Unhappy with paper by Dr. Farsalinos

[readeuler]

Facts are facts. If Dr. Farsalinos were in the business of recommending techniques/liquid/hardware to interested parties, he would run a vape shop, no?

He is in the business of finding facts and inferring reasonable conclusions.

The facts are that using the liquid and hardware from the study, blood plasma tended to be at such-and-such a level, and the uptake had XYZ relationship to that of a conventional cigarette.

A reasonable conclusion would be that, using the same hardware and inhalation practices, liquid of a certain nicotine concentration is necessary to provide a blood plasma profile similar to a conventional cigarette. Based on his research, that concentration appears to be approximately 50mg/ml.

 

[DC2]

To Alien Traveler...

It is well known here that most (if not all) vapers decrease their nicotine "addiction" over time while vaping.
Or at the very least maintain it where it currently is.

So what exactly is your specific concern?

 

[Zealous]

Allow me to expand a bit more. I know that most vapers chain vape. Why do they do it? Were they used to it when they were smokers? Obviously not.
Perhaps they like the flavor and want to vape all time. That is definitely a possibility. However, there is another possibility. They just want to get the nicotine they need, and cannot do it unless they chain vape. In reality, the slow nicotine delivery causes higher liquid consumption. In my opinion, any small residual risk from e-cigarette use will not come from nicotine but from other chemicals (e.g. aldehydes, due to heat). If you had the ability to use the e-cigarette as smoking (get significant nicotine hit), then you would probably consume much less liquid. This would make vaping even safer.
Of course now most vapers are used to chain vape, and it will be difficult to change their habit. But for new vapers, perhaps it would be better (and preferable to them) to use the e-cigarette in the same way as smoking.

First of all I would like to say how much I appreciate your efforts & I appreciate that you have provided some good information that might encourage EU (and whomever else is thinking about limitations) to consider allowing levels higher than 20mg nicotine rather than placing a limitation there. While 20mg might be fine for me, it's not fine for everyone & I could see it interfering with some having success with ecigarettes as a stop smoking aid.

HST, I am curious will you do any testing on puffs of a cigarette in relation to puffs of an ecigarette, rather than just a comparison between 1 whole cigarette & puffs of an ecigarette? The reason I ask is because (I speak only for myself here) when i was a smoker I did not take the same amount of puffs off 1 cigarette every time I smoked one & it was very dependent on when I was doing it how many I took. On a smoke break I would get as many puffs in as I could which might be more than 10. In the evening I would take probably 1/3 fewer puffs (at least 1/3 of the cigarette would burn without me smoking it) but would smoke way more cigarettes simply because I could.

I feel like it might be a little bit inaccurate to compare a full cigarette in 5 minutes to 10 puffs of an ecigarette in 5 minutes without noting how many puffs off that whole cigarette were taken.

BTW & for the record, I would like to say that I do vape very much the same way I smoked. So I do not generally chain vape during the day but do tend to do so in the evening. So then if the hope is that someone would transfer their smoking habit to vaping they still might be a chain vaper if they smoked the way I did.

 

[TamiP]

Yeah, like others have said, I think his idea behind the thought is that by raising nic levels (50 is way too high for 90% of the vaping community in any case in my opinion, but that's just opinion) anyway, by raising the levels in the juice it would cut down the 'need' to chain vape. He may be missing the point of the emotional/mental need that ties in with it as much as the need for nicotine, but he's not exactly 'wrong'. I doubt there would be much call for commercially produced 50 mg levels of juice for most vendors to make it worth their while to do it. There's enough variation starting at 24mg to make it plenty even if most vapers DO prefer not to chain vape, or have to deter from vaping for long periods of time such as when flying, or working (unfortunately). However, I am VERY glad that there is such a wide variety of nic levels available so that everybody can make the best choice for their own needs. I'm even more glad that DIY is possible (at least now) so that I can make my juices at whatever level I feel the need to (12 mg most times).


Didn't see the good Dr's. response before I posted. LOL

 

[DrMA]

<snip>
major point about nicotine intake: users self-titrate nicotine intake.
If you were using a high-nicotine liquid and got similar to tobacco plasma nicotine levels, you WOULD NOT chain-vape. Moreover, smokers are not at all used to "chain-smoke". Have you ever thought that the huge failure rate of e-cigarettes (most smokers CANNOT switch with e-cigarettes) could be attributed to the inability of the smokers to get the nicotine hit they get from cigarettes?

This sums up my experience exactly. For a couple years I bought into the "gradually reduce your nic" fad and I ended up chain vaping 12 mg liquid to compensate, to the point of constantly building bigger and bigger battery mods and needing larger and larger tanks to accommodate all-day vaping.

A while back, and after reading Dr. Farsalinos' paper subject to this thread, I started doing the unthinkable - raise the nic level in my juice. Finally, I settled on 24 mg/mL as a good balance. My ejuice usage went down from 8-10 mL per day to 2-3 mL, I no longer chain vape, and thus I can carry a tiny mod with a tiny tank and the battery lasts 8-10 hours.

 

[Zealous]

This sums up my experience exactly. For a couple years I bought into the "gradually reduce your nic" fad and I ended up chain vaping 12 mg liquid to compensate, to the point of constantly building bigger and bigger battery mods and needing larger and larger tanks to accommodate all-day vaping.

A while back, and after reading Dr. Farsalinos' paper subject to this thread, I started doing the unthinkable - raise the nic level in my juice. Finally, I settled on 24 mg/mL as a good balance. My ejuice usage went down from 8-10 mL per day to 2-3 mL, I no longer chain vape, and thus I can carry a tiny mod with a tiny tank and the battery lasts 8-10 hours.

This is me too even though I never tried cutting back on nic gradually first. I always kept it higher so I would do it less often. When I "chain vape" in the evenings I'm fairly sure that it's not nearly as much as someone else's definition of chain vaping since I go through about 3ml in a 24 hour period.

 

[KFarsalinos]

In making recommendation utilizing word “recommendation” is not a mandatory part. Even decision shy US Supreme Court would confirm it.


Sorry, cigarette smokers self-titrate nicotine intake. Nothing was proved about self-titrating for vapers. However I believe (just believe, not know) that vapers do self-titrate. But at what levels? From your paper I see that even after 65 min of vaping and after nicotine level in vaper’s blood was 20% higher that after smoking the self-titration level was not reached. Moreover, there were no slowing down of nicotine level increase in a time interval from 35 to 65 min. So I am free to suppose that that vaper's self-titration level could be at twice (if not higher) of nicotine absorption level of smoker. You have stopped your measurements at 65 min, so we do not know for how self-titration works for vapers, but we do see from your results that consumption of 18 mg juice leads to higher nicotine level than smoking.


Could be attributed. But should it? There is no data confirming that it can help. Easy study: to compare success levels for vapers in smoking succession in countries with limited and not limited nicotine level in juices OK, may be not really an easy one, I know nothing about availability of needed data.


I am for freedom for vapers. As a political statement your paper is very good, but unfortunately for this forum (as you know you are very popular here) it is misleading for vapers. Some vapers greatly misunderstood such things as “self-titration”, “slower delivery”, etc. For example I see here such recommendations as “vape as much as you can” based unfortunately in part on your work.

I repeat once again that the paper does not provide any recommendation for any vaper (let alone for vapers who have completely stopped smoking). It says what we found: "this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes""

Our main concern regarding this are smokers, not established vapers who are now ex-smokers. The latter do not need any guidance, and do not need the data from this paper.
Smoking is considered the most effective nicotine-delivery product. This is not because of the maximum level of nicotine intake (you can reach equal levels even with NRTs, just use multiple gums), but because of the SPEED of delivery. Based on our results (and with the equipment we used), an 18mg/ml liquid is inadequate by far to provide nicotine fast-enough. I suppose you realize that we have seen the levels after 35 and 65 minutes. We did not dispute that the total amount of nicotine absorption is inadequate, we refered to the speed of delivery. This is a fact based on the numbers, not a recommendation. If someone misunderstood it, it is justified because the paper is written in a way to present results to a science audience. Obviously, in a presentation to non-experts, it could have been formulated in another way. But when we write the paper, we do not consider the possibility that someone may misunderstand our words.

As for the continuous elevation, it does not mean that it will continue inevitably. In fact, when cotinine was tested in dedicated vapers (in a study by JF Etter) he found that most vapers had lower cotinine levels compared to smokers, thus they were taking less total amount of nicotine daily.

Our conclusions may change depending on the devices tested. E.g, we used an EVOD atomizer. It would have been impossible to use it at 20watts for example.

 

[KFarsalinos]

First of all I would like to say how much I appreciate your efforts & I appreciate that you have provided some good information that might encourage EU (and whomever else is thinking about limitations) to consider allowing levels higher than 20mg nicotine rather than placing a limitation there. While 20mg might be fine for me, it's not fine for everyone & I could see it interfering with some having success with ecigarettes as a stop smoking aid.

HST, I am curious will you do any testing on puffs of a cigarette in relation to puffs of an ecigarette, rather than just a comparison between 1 whole cigarette & puffs of an ecigarette? The reason I ask is because (I speak only for myself here) when i was a smoker I did not take the same amount of puffs off 1 cigarette every time I smoked one & it was very dependent on when I was doing it how many I took. On a smoke break I would get as many puffs in as I could which might be more than 10. In the evening I would take probably 1/3 fewer puffs (at least 1/3 of the cigarette would burn without me smoking it) but would smoke way more cigarettes simply because I could.

I feel like it might be a little bit inaccurate to compare a full cigarette in 5 minutes to 10 puffs of an ecigarette in 5 minutes without noting how many puffs off that whole cigarette were taken.

BTW & for the record, I would like to say that I do vape very much the same way I smoked. So I do not generally chain vape during the day but do tend to do so in the evening. So then if the hope is that someone would transfer their smoking habit to vaping they still might be a chain vaper if they smoked the way I did.

What you mention during the period you were smoker is expected. You had higher need for nicotine because you could not smoke when you worked, so you took harder or more puffs during breaks.
The studies on nicotine absorption from smoking are mostly based on taking approximately 10 puffs from a tobacco cigarette within 5 minutes.. That is why you see studies asking vapers to take 10 puffs in 5 minutes.

 

[KFarsalinos]

This sums up my experience exactly. For a couple years I bought into the "gradually reduce your nic" fad and I ended up chain vaping 12 mg liquid to compensate, to the point of constantly building bigger and bigger battery mods and needing larger and larger tanks to accommodate all-day vaping.

A while back, and after reading Dr. Farsalinos' paper subject to this thread, I started doing the unthinkable - raise the nic level in my juice. Finally, I settled on 24 mg/mL as a good balance. My ejuice usage went down from 8-10 mL per day to 2-3 mL, I no longer chain vape, and thus I can carry a tiny mod with a tiny tank and the battery lasts 8-10 hours.

Reducing nicotine levels can be misleading, and may even lead to relapse to smoking. Of course it does not happen to everyone, but i have seen a lot of people doubling (or more) their consumption when reducing nicotine levels. My advice is that it is probably better to vape less liquid but higher nicotine levels rather than do the opposite.

 

[DrMA]

Reducing nicotine levels can be misleading, and may even lead to relapse to smoking. Of course it does not happen to everyone, but i have seen a lot of people doubling (or more) their consumption when reducing nicotine levels. My advice is that it is probably better to vape less liquid but higher nicotine levels rather than do the opposite.

My experience over the past year (N=1) agrees with this. I feel much better both physically and psychologically since doubling the nic concentration. The speed of delivery is probably much more important than the ultimate blood nicotine level achieved, and probably much more significant than is considered in the scientific literature on the subject.

I should add that I did try vaping liquid up to 48 mg/mL and down to 8 mg/mL before settling on 24 mg/mL as my own personal sweet spot at the moment. Higher nic levels were simply too irritating to be enjoyable, and lower would just lead to a disproportionate increase in volume consumption (i.e. chain vaping). The use of the word "titrate" is exactly right in this case, but in forum lingo I'll say: YMMV.

 

[Zealous]

The studies on nicotine absorption from smoking are mostly based on taking approximately 10 puffs from a tobacco cigarette within 5 minutes.. That is why you see studies asking vapers to take 10 puffs in 5 minutes.

Ok, thank you for letting me know. I did not see this information noted on the study, although it may have been & I missed it. I did see it noted as a comparison between 1 cigarette & 10 ecigarette puffs but didn't see where it noted how much of the cigarette was actually smoked.

 

[beckdg]

i vape 50mg/ml
@ 0.2Ω
that's upwards of 80 watts on average
my company contracts laboready pretty often to unload my truck... sometimes it takes over 12 hours
once every week or two i find myself lending out my spare pv to somebody who's run out of cigarettes
for those that can take the throat hit, i will say they do tend to self regulate
never seen one chain vape on my setup yet
less than PAD smokers usually just hand it back and tough it through the day... maybe ask for a hit or two to get through.

me... i no longer chain vape... usually! my stress headaches from lack of nic are gone. my throat and sinus irritation from chain vaping are a thing of the past. i never get nic sick.

i'm the exception to the rule, preferring such high nic and delivery. i realize that. but we are out there. it would be nice to have the options available to us from vendors.

thank you, Dr. Konstantinos Farsalinos! You're a god sent! May more follow in your footsteps in search of truth.

 

[Rossum]

I'm not sure why 50 mg/ml is controversial. Vuse contains 4.8% nicotine. If I'm not mistaken, that's ~48 mg/ml. My recollection is that some NJoys are also at 48 mg/ml.

 

[Rlrick]

First off my thanks to Dr. Farsalinos for all the hard work he has done for our community. As far as him being a new guy on the block I will take his words over many of the other people trying to demonize this credible new device which is helping so many such as my self to get off the one killer of all times. Regardless whether we use 50mg/ml of e-juice or 1mg/ml of juice our bodies will adjust to what ever level you use. Just as me I started out at 12mg/ml nicotine and now I am down to 1mg/ml of nicotine. I do vape hard during the night when I don’t have anything to do but during the day when I am busy I have been known to leave my mod at home by mistake and not miss it at all. I maybe gone 4-6 hours without it and not have any cravings at all. Vaping is what we want to make of it whether like myself trying to get away from smoking cigarettes which were making me into one of the statistics of the 480,000 per year. I smoked for 48 years at 2-3 PAD I knew how to regulate smoking to accommodate my daily needs of tobacco. Or whether you just enjoy vaping, which to me is not that bad as long as you don’t over due it. The old saying too much of a thing can be just as bad for you.

 

[Racehorse]

nicotine level in vapers continued to rise and after 65 min of vaping was 20% higher than that of smokers.

That doesn't worry me at all, nicotine isn't really dangerous. Unless you have very specific medical problems.

There is no way to compare nicotine of vapers and smokers w/out mentioning that smokers are getting theirs in a combustible form....that is the part that is dangerous and unhealthy

 

[Rlrick]

I agree with you 100%. The point I was trying to make was our bodies will adjust to what ever nicotine level you are using.

 

[Alien Traveler]

I repeat once again that the paper does not provide any recommendation for any vaper (let alone for vapers who have completely stopped smoking). It says what we found: "this study supports the need for higher levels of nicotine-containing liquids (approximately 50 mg/ml) in order to deliver nicotine more effectively and approach the nicotine-delivery profile of tobacco cigarettes""

Our main concern regarding this are smokers, not established vapers who are now ex-smokers. The latter do not need any guidance, and do not need the data from this paper.
Smoking is considered the most effective nicotine-delivery product. This is not because of the maximum level of nicotine intake (you can reach equal levels even with NRTs, just use multiple gums), but because of the SPEED of delivery. Based on our results (and with the equipment we used), an 18mg/ml liquid is inadequate by far to provide nicotine fast-enough. I suppose you realize that we have seen the levels after 35 and 65 minutes. We did not dispute that the total amount of nicotine absorption is inadequate, we refered to the speed of delivery. This is a fact based on the numbers, not a recommendation. If someone misunderstood it, it is justified because the paper is written in a way to present results to a science audience. Obviously, in a presentation to non-experts, it could have been formulated in another way. But when we write the paper, we do not consider the possibility that someone may misunderstand our words.

As for the continuous elevation, it does not mean that it will continue inevitably. In fact, when cotinine was tested in dedicated vapers (in a study by JF Etter) he found that most vapers had lower cotinine levels compared to smokers, thus they were taking less total amount of nicotine daily.

Our conclusions may change depending on the devices tested. E.g, we used an EVOD atomizer. It would have been impossible to use it at 20watts for example.

Thank you for directing me to look for papers by Jean-François Etter. His review paper I would like to recommend to ECF members as an interesting reading:

Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit - Hajek - 2014 - Addiction - Wiley Online Library

 

[JimmyDB]

Thank you for directing me to look for papers by Jean-François Etter. His review paper I would like to recommend to ECF members as an interesting reading:

Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit - Hajek - 2014 - Addiction - Wiley Online Library

new thread?

 

[Alien Traveler]

new thread?

Nope. I rather like this paper.

 

[JimmyDB]

Nope. I rather like this paper.

Right.

I took a look... my initial complain was that, again, EC use considered/called 'smoking'... that can make things confusing for the uninitiated. Especially when talking about cessation. X% after Y months are still 'smoking'... okay, but are they using analog tobacco cigarettes. <-- that's just a made up example, not a quote. It's easy for a ?reporter? to quote a line out of context and they seem to love NOT posting links to reference (reporters/editors/etc) material even when it's an online only version.

I'll be using the "Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit" paper moving forward when I talk to politicians. Very simply put, with references (which I would still need to check)... "so simple even a caveman can do it", only for politicians who don't care.