: Ref not known. However we do know that not everything in the e-liquid is converted into vapor; and it is also not reasonable to assume that the vapor contents directly reflect the liquid content, as this would not align with other results. For example we know that in cases where a small amount of contaminants have been found in the liquid (such as DEG), those were not detectable in the vapor: they weren't converted, or were inefficiently converted. The FDA among others have shown us this.
3: From the FA/Clearstream study, which showed the nicotine content of exhaled vapor in parts per trillion and thus insignificant by most standards. Far more nicotine would be consumed by drinking a quarter of a cup of tea than breathing air with nicotine at this concentration. Compared to the amount of nicotine in the normal diet, it does not even register.
If it is suggested that no nicotine at all should ideally be present in exhaled vapor, in order to fully satisfy a 'no-injury' requirement for bystanders, then it needs to be understood that the amount of nicotine in the normal diet is millions of times higher, which is why everyone tests positive for nicotine, even if non-smokers. And, should the usual 'what about the children' propaganda favourite be brought up, it can be addressed by this: if you feed your baby on the usual baby food of mashed-up vegetables, or make the same puree yourself - you can be assured that you are feeding your baby far more nicotine than is available in a smoky environment, never mind one with a little exhaled e-cigarette vapor. (Example: one portion of aubergine/eggplant contains the same amount of nicotine as absorbed by a person spending 30 hours in a smoky room.)
There is nothing inherently 'wrong' or 'toxic' about nicotine - it is a normal part of the diet, and it would be unhealthy to try and exclude it (partly because it is co-located with nicotinic acid, aka vitamin B3 or niacin).
Exactly what nic strength is needed?
Human tolerance to nicotine varies so much that we have seen enough evidence for a factor-10 difference: some cannot vape 6mg (6mg/ml or 0.6% nicotine) extensively without symptoms of over-consumption, and 12mg (12mg/ml or 1.2% nicotine) is too strong for them; and there are a small number of people who vape 60mg (60mg/ml or 6% nicotine) in order to achieve satisfaction, and with no signs of over-consumption.
In addition we know that beginners have poor technique, and often use equipment with less than optimal performance (in terms of nicotine delivery). For that reason (and others, such as the fact they are recent smokers or even dual-users, used to the much more efficient nicotine delivery of cigarettes), it is logical to think that beginners might need a higher nic strength initially.
This has been demonstrated to be correct in at least three clinical trials (three published, and at least one more not published: the Intellicig trials). For this reason Intellicig have introduced a new, higher strength of retail liquid. Previously, the highest-strength retail e-liquid has been 36mg (36mg/ml or 3.6% nicotine), but they have brought in a new 45mg strength (45mg/ml or 4.5% nicotine) to redress the 'beginner no-nic' issue. Since they have run clinical trials on this, and will almost certainly receive a pharmaceutical license to sell this strength, they have presumably shown it to be effective and acceptably safe.
It remains to be seen how advisable that is for experienced users with high-performance equipment. People know when they have had too much, of course, so it seems reasonably safe, in those terms. Perhaps what is needed are studies that show the long-term effects of high-level pure nicotine consumption. It will be twenty years before we have those. The Snus data tells us the risks are very low, although, logically, consumption of a whole-tobacco product is not the same as consumption of a single extracted ingredient.
Eissenberg 1, which is how we refer to the study you mentioned, was conducted with new vapers using minis that were incorrectly set up for beginners, and they were not given the right advice on how to use the equipment. As a result, little or no nicotine was delivered - and this could be expected to be the norm under that particular set of circumstances.
Dr Tom Eissenberg is a member here, and it was pointed out to him how the study parameters could be improved, assuming that efficient nicotine delivery was the goal. He then re-ran the study with results we refer to as Eissenberg 2 (these studies are in the medical literature as Vansickel, Eissenberg). The new results were completely different and showed that significant amounts of nicotine were delivered. As a result of this, Dr E. adjusted his view.
Nicotine or cigarette equivalency via e-liquid nic strength
It is worth pointing out that there is no possible way of determining any form of equivalency to cigarettes by using any form of numerical comparison involving the nicotine content of e-liquid. There is a massive logic error here which is pointed out in this article:
Nicotine equivalency of e-cigarettes vs cigarettes
You can compare tobacco and e-liquid (the pre-conversion phase), and you can compare cigarette smoke and vapor (the gas/vapor phase) - but you can't compare tobacco and vapor, or e-liquid and smoke, as that is about as relevant as comparing the Golden Gate bridge and a peanut.
It should also be pointed out that 1ml of e-liquid is about 6 cigarettes (at most) in terms of time/session equivalence (the nicotine issue is a separate one):
The number of cigarettes in a carto
A 20-a-day smoker would use about 3 cartos a day, assuming they got the nicotine strength right. This is because a regular carto contains about 1ml, which is about 22 drops, and most experienced vapers say that a 'cigarette equivalent session' is around 3 or 4 drops.
Vapor research
No real research has been conducted into the amount of nicotine in ecig vapor. Some numbers have been quoted as a by-product of research that was examining other issues. The three sets of numbers published that we have are not sufficient to base any factual statements on, as (a) they were not the main subject of the study, which addressed other issues, and (b) the numbers have not been repeated or are not repeatable.
1. Ecig vapor contains about 10% of the nicotine in cigarette smoke, per unit volume (i.e. per litre).
2. The total vapor produced by an ecig from a carto contains about 50% of the nicotine that was in the carto originally.
3. There is very little nicotine in exhaled vapor, and this amount can be described as 'not present' or 'detectable but of non-significant quantity'.
1: From a Laugesen, NZ study of a Ruyan V8 penstyle, using an average/low strength carto. For various reasons it is likely that this number could easily be increased to 50%.
2: Ref not known. However we do know that not everything in the e-liquid is converted into vapor; and it is also not reasonable to assume that the vapor contents directly reflect the liquid content, as this would not align with other results. For example we know that in cases where a small amount of contaminants have been found in the liquid (such as DEG), those were not detectable in the vapor: they weren't converted, or were inefficiently converted. The FDA among others have shown us this.
3: From the FA/Clearstream study, which showed the nicotine content of exhaled vapor in parts per trillion and thus insignificant by most standards. Far more nicotine would be consumed by drinking a quarter of a cup of tea than breathing air with nicotine at this concentration. Compared to the amount of nicotine in the normal diet, it does not even register.
If it is suggested that no nicotine at all should ideally be present in exhaled vapor, in order to fully satisfy a 'no-injury' requirement for bystanders, then it needs to be understood that the amount of nicotine in the normal diet is millions of times higher, which is why everyone tests positive for nicotine, even if non-smokers. And, should the usual 'what about the children' propaganda favourite be brought up, it can be addressed by this: if you feed your baby on the usual baby food of mashed-up vegetables, or make the same puree yourself - you can be assured that you are feeding your baby far more nicotine than is available in a smoky environment, never mind one with a little exhaled e-cigarette vapor. (Example: one portion of aubergine/eggplant contains the same amount of nicotine as absorbed by a person spending 30 hours in a smoky room.)
There is nothing inherently 'wrong' or 'toxic' about nicotine - it is a normal part of the diet, and it would be unhealthy to try and exclude it (partly because it is co-located with nicotinic acid, aka vitamin B3 or niacin).
Exactly what nic strength is needed?
Human tolerance to nicotine varies so much that we have seen enough evidence for a factor-10 difference: some cannot vape 6mg (6mg/ml or 0.6% nicotine) extensively without symptoms of over-consumption, and 12mg (12mg/ml or 1.2% nicotine) is too strong for them; and there are a small number of people who vape 60mg (60mg/ml or 6% nicotine) in order to achieve satisfaction, and with no signs of over-consumption.
In addition we know that beginners have poor technique, and often use equipment with less than optimal performance (in terms of nicotine delivery). For that reason (and others, such as the fact they are recent smokers or even dual-users, used to the much more efficient nicotine delivery of cigarettes), it is logical to think that beginners might need a higher nic strength initially.
This has been demonstrated to be correct in at least three clinical trials (three published, and at least one more not published: the Intellicig trials). For this reason Intellicig have introduced a new, higher strength of retail liquid. Previously, the highest-strength retail e-liquid has been 36mg (36mg/ml or 3.6% nicotine), but they have brought in a new 45mg strength (45mg/ml or 4.5% nicotine) to redress the 'beginner no-nic' issue. Since they have run clinical trials on this, and will almost certainly receive a pharmaceutical license to sell this strength, they have presumably shown it to be effective and acceptably safe.
It remains to be seen how advisable that is for experienced users with high-performance equipment. People know when they have had too much, of course, so it seems reasonably safe, in those terms. Perhaps what is needed are studies that show the long-term effects of high-level pure nicotine consumption. It will be twenty years before we have those. The Snus data tells us the risks are very low, although, logically, consumption of a whole-tobacco product is not the same as consumption of a single extracted ingredient.
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