Day 155: It’s for your own good.

June 25, 2014 by B 4 Comments

Disclaimer: I am not a doctor, or a medical expert, I am giving my opinion and backing it up with the research I’ve found. Please draw your own conclusions and do your own research. My opinions should never be taken as medical advice. I am not a scientist, or researcher and I might be wrong.  I’m not suggesting that any non-smoker should take up the habit of either smoking or vaping, nor am I suggesting that anyone should self medicate with any recreational substance.

“E-cigarettes aren’t currently regulated as medicines, so you can’t be sure of their ingredients or how much nicotine they contain – whatever it says on the label. The amount of nicotine you get from an e-cigarette can change over time.” [source]

I am absolutely sure that the ingredients of my eliquid are as stated on the label. If you look at the ECITA guidelines you can see good practice in action. The ingredients are: Propylene Glycol, Vegetable glycerine, PG based flavourings and nicotine. There is no need for the “dose” of nicotine to be absolutely accurate per puff on every device, nor is there any need to be concerned that the amount of nicotine obtained in serum levels from vaping changes over time. In order to explain why I believe this to be the case I need to go right back to smoking, and several studies on nicotine “self-titration” behaviours from smoking, best accessed as part of the discussion on the addictiveness of nicotine found here;

The “Nicotine titration” phenomenon is a strong argument in favor of research by the smoker of a satisfactory optimal dose of nicotine. Thus, if we change his cigarettes, he modifies his smoking parameters to keep constant his nicotine dose [17]. Smokers are able to extract the same amount of nicotine from low and high yield cigarettes [18]. In my laboratory, Caroline Cohen showed that when smoking at the same pace in 30 minutes two different cigarettes yielding equal CO and tar, the high-yield cigarettes were smoked less completely than regular cigarettes, and that smokers spontaneously lighted their own cigarettes later and smoked them less completely. They did not like at all these high-yield cigarettes, which they felt frankly aversive. Thus nicotine has a satiating, but not a rewarding effect, [19]. Also, in all my tests on rats, nicotine has been shown regularly aversive. We can therefore hypothesize that the titration phenomenon, rather than expressing the research of a reward minimal dose (threshold effect), rather express a “ceiling effect”, limiting consumption before the dose becomes aversive. In the event that the smoker could adjust his absorption of nicotine at a personal best, it was logical to try to improve the success of nicotine replacement therapy by adapting the dose to that absorbed by the smoker spontaneously, calculated from the salivary cotinine. The result is absolutely negative. [20]. [Source]

Smokers already know – instinctively and by habit – how to “dose” themselves with nicotine to satiation from smoking. Changing the amount of nicotine to a dose which was “too high” made the smokers dislike the cigarettes, smoke them less frequently, and dislike the experience. It is not beyond reasonable doubt to expect that vapers will, with experience, learn to titrate nicotine levels similarly when vaping, and indeed evidence suggests that this is the case. From Dr K. Farsalinos;

In this study a liquid with 18 mg/ml nicotine concentration was chosen, based on previous findings from our group showing that this is approximately the level of nicotine concentration needed for experienced vapers to consume 1 mg of nicotine in 5 minutes (which is similar to the level of nicotine in the smoke of one cigarette when smoked according to ISO 3308)⁷. Despite that, the main findings herein showed that such a liquid is insufficient to deliver nicotine to the blood stream as rapidly as smoking. In fact, it took about 35 minutes of vaping with the new-generation device at high wattage in order to obtain plasma levels similar to smoking one cigarette in 5 minutes. The first-generation device was even less efficient in nicotine delivery; even 65 minutes of ad lib vaping was insufficient to deliver to the bloodstream nicotine at levels similar to smoking. This was reflected in participants’ answers to questionnaires, showing that satisfaction and craving reduction was higher after using the new- compared with the first-generation device. Moreover, better nicotine delivery may be the reason why new-generation devices are more popular in dedicated users, most of which have quit smoking by using ECs^{10, 11}. Considering that it is reasonable to expect EC users to self-titrate nicotine intake in a way similar to smoking²⁰, this study indicates that there is an inherent inability of the EC to deliver nicotine to the blood stream at levels similar to tobacco cigarettes within the same time-period of use,..

Just as you don’t need a label on a cup of tea to tell you what level of the active ingredients you’re taking in, I don’t really need to know that the dose from each puff on my e cigarette is pin-point accurate either. After all I didn’t know, nor did I care what the dose was per puff from a cigarette. I’m not using it as a medicine to treat withdrawal. I’m using it to get the nicotine I used to get from smoking in the same way as I used to get it from smoking. A direct replacement.

This is also why the “fact” that my nicotine intake changes over time is actually a good thing. My nicotine intake from cigarettes changed over time as well – and I deliberately smoked in such a way as to ensure this would happen. Nicotine can be used as both a stimulant and a relaxant depending on how it is self-titrated on intake, therefore I am able to directly replicate this ability as a result of the variability in the “dose”. Regulating it as a medicine and removing the variability makes it less like smoking, and therefore less effective as a direct replacement for smoking. I did not smoke to relieve nicotine withdrawal. I do not vape to relieve nicotine withdrawal. I vape to nicotine satiation in order to keep my perceived benefits from nicotine use while reducing the harm from the delivery system. Harm reduction.

The leading deontological tenet of modern health ethics is the obligation to provide people with accurate information so they can make informed autonomous decisions about their own health. Thus, whatever one might think about actively promoting THR as public policy, it is per se unethical to mislead people in order to manipulate their health behavior, even if it is “for their own good” 

I am not using it as a medicine. I know what’s in it and in my experience I do indeed self-titrate my dose. Please engage with vapers and ask us what we do rather than impose regulations on us from the top down which will only destroy the very mechanisms by which vaping works.

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